Dying of Embarrassment – Is Inequality in First Aid Costing Lives?

As leaders in delivering first aid training a subject that is often raised is the hesitance some feel when deploying first aid to the opposite sex, and specifically, using equipment such as AEDs (Automated External Defibrillators) on women.

We often answer and discuss with first aid trainees’ subjects such as:

• Removing clothing – and not wanting to cause embarrassment
• Touching the opposite sex – and worries around this
• Legal complications – as a result of first aid to the opposite sex

We think it is an important subject to address – and something we want to champion to ensure the safety of all in workplaces. With over 936,000 women in engineering alone it is important that all industries consider and address such worries – to ensure the deployment of life saving actions are never not deployed due to embarrassment or inequality.

Over 2,000 women in the UK die every year due to the incorrect use of a defibrillator.

The #BraOffDefibOn campaign, founded by Jenny Legg, is designed to raise awareness of the correct way to use defibrillator pads on women – and to ensure would-be-lifesavers understand that it is okay to remove a bra in order to save a life.

BRA OFF DEFIB ON – Its 100% the right thing to do!

Jenny says “Women are as much as 27% less likely to have CPR done on them than men. Whether this be because of fear being sued, getting it wrong or accused of sexual harassment we need to change this ‘shocking’ behaviour. By having bra removal as a standard part of the safe use of an AED process we show the importance of ‘bare the chest to save the rest’. Simply put - Bra Off Defib On!”

When the heart suddenly stops pumping blood around the body it will cause a person to collapse and become unconsciousness, unresponsive and not breathing normally (if at all).

In this circumstance there is no difference between genders – they WILL die without prompt treatment – their best chance may initially rest in the availability of prompt CPR and use of an AED.

This guidance is no substitute for training, but when using an AED, follow your manufacturer instructions, which likely include:

• Switch the machine on and follow the automated instructions
• Remove clothing and expose the chest
• Peel of the sticky pads and apply either side of the chest as per the pictures shown
• Follow the automated instructions
• Provide CPR as per your local protocols and the automated AED instructions

Before using an AED, the chest of the patient should be bare. Any clothing or easily removed jewellery that could interfere with pad placement should be removed.

Undergarments, such as bras can have metal in them, which can affect safe operation of the AED, which is a lifesaving device.

Only deal with what you can quickly as it’s a time sensitive emergency.

Giving immediate assistance to someone who’s in a life and death situation is an intense situation and the added pressure of removing a woman’s bra makes it even more intimidating, with concern over legal consequences for “exposing” someone without their permission.

Common Law gives protection for people acting for the benefit of another. So if you are reasonably trying to save someone's life and find yourself needing to use an AED on a patient and there is any suspicion their bra is underwired.

We advise:

• Cut off the bra
• Place the AED pads as shown – based on gravity and female anatomy you may need to lift breast tissue out of the way to fit the pad correctly.
• Use clothing or similar to maintain the patient’s dignity from surrounding onlookers.
• Once in place the AED will be able to carry out its checks and functions.

Jason Barstow, a prehospital care first aid instructor at MRS Training & Rescue says

“This is a lifesaving intervention on your part. You are not doing anything wrong; you are doing the right thing”

All our First Aid instructors deliver training that addresses what to do for all genders. It is standard practice when discussing defibrillators, to talk about chest preparation prior to pad placement, which should include bra removal if there is suspicion of it being under wired.

However, as the Resusci Anne dolls we use for practising using a defib correctly, are decidedly flat chested, it is important this topic is addressed to build confidence in CPR training and practice how to apply a defib to individuals that are not flat chested.

We have also created a flyer to give all delegates to highlight this issue.

In our first aid training we also address and debunk the worries delegates raise in relation to being sued or accused of assault because of delivering lifesaving actions. Whilst it is theoretically possible for a first aider to be sued under UK civil / criminal law, for assault, this has been tested in court and has always failed as it doesn’t meet the public interest test for a lay person doing a good deed.

For you to be successfully sued you would have to leave the person you are helping in a worse condition than when you found them. This is extremely unlikely because in a cardiac arrest the person will die if not treated.

Jason says “One of my scariest training conversations happened in a learning environment where a male teacher talked about ‘safeguarding issues’ in exposing a female pupil’s chest. Excellent and up to date trainers and training practices should be well equipped to inform and educate around this issue. There is no excuse for not having the conversation.”