Bye-bye bystanders? A recent Duke study revealed that bystanders are less likely to perform CPR on patients in predominantly Hispanic neighborhoods, most likely due to a lack of accessible CPR training and initiatives.
The study’s lead author was Audrey Blewer, assistant professor in family medicine and community health at the School of Medicine, and it was published in the journal Circulation at the close of 2019. It uses data collected from 2011 to 2015, comparing the rate of bystander intervention during cardiac arrest in different communities based on the proportion of Hispanic residents.
While most bystanders did not intervene—less than 40% overall—the rate was lowest in neighborhoods where 75% or more of the residents were Hispanic. Researchers like Blewer want to tackle this dilemma with health education.
“Over the past 10 years that we’ve been doing this research, what we’ve really tried to do is think about ways to target CPR training to family members of high-risk cardiac patients,” Blewer said.
The data stands out in a city far ahead of the national pack in CPR success. According to the city’s 2019-2021 strategic plan, Durham has a 14% cardiac arrest resuscitation rate, which exceeds the national rate of around 6%.
Heart disease was still the second leading cause of death for Durham residents from 2013 to 2017, with 131 deaths per 100,000 residents. Although cardiac arrest represents less than 10% of 911 calls, the acute nature of these incidents has influenced city officials to take action.
“This is absolutely a call to action to improve and expand CPR training and defibrillator access,” study contributor Monique Starks said in a 2017 release for a similar research study.
As an alternative to these serious 911 calls, bystander intervention in cardiac arrest episodes improves the rate of survival when a person goes into arrest outside of the hospital. This includes public locations as well as private locations like patients’ homes.
However, the study revealed that in communities where at least three-quarters of the population is Hispanic, the rate of CPR performed by bystanders was 27%, a significant drop compared to a 39% resuscitation rate in neighborhoods where less than 25% of residents are Hispanic.
The authors also reference dispatch CPR (D-CPR), a form of CPR that is administered under the guidance of an emergency dispatcher. D-CPR is associated with increased survival rates in episodes of cardiac arrest.
Language barriers can pose an obstacle in providing D-CPR to Hispanic communities, and the study suggests that training should be provided to communities and dispatchers alike to improve accessibility. Blewer said she hopes the findings of this study will influence educators to take a more specialized approach to CPR training.
“I think the biggest message here is that CPR training is not one-size-fits-all,” she said.
Durham’s Strategic Plan states that further growth in this area will be monitored by the Durham Fire Department since firefighters also receive EMS training. However, the department was unable to provide specific information about the demographics of this statistic.
“At this time the Durham Fire Department does not have the resources to accurately provide that data,” wrote Battalion Chief Tina Hamlin in an email.
The Chronicle also reached out to Duke Hospital, which did not have the requested information, and the Durham County Health Department, which did not respond to multiple requests for comment.
Although some questions about cardiac health in Hispanic communities may remain unanswered, Blewer is optimistic that these disparities can improve with increased health literacy.
“We need to start thinking about ways to modify CPR training curriculum and 911 instruction to [reflect] the diversity we see in Durham and the US in general,” she said.
The findings in this study come on the heels of a similar study published in 2017, which showed that the rate of people receiving CPR in predominantly black neighborhoods was less than 20%, compared to 47% in predominantly white neighborhoods. Previous studies have also focused on the link between socioeconomic status and resuscitation rates, and areas with high levels of poverty were more likely to have low bystander CPR rates.
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Nadia Bey, Trinity '23, was managing editor for The Chronicle's 117th volume and digital strategy director for Volume 118.