A team of emergency medical services instructors in Boston started a petition to convince the American Heart Association to improve gender inclusivity in its education guidelines.
The petition, started by a team of EMS instructors from Harvard University and Massachusetts Institute of Technology, seeks to expand CPR classes to include mannequins that are not just male presenting, in order to provide students with training that is more representative of the population.
Roanna Zou, a member of CrimsonEMS at Harvard University, is an AHA-certified CPR and Automated External Defibrillator instructor. Zou said in training, she and other instructors received questions about whether performing CPR on women was the same as performing CPR on men.
“We started doing some research into the literature,” Zou said. “It was very clear that there is this difference in this gap between men who are receiving out-of-hospital cardiac arrest bystander CPR, and women who are receiving that.”
Over 350,000 out-of-hospital cardiac arrests occur each year in the United States, according to the AHA. If performed immediately, CPR can double or triple the chance of survival from an out-of-hospital cardiac arrest.
Men are 29% more likely than women to survive an out-of-hospital cardiac arrest and 27% more likely than women to receive bystander CPR in public locations, according to a 2018 study from the National Center for Biotechnology Information.
Zou said she reached out to the EMS team at MIT, and her team was not alone in seeing the disparity. In MIT’s classes, students were also asking if CPR should be performed on women.
“That question seems ridiculous,” MIT EMS Instructor Charles Sloane said. “But it’s a common one.”
The discussions between Harvard and MIT EMS quickly “snowballed” into a project to change AHA education guidelines and develop a female-presenting mannequin attachment.
Zou said she presented statistical findings on gender disparity in bystander CPR in a meeting with the AHA, and said the AHA responded by saying that if her team could show public interest in gender inclusivity, the association would take the issue into consideration when making the next revisions on education guidelines in 2025.
The team will present their petition at their next meeting with AHA on May 2 to show public support, Sloane said.
In addition to efforts to change AHA guidelines, the team is also designing a mannequin attachment to mimic female-presenting human anatomy that is compatible with AED pads to reduce bystander response time.
“When you perform compressions, and especially when you bring in the use of an AED, what we stress in classes is that you want to expose the patient’s chest,” Zou said. “There is that hesitancy where you want to protect someone’s privacy, but that hesitancy can also lead to delayed beginning of compressions [and] of AED usage.”
Many professionals in the field have expressed interest in female-presenting mannequin attachments.
Finn Reardon, captain of training at University Volunteer Ambulance Corps at the University of Maine, said he has also noticed its gender inclusivity issues working with AHA. He said when he listened to the team’s project presentation at the annual National Collegiate Emergency Medical Services Foundation Conference, he wanted to bring the project to Maine.
“Maine is a pretty limited demographic of people, so having any sort of diversity and being able to get gender inclusivity wherever I can is really important to me,” Reardon said. “We do a lot of outside CPR classes with the greater community of the Bangor and Orono areas, so I’m hoping to have a positive impact on them.”
Christopher Hernan, the chair of Mission CPR at University of Massachusetts Amherst Emergency Medical Services, said the project is “obviously advantageous” in improving CPR education and he “won’t hesitate” to implement female-presenting mannequins in his classroom.
“As an EMT, I know some of my colleagues in my collegiate agency, even some of them would be uncomfortable doing CPR on a woman and attaching AED pads to a woman,” Hernan said. “[These are] gender disparities that have been constant forever. It’s still sneaking its way into life saving action, even for first responders, which is completely, absolutely inexcusable.”
Elijah Darden, assistant field director of Public Health and the co-head of the Education Committee at Washington University in St. Louis Emergency Support Team, said while WashU has included additional training to address gender disparities and improve recognition of a female-presenting patient’s CPR needs, the foundation of CPR in basic life support classes is still hands-on learning.
“It’s really, really essential to practice with these female mannequin covers or female mannequins with undergarments and the other strategies that we already implement, just so people can have that hands-on training and help combat those misconceptions and those implicit biases,” Darden said.
Arden Pedraja, president of WashU EST, said the organization has connected the project team with WashU professors to help design survey questions and to help collect data to implement the mannequin attachments when they receive the prototype.
“As a CPR instructor, I’m really tired of telling our students all of these changes and being like, ‘this is an issue, but we are still practicing on only male-presenting patients,’” said James Lewis, education committee co-head of WashU EST. “I, for one, am really, really excited to be able to start using these female-presenting mannequin covers in our classes.”
What’s next? A trans manikin? How about one that truly represents the population- obese with a history of smoking and high fat diet, and non-compliance with diabetic medication? For Pete’s sake, if you’re any sort of qualified instructor, you should be informing your students about various ways to landmark your hand position, how to maintain modesty for your patient, the fact that MI doesn’t present the same way in women as it does in men, and more. There’s more to instructing people in proper CPR that putting on the video, timing a few sets of compressions, and grading a test. Maybe if some people were better instructors students wouldn’t have to be asking some of these questions. In over 30 years of instructing, I’ve never been asked any of these questions- probably because I gave the “answers” as part of the presentation, instead of sitting on my hands as the video played.