Race and CPR If you have a heart attack, and you’re not in a hospital, how likely are you to survive? It depends entirely on where you are. According to data in a recent study from the American Heart Association, survival rates range from 16% in Seattle to just 0.2% in Detroit. Heart attacks outside hospital account for nearly 15% of all deaths in the USA. Over 1,000 people a day suffer a heart attack in the street, but in the last 30 years, survival rates have remained constant, at just 9.5%. These simple figures conceal three really shocking facts. First, bystanders only give CPR 25% of the time. 75% of the time, they either don’t know what to do, are scared about infection from mouth to mouth rescuscitation, or are concerned that giving incorrect CPR could render them liable to legal action if the patient dies. There are Good Samaritan laws in every state that offer protection to anyone acting with good intentions to aid the victim to the best of his or her ability during a medical emergency, but many people are still reluctant to intervene. Secondly, only 1 in 30 bystander resuscitation attempts is successful. Levels of CPR training are so low that it is usually administered by people who don’t know what they are doing. The first 180 seconds are critical: immediate CPR, properly applied, can buy time for paramedics to arrive, but without training, it is often ineffective. Lastly, the primary factor affecting survival rates is race. Whites are far more likely to survive a heart attack than Latinos or blacks. The reasons for this are not medical, but social. In some cases, there are cultural barriers: there may be strong taboos against touching someone of the opposite gender, particularly when a woman’s chest is involved. In other cultures, touching someone of the same gender might lead to harassment based on sexual orientation. In ethnically mixed neighborhoods with a high immigrant population, language can be a huge barrier.  Sometimes, the problem is legal: bystanders are worried about having to identify themselves to law enforcement if they get involved. In high crime areas, people have learned to ignore whatever is happening, and not get involved. However, the main influencing factor is simply that in poorer neighborhoods, fewer people have CPR training, so the chances of receiving immediate treatment is lessened. In affluent white neighborhoods, there is a 65% chance that someone collapsing in the street will get CPR from a bystander. In a poor black neighborhood, that reduces to under 10%. Comilla Sasson of the University of Colorado Anschutz Medical Campus in Denver, primary author of the AHA study, advocates that heart attack survival rates could be improved by targeting poor and ethnic areas. "Barriers to CPR training can be as simple as when and where the training is held," she observes. "We need to shift our thinking to target CPR training to the areas where it is most needed."

CPR-Manikins-CompilationAre CPR training manikins inherently racist?

Race has also recently become an issue in CPR training, because of the manikins used for training. In February 2013, Kimberly Thompson of Orange Park, FL, claimed that during CPR training at Plantation Oaks Elementary School, training manikins were assigned based on skin color. Her 10-year old daughter, who is bi-racial, was given a black manikin, which, said Thompson, led to her being teased about her race. The school disputes this, and says that no teasing occurred. Regardless of the specifics of the Plantation Oaks case, this does pose a tricky question for trainers and manufacturers of manikins. "Volunteers and consumers have told us they prefer to learn CPR on mannequins that reflect their populations," said Metro Jacksonville's American Heart Association Vice President, Rebecca White. Leading manufacturers like Simulaids, Prestan, and Laerdal make manikins with a variety of skin colors. Prestan say that they did this “at the urging of our distribution base worldwide and many instructors” who felt that having white-only manikins was a potential barrier to teaching CPR to non-white students. Manufacturers have struggled to find an acceptable way of describing their manikins. Prestan refer to them as Dark, Medium and Light Skin Tone, CPRlene went for Black and White, while Simulaids opted for African American, Caucasian, and the somewhat controversial Helal Arabian. (Helal refers to Islamic law, so the mingling of religious connotations and skin color is something that both Muslims and non-Muslims understandably find offensive.) However, as Thompson, who is a nurse, points out, “You don't get to pick the victim that you're going to work on, so why are we racially selecting mannequins? They should all be one color, blue, orange, green. I just think that it should be neutral.” That’s the approach taken by CPR Prompt, who offer adult, child and infant manikins in blue and tan, and Basic Buddy, who went for red. This gives CPR trainers both an option and a dilemma. On the one hand, they can go for unrealistic red or blue training manikins. On the other hand, they can go for more realistic training devices, which is what both trainers and trainees usually want, but risk being accused of either deliberate or involuntary racism. CPR training can, and does, save lives. It is vital to train as many people as possible, especially in poor and ethnic neighborhoods. For CPR training programs to be successful, it is essential to ensure that race is not seen as an issue. For some, the color of the training manikin will undoubtedly affect their inclination to undergo training, or may affect their attitude to the instructor. CPR trainers will need to evolve strategies to address this if survival rates for black and Latino patients are to be brought in line with survival rates for whites. Lives are more important than the color of a plastic doll.