A man in line at the coffee shop suddenly slumps to the floor. Around the shop, cups stop halfway to mouths. Folks are wondering: is he drunk and passing out? Is it drugs? Has he fainted? What about stroke or cardiac arrest?
A few people step back. Someone pulls out a phone. Everyone glances around the room, waiting to see what will happen next and who will move first.
For a few long seconds, nobody does.
It isn’t that the people in that room don’t care. Almost all of them do. What’s happening has a name: the Bystander Effect. And in a cardiac emergency, those moments of hesitation matter more than almost anything else.
This November is CPR Awareness Month, so we’re looking at why people freeze, why the picture is more hopeful than you might think, and five simple ways to make sure you’re the one who acts.
What is the Bystander Effect?
The Bystander Effect is the tendency for people to be less likely to help in an emergency when other people are around. Psychologists Bibb Latané and John Darley studied it in the 1960s, after a widely reported New York murder case in which dozens of neighbours were said to have done nothing. (Later reporting found that story was badly exaggerated, and several people did call for help. But the research it sparked still holds up.)
Their work found that in a group, a few things get in the way of helping:
- We’re not sure it’s an emergency. We look at others for cues. If no one else seems alarmed, we assume it must be fine.
- We assume someone else will act. Psychologists call this diffusion of responsibility. The more people around, the less responsible each one feels.
- We’re afraid of getting it wrong. Nobody wants to look foolish in front of a crowd, or to make things worse.
That last one is the big one when it comes to CPR. And it’s the one training fixes best.
The good news: most people do step in
Here’s the part that doesn’t get told as often. When researchers looked at real-world situations instead of lab experiments, they found people are far more helpful than the Bystander Effect suggests.
A 2019 study published in American Psychologist reviewed security camera footage of 219 public incidents in the UK, the Netherlands and South Africa. In about 9 out of 10 of them, at least one bystander stepped in to help, and usually several did. The more people who were present, the more likely the person was to get help.
In other words, people want to help. Often what’s missing is the confidence to go first, and the know-how to do something useful once they do.
Why it matters so much for cardiac arrest
When someone’s heart stops, there’s no time to wait and see. According to Heart & Stroke, there are about 60,000 out-of-hospital cardiac arrests in Canada every year, roughly one every nine minutes, and only about 1 in 10 people survive.
Immediate CPR keeps blood flowing to the brain and vital organs until paramedics arrive, and an AED can shock the heart back into a normal rhythm. Yet Heart & Stroke reports that bystander CPR rates across Canada range from just 42% to 72%, and bystanders use an AED in only 13% of cardiac arrests in public places. They also found women are less likely than men to receive CPR from a bystander in public.
Every one of those gaps is a moment when someone nearby could have helped, and didn’t.
Five ways to break the Bystander Effect
The good news is that the Bystander Effect is easy to interrupt once you know it’s there. Here’s how.
- Notice it, and decide not to wait. Simply knowing the Bystander Effect exists makes you less likely to fall into it. If you see someone collapse and everyone is frozen, assume no one has helped yet.
- Go first. Once one person acts, others follow. Check the scene is safe, check the person for a response and normal breathing, and if they’re unresponsive, act.
- Point and assign. “Someone call 911” often means no one does. Point at a specific person: “You in the red jacket, call 911 and put it on speaker.” “You, find the AED.” Clear jobs turn a frozen crowd into a team.
- Start compressions. If the person is unresponsive and not breathing normally, push hard and fast in the centre of the chest. If you’re not familiar with or comfortable giving breaths, compression-only CPR is still far better than nothing. The 911 dispatcher can coach you, too.
- Get the AED. AEDs talk you through every step, and they only deliver a shock if one is needed. You don’t need to be an expert, you just need to turn it on and follow the step by step instructions given by the AED unit. (Learn more in Understanding the Importance of AEDs.)
These steps are a starting point, not a replacement for hands-on training. Practising on a manikin with an instructor is what makes them automatic when it counts.
“What if I do something wrong?” A quick word on the law
Fear of being sued keeps some people from helping. In Ontario, the law is on the side of people who step up.
- Ontario’s Good Samaritan Act, 2001 protects people who voluntarily give emergency first aid at the scene, without expecting payment, from liability for damages, unless they’re grossly negligent.
- The Chase McEachern Act (Heart Defibrillator Civil Liability), 2007 gives similar protection to people who use an AED in good faith in an emergency.
The Canadian Red Cross notes that every province and territory has legislation protecting people who voluntarily help in an emergency. And yes, ribs can crack during CPR. As the Red Cross puts it, that’s preferable to death.
This is general information, not legal advice. We’ll take a deeper look at the legal side of CPR in a future post.
Kindness, in action
November 13 is World Kindness Day, and it’s a good reminder that kindness isn’t only about holding doors and paying for the next person’s coffee. Sometimes the kindest thing you can do for a stranger is to be the person who doesn’t hesitate.
And kindness is contagious. When one person steps forward, it gives everyone else permission to help, too. That’s the Bystander Effect working in reverse.
This CPR Awareness Month, be the one who acts
The difference between freezing and acting usually comes down to one thing: confidence. And confidence comes from training.
First Aid 4U is an award-winning Canadian Red Cross Training Partner, with courses at 35+ locations across Ontario. Getting ready is easier than you think:
- CPR and AED certification. CPR Level A and Level C courses teach you to recognize cardiac arrest, give high-quality compressions and use an AED, with Canadian Red Cross certification valid for three years.
- Blended learning that starts today. Do the online theory at your own pace, then book your in-person skills session when it suits you. See blended CPR options.
- Train together. Bring your office, team, school or group of friends. Request a private group session.
- Already trained? If your certificate is close to its three-year mark, check your recertification options.
