Most CPR manikins don’t have breasts, which contributes towards women being less likely to receive life-saving first aid from bystanders, a study has found.
The study led by Dr Rebecca Szabo, the lead of the Gandel Simulation Service at the Royal Women’s hospital in Melbourne, analysed all manikin models on the global market designed for adult cardiopulmonary resuscitation training.
Of the 20 different manikins, the researchers found all them had flat torsos, with only one model having a breast overlay. Eight were identified as male and seven had no gender specified.
The study, published in the journal Health Promotion International, highlights the findings as an equity issue with implications for the human right to health.
Australian research published in June found women are less likely to receive life-saving CPR after cardiac arrest and less likely to survive.
A survey by St John Ambulance in the UK, published in October, found women who go into cardiac arrest in public are less likely than men to receive chest compressions from bystanders as people “worry about touching their breasts”. The study suggested “unequal outcomes for women after cardiac arrest may start in CPR training and CPR manikin design related to implicit bias.”
Szabo, an obstetrician and gynaecologist, embarked on her research when she could not find any CPR manikins with breasts to train healthcare workers in life support for maternal cardiac arrest in pregnancy. She was concerned as Melbourne’s Delta Covid-19 wave in 2021 was leading to sicker patients and more ICU admissions.
“In the end we purchased a chest plate with breasts online,” Szabo said. “It’s similar to what a drag queen would wear and goes on like a singlet. We put that on our manikin for training.”
Szabo said CPR compression technique is no different for women, and that training on manikins representative of both sexes “may help people feel more comfortable … being confronted with a bra, breasts and something different” in a real-life emergency.
Breasts may also influence how defibrillator pads are applied, especially if there are breast implants or larger breasts, she said.
Despite worse CPR outcomes for women being well documented, “our study shows despite this little has changed in diversity of available CPR training manikins globally”, Szabo said.
“Our study is the first of its kind to name this as a gender and human rights issue linking this to business human rights and the commercial determinants of health.”
The authors of the study have urged CPR training providers and manufacturers to commit to improving the diversity of CPR training manikins, which they say should be the responsibility of those organisations.
“Governments, manufacturing companies, training bodies and those of us procuring and using these important training products all play an important role to address this important issue that may improve outcomes for women,” Szabo said.
She said this aligned with the aims of the National Women’s Health Advisory Council, chaired by Australia’s assistant minister for health, Ged Kearney, “to tackle ‘medical misogyny’,” on a range of key concerns including cardiovascular disease.
Prof Bronwyn Graham, the national director of the Centre for Sex and Gender Equity in Health and Medicine opened in March by The George Institute for Global Health, said “Szabo and colleagues’ findings are emblematic of a widespread bias in the health and medical ecosystem that has led to healthcare practices being optimised for the white male body; with detrimental and sometimes deadly implications for anyone who doesn’t fit this mould”.
“It highlights the critical need for regulatory bodies at all stages of the health and medical pipeline – from fundamental research through to the tools used to educate healthcare providers – to have policies that mandate consideration of sex and gender,” she said.
“Without such policies, these often insidious biases remain, and we will continue to put the lives of women and girls, and other marginalised sex and gender groups (including those with variations in sex characteristics, trans, and gender-diverse people) at risk of harm on a daily basis.”
