In poor, mostly Latino areas of Denver, Colorado, people who suffer cardiac arrest are less likely to get help in part because distrust of law enforcement and language barriers stop bystanders from calling 911 or learning CPR, researchers say.
"We always sort of take it for granted the people will call 911, and this is the first study to really take a step back and say, gosh there's real barriers that we need to talk about," said Dr. Comilla Sasson, who led the new study.
People who live in poor and minority neighborhoods are more likely to suffer cardiac arrest outside of a hospital, and less likely to receive bystander cardiopulmonary resuscitation (CPR) or to survive, Sasson and her colleagues write in Annals of Emergency Medicine.
The results of the survey point out several misconceptions that need to be addressed in such communities, like the fear that first responders "aren't going to help you unless you're documented or that they're going to arrest you," Sasson, an emergency physician at the University of Colorado School of Medicine, told Reuters Health.
"It's something we spent a lot of time here in Denver really talking to our police officers and talking to our community members to let them know that if you call 911 we're not going to ask for identification - we're here to help you," Sasson said.
For their study, Sasson and colleagues recruited residents of five low-income, primarily Latino neighborhoods in Denver to form focus groups and do individual interviews to find out what might prevent them from calling 911, learning CPR or performing it.
A total of 55 people participated in six focus groups, along with an additional nine individual interviews.
The researchers identified six major barriers to calling 911, including the fear of law enforcement if the bystander was undocumented or had a criminal history.
Participants also misunderstood or were not aware of Good Samaritan laws and worried that law enforcement or the victim's family would blame them if the person did not survive.
Cultural and language issues were also important. For instance, there was considerable concern about the propriety or safety of touching another person, especially a stranger, in the chest area or on the mouth.
"I don't know if it's limited to Hispanic culture or not, but the hesitancy to touch another person, especially in the chest, and if it's a woman, oh my goodness . . . Uh, there is great hesitation on the older people's part," said one participant.
Many also expressed the fear of not being able to communicate with an emergency dispatcher.
"One of the things we found that's specific to the Latinos in Denver, and I think it's something that's important for people to know, is when you do call 911 how to say the right words to get through faster," Sasson said.
It can take 5 to 10 minutes for the dispatcher to communicate with somebody who doesn't speak English while trying to figure out the medical emergency, Sasson said, so she trains people in the community to say "heart stopped, Spanish interpreter" when they call 911.
"It's not rocket science by any means, but 'heart stopped' triggers that this is a medical emergency," Sasson said, and saying "Spanish interpreter" immediately lets the operator know they don't speak English.
The main reasons people gave for not learning CPR included the cost, lack of classes and not being aware of how CPR can save lives.
"We know from the research we've done that Latinos are 30 percent less likely to have CPR performed and what the study really showed it was not that Latinos don't want to do CPR or that they're afraid of it," Sasson said.
"It's truly, I think, that we haven't gotten the messaging out on how important it is and how easy it is to do, especially now that you can do it without breathing into somebody's mouth - you can do hands-only CPR."
Sasson said the American Heart Association has a Spanish-language website at heart.org/rcp with training materials and a 60-second video that people can watch to learn how to do hands-only CPR in Spanish.
"Cardiac arrest is a major public health problem and bystander CPR significantly improves your odds of survival on the order of tripling (them) and there's large disparities in who receives bystander CPR," Dr. Ben Bobrow, who wasn't involved in the study, told Reuters Health.
"There's both economic and racial disparities in who has access to life-saving therapy like CPR and it's unacceptable that people shouldn't have access to simple life-saving interventions like CPR," said Bobrow, who is medical director of the EMS and Trauma System in the Arizona Department of Health Services and the University of Arizona College of Medicine in Tucson.
