Oct 25 2012
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When Crossing the Street is the Difference Between Life and Death

Comilla Sasson, MD, MS, FACEP is an attending physician at the University of Colorado Hospital and Assistant Professor in the Department of Emergency Medicine at the University of Colorado.  Sasson was a Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of Michigan from 2007 to 2010. Her latest study is published in the October 25th, 2012 issue of the New England Journal of Medicine.

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Dead. How do you make someone “undead?” How, with just your two hands, can you prolong the time that paramedics have to restart a person’s heart? How can a normal, ordinary person make a difference and literally save a life?

We know that a person’s chances of surviving an out-of-hospital sudden heart arrest decreases by 10 percent for every one minute he/she does not get CPR (cardiopulmonary resuscitation).  I had learned about hands-only CPR in my medical training.  Hands-only CPR is where all you have to do is push hard and fast (to the tune of “Staying Alive”) at a 100 times a minute until helps arrives.

But time and time again, I cared for African-American patients in Atlanta who had laid in their families’ homes for critical minutes as their brains slowly died from a lack of blood supply from the heart.  Their hearts had stopped and no one called 911. No one placed their hands on the chest and started doing hands-only CPR.

Maybe this is just Atlanta? Is it the color of a person’s skin or is the place where he or she collapses that makes the difference?

In my Robert Wood Johnson Foundation Clinical Scholars Program (RWJCSP) at the University of Michigan (2007-2010), I learned about the importance of neighborhoods in determining a person’s health.  After wading through the literature, my a priori hypothesis was that having someone stop to provide CPR is completely dependent upon others; therefore, the neighborhood plays a large role in whether or not someone does CPR.

After consulting with my two RWJCSP alumni mentors, David Magid, MD, MPH, and Arthur Kellermann, MD, MPH, FACEP, the question became clear: What role does the racial and socioeconomic composition of a neighborhood have on an individual’s likelihood of receiving life-saving bystander CPR?

The results we found were staggering. Published in the New England Journal of Medicine on Oct. 25th, 2012, we found that patients who arrested in a black, low-income neighborhood (median household income of less than $40,000 per year) had a 51 percent lower likelihood of having someone stop and do CPR as compared to cardiac arrest victims in a white, high-income neighborhood.  In general, poorer people were less likely to have bystander CPR as compared to their higher-income neighbors.  This means that, literally, crossing the street was the difference between life and death.

We also found that cardiac arrest victims who were black, Latino and older were less likely to have someone do bystander CPR. This compounded the health disparities we are seeing at both the individual and neighborhood levels.

In follow-up to this research, with the support of the Robert Wood Johnson Foundation, we conducted qualitative studies with neighborhood residents from low-income black and Latino neighborhoods in Columbus, Ohio and Denver, Colorado.  The barriers to learning and performing CPR were surprisingly not insurmountable.  Make CPR training free. Make CPR simpler.  Make sure that we do not get sued if we stop to help someone.

We listened to our community partners and, working in conjunction with our local American Heart Association and American Red Cross partners, we are now targeting our CPR education efforts on the neighborhoods where we know we can have the most impact. Our neighborhood residents are empowered and engaged to be our CPR health educators, teaching friends, family members,  and even Zumba class participants how to do hands-only CPR.

The policy implications of this paper are large.  We should be collecting data on cardiac arrest and how often our neighborhood residents are providing CPR. Most importantly, we must change the paradigm of CPR training where the same people keep getting trained, to a new model that is data-driven, evidence-based and done in conjunction with our neighborhood residents.

It is easy to document health disparities. But it is way more exciting and satisfying to change them by doing the simple things right.

Hands-only CPR is as simple as learning to tie your shoelaces. I would argue, that when a child learns to tie her shoelaces, she should also be learning how to save a life with those two same hands.

Read Sasson’s earlier post on the RWJF Human Capital Blog.

Tags: Black (incl. African American), Clinical Scholars, Diversity, Emergency Care, Health Disparities, Latino or Hispanic, Research & Analysis, Seniors (65+), Voices from the Field