Bystander Assistance During Medical Emergencies by Patient Appearance

Most people assume that they can rely on civic generosity to save them if they experience a medical emergency in public. Popular movies and television shows often depict heroic strangers who swoop in to manage the scene, minimize damages, and call an ambulance at the site of a medical crisis. Interestingly, research shows that bystanders without medical credentials still have high chances of significantly improving patient survival outcomes before EMTs arrive on the scene [4]. However, emerging data proves these courageous accounts to be rare in real life scenarios. In most cases, bystanders avoid intervening when someone nearby is experiencing a medical emergency. Even worse, bystanders step in far less often when non-white people, younger people, and women are facing a medical emergency. This evidence suggests that inequality of health outcomes extends beyond the hospital’s care and into the public response.

Cornell’s Sociology Department leads research on racial and socioeconomic gaps present in public response to medical emergencies. Researchers Erin York Cornwell, PhD, and Alex Currit, MA, analyzed data from the National Emergency Medical Services Information System (NEMSIS) covering nearly 22,500 accounts of medical emergencies in public streets[5]. When considering all public medical emergencies, only 1 in 39 patients receive bystander support before trained professionals enter the space [3]. This indicates that bystanders neglect to intervene during public medical emergencies almost 97 percent of the time [4]. The data displays consistently low rates of bystander support even in heavily occupied areas, implying that in many cases immediate bystanders fail to support the patient [4].

However, this data does not remain consistent across all racial and ethnic groups. While 1 in 24 white patients receive bystander support during a public medical emergency, only 1 in 55 black patients receive this same support during a medical emergency [3]. This signifies that black patients’ chances of obtaining assistance from strangers are nearly 60 percent lower than that of white patients' chances [4]. Moreover, previous research has shown that black patients have a lesser chance of receiving CPR from bystanders during life-threatening medical emergencies [4]. These statistics highlight significant racial disparities in bystanders’ willingness to respond to a patient during a medical crisis.

These disparities persist even in medical emergencies pertaining to children. Researchers at Children's Hospital of Philadelphia observed data from over 7,000 adolescent patients and concluded that only 47 percent of children who were experiencing cardiac arrest outside of the hospital acquired CPR. A careful inspection of the statistics revealed that black children had a 41 percent lesser chance of receiving bystander CPR than white children. For Hispanic children, bystander CPR rates were nearly 22 percent lower than those for white children. Additionally, black children living in areas concentrated with lower employment, education, and income levels were the least likely out of all groups to receive bystander CPR [1].

Disparities in bystander support during medical emergencies also transcend into the perceived gender and age of the patient. Researchers Mark Faul, PhD, MA, Shelley N. Aikman, PhD, and Scott M. Sasser, MD analyzed data from NEMSIS and discovered that bystanders are more likely to help patients that they perceive to be male and to be older [2]. They found that during these medical emergencies, services were sent nearly 40 percent of the time when the patient was between ages 60-99 but only 20 percent of the time when the patient was between ages 0-19 [2]. Additionally, they concluded that the most critical medical emergencies more often received bystander support and intervention [2].

Researchers offer varying explanations behind disparities in bystander support. Most commonly, they suggest that residential segregation plays a large role. Residential segregation can concentrate poverty and socioeconomic disadvantage into certain communities, advancing unequal health outcomes. Sociologists also suggest that socioeconomic disadvantages in a region can impact community relationships for the worst [3]. These strained relationships and the limited trust that community members hold for one another can produce lower rates of bystander support during public medical emergencies [5]. Additionally, these communities may have a dearth of medical services and institutions that would motivate a bystander to involve emergency services during a medical crisis [5]. Moreover, some researchers point to a racial gap in CPR and first aid training, implying that residentially segregated areas have less immediate medical support from community members to tackle an emergency [4]. However, these two explanations cannot address the unequal outcomes of bystander support that persist in integrated communities. For this, researchers look towards discriminatory stereotypes related to perceptions of safety. Bystanders’ decisions to intervene are largely based on personal assessments of their own safety [4]. Bystanders might perceive black patients as a threat to their safety, even in scenarios where the patient is helpless [4]. Furthermore, bystanders may feel less threatened by older patients experiencing medical emergencies.

Given these numerous explanations, to better understand disparities in bystander support for medical emergencies, it is imperative that researchers continue analyzing community social contexts, gaps in medical certifications, and harmful stereotypes around personal safety. Altogether, this data indicates that our focus on solving unequal health outcomes should expand into public response towards medical emergencies. As researchers warn that preventative measures largely increase patients’ chances of survival, the next step is to assess how to close the racial, gender, and age gaps in bystander intervention.

References:

1. Black children in poor areas less likely to get bystander CPR. www.heart.org. (2019, July 10). Retrieved November 14, 2021, from https://www.heart.org/en/news/2019/07/10/black-children-in-poor-areas-less-likely-to-get-bystander-cpr.

2. Faul, M., Aikman, S. N., & Sasser, S. M. (2016). Bystander intervention prior to the arrival of emergency medical services: Comparing assistance across types of medical emergencies. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors. Retrieved November 14, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4933010/.

3. Kelley, S., & April 14, 2016. (2016, April 14). Having a medical emergency? don't count on strangers. Cornell Chronicle. Retrieved November 14, 2021, from https://news.cornell.edu/stories/2016/04/having-medical-emergency-don-t-count-strangers.

4. Rapaport, L. (2016, April 20). Do bystanders help black people less often in medical emergencies? Reuters. Retrieved November 14, 2021, from https://www.reuters.com/article/us-health-emergencies-bystanders-race/do-bystanders-help-black-people-less-often-in-medical-emergencies-idUSKCN0XH23K.

5. York Cornwell, E., & Currit, A. (2016). Racial and social disparities in bystander support during medical emergencies on US streets. American Journal of Public Health, 106(6), 1049–1051. https://doi.org/10.2105/ajph.2016.303127