Previous medical studies have shown that Latino cardiac arrest victims are 30 percent less likely than whites to have bystander CPR performed on them, and now a new study confirms the actual barriers that prevent bystanders from learning CPR, dialing 911 when an incident occurs, and providing CPR to victims. According to the study in Denver (Colo.), a major factor is “language barrier,” with most study participants believing they were unlikely to have a competent interpreter answer their 911 call. Other factors found by a team from the University of Colorado School of Medicine include a distrust of law enforcement, fear of financial costs and a low incidence of proper training. Bystander CPR has long been proven to increase survivability, in some cases up to three times the rate as with no CPR. The study found six key barriers: fear of becoming involved because of distrust of law enforcement, financial, immigration status, lack of recognition of cardiac arrest event, language, and violence. In addition, seven cultural barriers were identified: age, sex, immigration status, language, racism, strangers, and fear of touching someone. Participants in the study suggested that increasing the availability of tailored education in Spanish, increasing the number of bilingual 911 dispatchers, and policy-level changes, including CPR as a requirement for graduation and strengthening Good Samaritan laws, may serve as potential facilitators in increasing the provision of bystander CPR.
According to the study, “The fear of becoming involved because of the distrust of law enforcement, a result of possible undocumented status or outstanding warrants, was a common barrier that precluded our high-risk neighborhood residents from calling 911.” Communities may want to work closely with law enforcement and EMS, the researchers said, to ensure that police, fire, and first responders do not ask for any type of documentation before assisting the person. This information must be addressed in community-based CPR training so that the fear of deportation or outstanding warrants does not deter individuals from activating 911 services. Study participants also suggested that law enforcement participate in the training in the community to help reassure residents in these high-risk neighborhoods that police are willing to help.
Language barriers were also an important concern for study participants. “Previous research has shown that callers with limited English proficiency are more likely to have significant delays in the timing and receipt of lifesaving interventions by dispatchers.”
Significantly, “Many of our participants believed that if they called 911, they were unlikely to have a competent interpreter who could assist them in their primary language.” Community CPR training should teach callers to say key words, the researchers said, such as “heart stopped,” and “Spanish interpreter,” so that delays can be avoided in identifying the type of call being made.
A lack of recognition of out-of-hospital cardiac arrest symptoms was also identified as a common barrier to calling 911 and performing CPR, the study found. Study participants suggested that additional time be given to discussing how to recognize a potential out-of-hospital cardiac arrest victim, given that the awareness of cardiac arrest and bystander CPR is low in Spanish-speaking countries.
Finally, the financial costs of 911 activation were another significant barrier to 911 use. According to study participants, in Mexico, patients’ families must pay before transport can occur. Even in the United States, “These cultural ideas about 911 persist and community members are hesitant to call for EMS because they do not have the means to pay for transport at EMS arrival,” the study said.
This information must be addressed in community-based CPR training, the researchers said, so that neighborhood residents are aware they do not need to pay up front and can be billed later. Even so, “Community members may still be hesitant to call 911 because of the high cost of ambulance transport versus waiting for a family member or friend to drive them to the hospital.”
Read the entire study here.
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