title: Does the sex of a simulated patient affect CPR?
abstract: BACKGROUND
  While males and females are equally at risk of sudden cardiac arrest (SCA), females are less likely to be resuscitated. Cardiopulmonary Resuscitation (CPR) may be inhibited by socio-cultural norms about exposing female victims' chests. Empirically confirming this hypothesis is limited by lack of patient simulators modeling realistic female physiques. A commercially-available patient simulator was transformed to evaluate how physical attributes of a patient's sex might influence lay participants who were asked to resuscitate a female versus a male during simulated cardiac arrest.
  
  
  METHODS
  Sixty-nine participants consented to be in the study. Participants were randomly assigned to provide CPR and defibrillation as instructed by a commercially-available automated external defibrillator on a patient simulator presented as either a male or female experiencing cardiac arrest.
  
  
  RESULTS
  Rescuers removed significantly more clothing from the male than the female, with men removing less clothing from the female. More rescuers' initial hand placements for CPR were centered between the female's breasts compared to the male, on which placement was distributed across the chest towards the nipples.
  
  
  CONCLUSIONS
  While rescuers had better hand placement for CPR on the female, both men and women rescuers were reluctant to remove the female's clothing, with men significantly more hesitant. Reticence to remove clothing was often articulated relative to social norms during structured interviews. We suggest that using only male simulators will not allow trainees to experience social differences associated with the care of a female simulated patient. Realistic female patient simulators are needed.
authors.affiliation: Department of Psychology, Université Laval, Québec, QC, Canada; Healthcare Human Factors and Simulation Laboratory, W21C Research and Innovation Centre, University of Calgary, Calgary, AB, Canada.
authors.forename: Chelsea E
authors.initials: CE
authors.lastname: Kramer
authors.affiliation: Department of Psychology, University of Calgary, Calgary, AB, Canada; Healthcare Human Factors and Simulation Laboratory, W21C Research and Innovation Centre, University of Calgary, Calgary, AB, Canada.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Wilkins
authors.affiliation: Department of Psychology, University of Calgary, Calgary, AB, Canada; Healthcare Human Factors and Simulation Laboratory, W21C Research and Innovation Centre, University of Calgary, Calgary, AB, Canada; Department of Anesthesia, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Davies
authors.affiliation: Department of Psychology, University of Calgary, Calgary, AB, Canada; Healthcare Human Factors and Simulation Laboratory, W21C Research and Innovation Centre, University of Calgary, Calgary, AB, Canada. Electronic address: jkcaird@ucalgary.ca.
authors.forename: Jeff K
authors.initials: JK
authors.lastname: Caird
authors.affiliation: Healthcare Human Factors and Simulation Laboratory, W21C Research and Innovation Centre, University of Calgary, Calgary, AB, Canada.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Hallihan
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000193:education* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008348:Manikins; D012737:Sex Factors; D000066908:Simulation Training
keywords: Automated external defibrillators (AEDs); Bystander resuscitation; Cardiopulonary resuscitation (CPR); Experimental research; Patient simulation; Sex differences