What is the Bystander Effect?

The bystander effect refers to reluctance by witnesses to help a person in distress such as a medical emergency, when there are other people present. In the context of Sudden Cardiac Arrest (SCA), bystanders may refrain from dialing 911, offering CPR, or using an AED on the person in need.  

Common Reasons for Bystander Hesitancy

One common reason for the bystander effect is a psychological phenomenon known as diffusion of responsibility. This is a misguided tendency of individuals to expect others to be better suited to step in and help. This way, the individual feels less personal responsibility towards the person in distress.

However, it is always best to assume that nobody else has called 911 yet and take that immediate and simple action if you ever witness an emergency. Don’t be afraid to call 911! Dispatchers are trained to help you, you are not alone.

Another reason why the bystander effect happens is fear that intervention may be interpreted as inappropriate. For example, men may hesitate to give CPR to women because it involves contact with the breast area, and they fear that this may be seen as lewd. It is critical to normalize the provision of CPR to women, exposing the chest of a person to save their life is necessary.

Drawing upon research showing that those wearing bras are less likely to receive effective AED treatment. A 2015 study conducted by Canadian psychologists at the Universities of Laval and Calgary found that only 42% of participants removed the manikin’s bras as required for proper AED use. 

The element of race and ethnicity can also play a role in influencing bystander willingness to help. Alarmingly, Black victims are just HALF as likely as white victims to receive bystander help during medical emergencies! 

One study found a direct relationship between the median household income and racial composition of a neighborhood and the probability that a person in need would receive bystander CPR. The study cited the cost of CPR training, a lack of outreach to minority neighborhoods by organizations that promote CPR, language barriers, and cultural issues around learning and performing CPR as some reasons for the disparity. 

Other studies have shown that individuals who suffer SCA in predominantly Hispanic neighborhoods were also less likely to receive bystander CPR and had a lower likelihood of survival. These findings suggest an important need to understand the underlying disparities in CPR delivery and unmet CPR and AED training and knowledge needs among Hispanic communities.

Bystanders may also hesitate to initiate CPR and use an AED on a SCA victim because of misinformation, such as fear that they could apply an excessive shock and kill the victim. But don’t worry– AEDs will automatically analyze the patient’s heart rhythm and will only deliver a shock if the rhythm is determined to be “shockable.” 

AEDs will not provide a shock to anyone who is not in a fatal heart rhythm. AEDs are safe and specifically designed to be used by lay persons with little medical training.

A potential responder may also be afraid they do not possess the right skills and could inadvertently make the situation even worse. Witnesses of a medical emergency often fear that they may be subject to blame or legal action if they are perceived to have caused harm to the victim when trying to help them. However, the law actually encourages lay people and bystanders to perform CPR and to use an AED on people who have suffered from SCA and it actually protects them from litigation.

The importance of bystander CPR

Out-of-hospital cardiac arrest is an extremely serious condition which without intervention kills the victim within minutes. It is therefore critical that the patient receives CPR within a few minutes of onset. Patients who receive bystander CPR before the arrival of EMS are two to three times more likely to survive than those who fail to get CPR.

Initiation of CPR is critical in the SCA chain of survival, which refers to a sequence of steps that should be taken in quick succession to improve the chances of survival. In the absence of bystander intervention, and with EMS arrival often taking over 5 minutes, virtually all SCA victims would die without bystander CPR and defibrillation.

Encouraging bystander action 

One of the most effective ways to encourage bystander action when witnessing a SCA, is empowering lay persons with CPR and AED training. Trained people feel more confident to intervene when they witness a medical emergency.

Boosting bystander confidence and action can be accomplished through public awareness drives and provision of AEDs. At Avive, we have developed a program called the 4-Minute City initiative that does just that! We work with communities to deploy AEDs, and train residents in those communities on SCA awareness, CPR and AED use. Our initiative encourages and empowers residents to rush to a neighbor’s aid when SCA incidents occur. The overall goal of the program is to save more lives by placing more AEDs when and where they are needed most. The program aims to get AEDs to SCA patients within 4 minutes, a critical window of time for survival.

Don’t let fear prevent you from saving a life! Take action in the moment.

None of us can predict exactly how we will react during an emergency. But simply knowing about the bystander effect phenomenon can help you try to overcome any hesitancy to take action that could arise in the moment.

It is a good idea to try to be mentally prepared to assist during a potential future cardiac emergency. Know that if you ever see someone collapse suddenly and become unresponsive, you will need to CALL-PUSH-SHOCK–it is important to keep this in mind at all times!

Imagine in detail how you would feel if you encountered this type of scenario. Examine any internal fears or implicit biases that are likely to emerge, and think through the set of actions you would need to take, if and when the time comes.

It may also help to be aware that robust Good Samaritan laws do exist in most states to help to absolve bystanders who offer reasonable intervention from blame in case a patient they are helping worsens or dies.

You may not feel very confident or comfortable becoming involved in an emergency situation with a complete stranger, but remember, everyday people can do extraordinary things! The person’s life could depend upon your willingness to assist. Try to remain calm and take action. If you are able to overcome any fears that arise and take action, you could save a life.

Here are a few videos on the importance of prompt bystander intervention:

Jason Grady, System Manager for Emergency Cardiac Care at Northside Hospital in Georgia, on Bystander Response:

Erick Woertink’s SCA Rescuer Story:

Dr. Dupont, Interventional Cardiologist, Northside Hospital, “Don’t Hesitate – Start CPR!”