Abstract 2660: Racial Disparities in the Rate of Bystander CPR
Purpose: Disparities in health care are widely documented. We conducted this study to test the hypothesis that there were no differences in the frequency of bystander CPR when the victim of out-of-hospital cardiac arrest (OOHCA) is classified by race.
Methods: The EMS system uses a two-tiered response of first responders/basic life support followed by paramedics. The service responds to approximately 50,000 calls annually. All calls are handled by an emergency call center which provides prearrival instructions, including CPR prompts to the lay person. All out-of-hospital cardiac arrests (OOH-CA) that were treated by paramedics in our system during 2005 were included. Patients were excluded if the paramedics stopped resuscitative efforts on their arrival. (obvious death, DNR orders, etc.) Demographic information was collected on all patients, as was the time of day and location of arrest. Time intervals from emergency call receipt to BLS and paramedic arrival were recorded. EMS noted the race of the patient, and whether or not bystander CPR was being performed on their arrival. Statistical testing included chi-square, Mann-Whitney, and regression analysis.
Results: A total of 770 patients in cardiac arrest were studied, with 563 patients classified as “white”, 185 classified as “black,” and 22 unclassified and excluded from further analysis. The proportion of patients receiving bystander CPR was 45% for white, 34% for black, and 35% for other. (p<0.001) The rate of return of spontaneous circulation (ROSC) was significantly higher in whites than blacks. (30% vs. 17%; p<0.0001) The proportion of OOH-CA occurring in the home was similar for whites (73%) and blacks (70%), however the rate of bystander CPR for OOH-CA occurring in the home was significantly lower. (33% vs. 20%; p<0.0001)
Conclusions: Significant racial disparities in the frequency of bystander CPR exist. While both groups had lower rates of bystander CPR when OOH-CA occurred in the home, significant disparities existed here as well. These findings have important implications for focusing on CPR training for all, with emphasis on increased training of the black popoulaiton.