Are women dying because men are afraid of breasts?

Apparently, the fear of breasts is resulting in women receiving inferior CPR and is endangering lives. Something different is actually going on, here is information on the case.

There is a petition in the United Kingdom to “Require female CPR manikins in all certified first aid training programs”. 

The problem this petition is claiming to solve is to make the public more comfortable with female anatomy so that CPR can be more reliably effective on both men and women.

This petition stems from a research paper “Female anatomical manikins in basic life support training: A mixed methods study”. The participants in this study were nursing students in Spain. 

Much of the results in this study are irrelevant, but one particular finding was interesting. Some of the students were placing their hands in the incorrect location on female manikins after being trained on where to properly place their hands with male manikins.

This implies that the training was in some way insufficient and that had the female manikin not been subsequently available, the trainee may have placed their hands in the wrong location on a live casualty/patient.

Basic Life Support (BLS) courses are not traditionally courses that the public takes however. A BLS course is approximately 4.5 hours of resuscitation theory and training. Basic resuscitation courses for laypeople are usually the CPR level A and C. A is adults about 1.5 hours, C is adult + child + infant about 2-2.5 hours.

The petition assumes that because the nursing students did it wrong, that the public would also necessarily do it wrong. Given the increased level of training, this is not a big logical leap, but it still is not what the study was looking at. 

The petition looks to enforce what is essentially a doubling of manikins in all first aid courses at all levels, it is not restricted to BLS.

The hope is that through doing this, the public will be comfortable performing CPR on the female body.

Unfortunately, the messaging around this has included or implied that women are dying because men are afraid of breasts. The response has overwhelmingly been that men would not be afraid if they were not the targets of false claims of sexual assault. So now the conversation has been largely refocused around that.

First of all, when looking at CPR and the issue of legal liability. The only relevant response comes from information that is already standard is every first aid course in the very first section that is discussed within the first 30 minutes. Usually the first 10 minutes.

In most countries around the world, Canada and the United Kingdom included, when an adult becomes unresponsive a first aider gains ‘Implied Consent’. Even if the first aider is told to not touch the casualty (even by the casualty) before they go unconscious, once the casualty is unconscious they have consent.

Consent for what? To do whatever is necessary within the limits of “reasonable skill and care” to “preserve the casualty’s life”. CPR easily falls within the limits of reasonable skill and care. Both of these countries have Good Samaritan legislation which protects first aiders because the medical industry has already anticipated this risk.

The health care system does not want people to be afraid to help, so a significant amount of effort has been put in place to protect people that are just trying to help. This is so significant that I and everyone I have ever talked to about this subject in the first aid industry have never heard of even one case of someone being successfully sued for providing first aid in Canada or the United Kingdom.

There have been some reports of issues in China, but they don’t have Good Samaritan legislation, so that is different.

If someone has this concern about not being legally protected while performing CPR then either: 

1. the government has not sufficiently protected the public, 

2. their first aid trainer was incompetent, or 

3. that individual has decided to be afraid and is not willing to engage in critical thinking. 

Looking at the big picture, between 7-10% of people who have a cardiac arrest outside of a hospital survive to discharge.

There are numerous factors that come into play here. Here are some of them:

1. How long the delay is from cardiac arrest until CPR begins.

2. The effectiveness of the responder’s CPR.

3. If a defibrillator is present and can be used in tandem with the CPR.

4. How rapidly emergency services (911) is activated.

5. The effectiveness of the paramedics (this has many subcategories).

6. The effectiveness of the hospital (many subcategories).

7.  Does the patient have a DNR (do not resuscitate order).

All of these factors and more will go into the statistic of 90-93% of individuals who have an out of hospital cardiac arrest not surviving to discharge. While some may think that the DNR element should not be included in the stat, in some studies it is, that is just the reality of the stat.

When looking at women specifically. There are other considerations that go beyond potential bystander discomfort with breasts, here are some:1. Different symptoms. Women often present with different symptoms than men (back pain as opposed to chest pain).

2. Symptom dismissal. Women more commonly dismiss their symptoms. This results in delayed treatment, if at all. A cardiac event has often progressed further in women than men when first responded to due to this.

3. Harder to detect. It is more common for women to develop cardiac conditions that are difficult to detect than men. Microvascular disease, plaque building in smaller blood vessels is an example.

Overall, on average, women are harder to save than men in this area. It goes far beyond a layperson’s level of comfort with a stranger’s breasts.

Even though the challenge referenced in the petition represents a percentage of a percentage, and might not be a large issue in comparison to others, that does not necessarily mean it should be ignored.

As an example. If double the number of people received the existing CPR training, it would likely have a greater positive impact on women than changing existing CPR training. Not everything is mutually exclusive though, it should always be explored if one can just do both.

