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“Location, location, location” isn’t just a mantra used by real estate agents. It’s a big reason why some people with cardiac arrest receive life-saving bystander CPR and others don’t.

Studies show that Blacks and Hispanics in low-income neighborhoods are up to 50% less likely to get bystander CPR, or cardiopulmonary resuscitation, compared to more affluent white neighborhoods. When performed immediately after the heart stops beating, the procedure can double or triple the chance of survival.

The American Heart Association issued updated guidelines in October 2020 saying CPR training “should target specific socioeconomic, racial and ethnic populations” who have historically exhibited lower rates of bystander CPR.

“Oftentimes, those are also the same communities that have the highest incidence of cardiac arrest, so in terms of number of lives lost, the impact is that much more significant,” said Dr. Marina Del Rios. “We have to be more thoughtful and deliberate about engaging with communities at high risk.”

Guidelines for bystander CPR are the same regardless of where you are: Call 911 and press hard and fast in the center of the chest, for 100 to 120 compressions per minute, at least two inches deep, until Emergency Medical Service workers arrive.

Too few people have been trained to perform CPR in some neighborhoods due to a lack of resources and other barriers.

“We need to come up with unique and novel ways to deliver education in marginalized communities,” said Del Rios, an associate professor of emergency medicine at the University of Illinois College of Medicine in Chicago. “With more mandates to have CPR taught in schools, can we have the kids in those communities teach their parents? Can we engage with churches and do CPR training programs in concert with their health ministry? We need to take CPR training where people live, congregate and work.”

She urged government agencies to provide free training and pointed for example to the Illinois Heart Rescue, which provides CPR education in churches, schools and community organizations. 

The key to reaching under-served communities is spreading the word about bystander CPR by any possible means, Del Rios said.

“You can teach CPR in schools, parks and public libraries. You can go on TV, radio or do videos on TikTok and Instagram and remind people you don't have to be a medical provider to do CPR, that the dispatcher will give you instructions over the phone,” she said.

“It’s just like with vaccines: If people hear about it from multiple places, they're more likely to do it.”

Another possible way to reach under-served communities is to teach CPR at “high risk workplaces” where cardiac arrest is more likely to occur.

“I think that anyplace where you’re exerting yourself a lot should have people on staff trained on how to do bystander CPR. A gym is a good example, but also places where manual labor is done such as construction sites, landscape maintenance and farms. Any place that has exertional risk should provide their employees opportunities to learn bystander CPR,” Del Rios said.
Since few studies have been done on the topic, there’s a dire need for research to explore what, exactly, is causing low bystander CPR rates in specific communities, she said.

“We need studies with context. Barriers faced by Blacks in New York City might be different than those faced by Black people in rural areas, and Latinos may face different barriers than Asian-Americans,” she said. “We need to ask diverse populations what works best for them and why, and then design meaningful education programs with their input.”

In the meantime, it’s important to get rid of fears about bystander CPR that face all communities, such the fear of possibly injuring someone or being sued. Del Rios said Good Samaritan laws protect you from legal action if you perform CPR on someone.

“And if you save their life, the last thing that person is going to worry about is you bruising their chest,” she said.

Another common worry is that you might get a disease by performing mouth-to-mouth resuscitation. That particular fear can be dispelled through a better public understanding of Hands-Only CPR, she said.

“Now that we’ve simplified CPR by teaching Hands-Only CPR, we need to figure out how to improve access to it in these communities,” she said. “We’ve democratized it, but we still have to get people to go to the training.”