Cultural Barriers Sometimes Make People Of Color Less Inclined To Call Emergency Services For Cardiac Arrest

Cardiac Arrest
Hispanics are 30 percent less likely than whites to have someone by their side to perform CPR when they go into cardiac arrest. They are also less likely to call hospitals for help, according to a new study. Courtesy of Shutterstock

Over 359,000 cases of cardiac arrest took place outside of hospitals in 2013, with the survival rate at a low 9.5 percent and a rate of nearby bystanders performing CPR at 40.1 percent, according to the American Heart Association. Now a new study is pointing to how ethnicity may play a role in these outcomes.  

Latinos are less inclined than whites to phone emergency services, and along with blacks are 30 percent less likely to have a bystander nearby to resuscitate them should they go into cardiac arrest. The study, published Dec. 12 in the international science journal Annals of Emergency Medicine, found that numerous factors including socio-economic and minority statuses and lack of trust among law enforcement were the basis behind these trends.

"Residents of low-income, minority neighborhoods have two strikes against them: The incidence of out-of-hospital cardiac arrest is much higher than average and rates of bystander CPR are below average," Dr. Comilla Sasson, an assistant professor at the University of Colorado School of Medicine who specializes in emergency medicine and the lead author of the study, said in a press release.

Sasson did not immediately return emails for comment to Medical Daily.

The study, targeting Latino populations, took place during the summer 2012 in Denver, Colo., with subjects purposely selected from five neighborhoods, comprised primarily of Latinos and where researchers found that cardiac arrest was two to five times more likely to take place than the county median along with below average rates of bystanders performing or able to perform CPR.  Half of the participants exhibited an annual income below $30,000. All were 13 or older, with the majority being 30 years or above at 70 percent. Eighty-eight percent of the total were Latino and 75 percent were female.

Subjects, split into six focus groups and interviewed on their knowledge of CPR and cardiac arrest, told researchers that they were less inclined to dial 911 during a cardiac episode out of fear brought on by distrust in police forces primarily along with language barriers, becoming involved in violence, financial and immigration statuses, and the inability to recognize the symptoms of cardiac arrest. They also listed language and immigration along with age, sex, racism, strangers, and fears over touching other people as reasons for the lack of bystanders nearby and able to perform CPR. Some also were under the false pretense that ambulances charge before transporting people to hospitals, a usual routine in Mexico, though not in the United States.

"You also have to take into consideration that a lot of people that live in this neighborhood only speak Spanish, so if you have someone only speaking English trying to tell them how to do CPR, it’s going to fail. So there is a need to have a translation there, and I know it’s horrible to be put on hold, but at the same time you want it done to where it’s successful and not hindered,” said one subject in a quote published in the study.

The study is not the first to identify cultural barriers that prevent ethnic minorities from seeking help in these situations. Research in neighborhoods in Columbus, Ohio found that finances, lack of information, and lack of motivation to be the three primary hindrances on learning CPR along with personal health, emotional worries, and fear of legal disciplinary action. Neighborhoods for this study were primarily of lower-income status and composed mainly of blacks.

Many pointed to flaws in education and law, saying that school systems should work harder to teach Spanish and should require that all students learn how to perform CPR in order to graduate. They also suggested that changes in policy and employing more bilingual emergency dispatchers would help save more cardiac arrest victims.

"We need to do a better job of overcoming the significant barriers to timely medical care for Latinos suffering cardiac arrest. Culturally sensitive public education about cardiac arrest and CPR is a key first step," Sasson said in the press release.

Source: Sasson C, Haukoos JS, Ben-Youssef L, et al. Barriers to Calling 911 and Learning and Performing Cardiopulmonary Resuscitation for Residents of Primarily Latino, High-Risk Neighborhoods in Denver, Colorado. Annals of Emergency Medicine. 2014.

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