Unfortunately, the petition runs into a problem, the cost of manikins. I am going to provide the entire initial proposal and bold highly relevant sections:

“The Government should implement minimum standards for first aid training providers to ensure every trainee practises CPR and first aid on a manikin with female anatomy. All training providers should be required to include anatomically accurate female manikins alongside standard male manikins.”

CPR training at levels below BLS (basic life support) do not use bag-valve masks (BVMs). CPR is done with a combination of chest compressions and mouth-to-mouth ventilation. While face shields are used, for public health reasons trainees do not share manikins.

This means that either:

a) This petition necessitates a doubling of all adult manikins in first aid courses. Or

b) This petition necessitates a changing of resuscitation standards to compression only.

While compression-only CPR is taught, it is done so as a last-resort if rescue breaths are considered impractical. Virtually every resuscitation standard for the last 20 years has indicated that providing compressions with ventilation is better if the trainee can do it correctly.

I sincerely doubt the petition is looking to remove rescue breaths from the standard, as that would be counterproductive, so it is logical to conclude a doubling of manikins.

Here are some problems with that:

1. Cost, manikins are very expensive. 

Cleaning them is also very expensive. They have to be completely sterilized after each course to meet most training standards. In addition to the purchase of the manikins this is also increased cost in cleaning supplies, this cost will be passed onto the consumer (trainee) and will increase first aid course prices.

This is not a trivial expense. The logistics and cost of this many manikins at scale is significant.

2. Instructor challenges. 

First aid instructors will not want to clean that many manikins. As it stands, there has been a shortage in first aid instructors for years. The margins in the industry are tiny, they do not make significant money compared to the labour involved in the job. This is a near doubling of the equipment they need to carry and clean.

3. Time

First aid courses are already on a fairly tight schedule. Most training standards require the instructor to assemble and disassemble the manikins. They are also a fairly practical-intensive course. Realistically if one wanted to respect this petition it would be prudent to add an additional two minutes of CPR on the female manikins in addition to the male ones.

But two minutes in a CPR course is not two minutes. They need to do it correctly for two minutes. This does not include setup time, restarting a scenario, errors, corrections, resettling the class, and inevitably managing the classrooms where people will start fondling the breasts as a joke.

That last part isn’t a particular problem, but it takes additional time. First aid was a one-week course that was condensed into approximately 16 hours with no content removed. The instructor doesn’t have time. These days people prefer blended training where there is only one day in class and the theory is done online. This means even less time with the instructor.

All of these are forces which disincentivize getting people in a course. Cost increases, scheduling issues with instructors due to attrition, and asking people to stay longer will result in less people being trained.

If this petition does not find a way to accommodate the reality of the first aid training industry, then it will very likely result in less people being helped which in turn would mean less women being helped. This goes against its own interest.

To address the most discussed part of this, the sexual assault component going around on social media.

It makes absolute sense that this would be the initial reaction from the internet. To be surprised by this would only speak to one’s lack of awareness of the current zeitgeist.

The “redpill” and “manosphere” movements are massive to the point of arguably being mainstream. A common talking point in politics in some countries around the world right now is that men and women are ideologically divided among the political right and left.

There was an app called “Tea Dating Advice” which was marketed as a tool for women to create a database on men so they could secretly inform each other as to which men are undesirable or dangerous. This included the sharing of these men’s personal information to essentially blacklist them from the dating market. In some cases, it was used to protect women from alleged criminal activity, in many cases it was simply used to socially alienate men.

Tea Dating Advice was hacked, the information of the users (the women) was distributed around the internet, including what they said about who, and they were publicly shamed. The response was generally positive and the internet collectively rejoiced with basically ‘what goes around comes around’.

Remember the common meme about women being asked whether they would rather be alone in a forest with a man or a bear and women would continually answer the bear?

Telling men to not be afraid of sexual assault allegations with court case statistics misses the point, they are afraid of being destroyed from multiple sources. Like cancelled on social media and losing their job. Their perception is effectively their reality.

Here is what has a better chance to work:

Laws already exist to protect first aid responders (Good Samaritan legislation).

If you are ‘caught’ on video saving someone’s life and they try to ‘cancel’ you, the overwhelming response from the internet is likely to be to support you and counter-cancel the accuser.

Go get first aid/CPR training. If the instructor knows what they are doing, they will teach you how to landmark the sternum which is the same on any adult be they male or female.

If that fails, just watch our videos on YouTube. I have explained this all multiple times, it really isn’t that complicated.

Learn more and watch the full video here.

Vezina is the CEO of Prepared Canada Corp. and is the author of Continuity 101. He can be reached at info@prepared.ca.