First Aid Trainers. We’ve all been there. That student on a course goofing around and making jokes about ‘kissing’ Annie. Whilst this might seem like an immature, but essentially innocuous comment, think about this from the perspective of someone who has been sexually violated? As a survivor of sexual abuse, I personally feel very uncomfortable by men* making jokes about sexually assaulting women whilst they are unconscious.
*Most women, and most men for that matter, do not joke about such things.
Worse still, these types of comment are likely to perpetuate the culture where women are withheld potentially lifesaving First Aid treatment involving CPR, rescue breaths or use of an AED. According to the #BraOffDefibOn campaign and @womanikin, women are 27% less likely to have CPR done on them then men, reducing their chances of survival towards 0%.
So what is the difference between lifesaving treatment for an unresponsive not breathing casualty and a sexual offence? Let’s break it down.
According to the Sexual Offences Act 2003, the elements of the offence of sexual assault are:
• A person (A) intentionally touches another person (B)
• the touching is sexual
• (B) does not consent to the touching, and (A) does not reasonably believe that (B) consents.
If we apply this logic to First Aid treatment for an unresponsive not breathing casualty, then yes, it is true that a person (A) intentionally touches another person (B).
- In order to manually pump blood around someone’s body, you do need to touch them; you need to compress their chest a third of their body size. ‘When you perform CPR on a woman, using correct technique could mean that your hand will touch or even partially cover a breast.’ New CPR Training Tool Has Breasts And This Is Why It Matters To Women. In this context, that is OK.
- In order to get air into someone’s lungs without medical equipment, you do need to cover their mouth with yours. (Do remember that rescue breaths are completely optional. If you don’t feel comfortable with this, then compression only CPR is an effective treatment, only slightly less effective than CPR with rescue breaths. Compression only CPR is significantly more effective than not doing anything!). In this context, that is OK.
- In order to use an AED, the casualty’s chest does need to be bare, especially in the case of underwired bras. You DO need to remove a bra to safely use an AED; watch this video from Passion Health MCR to find out more. In this context, that is OK.
Now that we have unpacked the ways that First Aid and sexual assault could be considered ‘similar’ i.e. a person intentionally touches another person, let’s have a look at they ways in which these two concepts are completely different.
Sexual assault: the is touching sexual
There seems to be some confusion here between ‘women’s bodies’ and ‘sexual’. Personally I think that there is nothing less sexual than a situation requiring this type of First Aid Treatment, and anyone who has found themselves in a situation where an AED has been necessary would agree with me.
Whilst researching this article, I found that artwork of women receiving lifesaving treatment has been censored as ‘containing unsuitable themes’. Whilst some of the comments about this artwork were highly unsuitable, if we are not even comfortable seeing images of women receiving potentially life-saving treatment, then how likely is it that we will be comfortable actually giving women potentially life-saving treatment in an emergency?
What are your views on artwork depicting First Aid care? Comment below!
Censored drawing of Aed girl 02 by bloodilla
I think some confusion creeps in due to our culture, where men typically only think of (or see) breasts in a sexual context. This problem is not exclusive to First Aid; many new mothers experience discrimination against breastfeeding in public Breastfeeding in Public: Disgust and Discomfort in the Bodiless Public Sphere.
Finally, the media is not helping to clarify the confusion between sexual acts and First Aid Treatment, with headlines such as ‘Here’s the story behind the ‘most kissed face in the world’.
| Reality check: · Would you consider repeatedly compressing your partners chest hard enough to potentially break their ribs ‘sexy’? · Do you pinch you partners nose and tilt their head back when you kiss them? (If you do, perhaps you should be reading this article instead? How to Kiss – wikiHow ) · Generally speaking, sexual touching does not involve electric shocks (and even if you are into that kind of thing, I would hope those shocks would not be strong enough to stop someone’s heart! FYI An AED works by switching someone’s heart off and on again. When delivering a shock it is very important that nobody is touching the casualty.) · Is a surgeon carrying out surgery ‘sexual’ in any way? · Someone who needs this type of treatment is essentially dead. Would you be sexually intimate with a corpse? If you answer ‘yes’ to any of these questions, I would suggest seeking help for Fetishistic Disorder from a trained sex therapist, as yes would not be considered an appropriate response to any of these questions to most people. See COSRT – College of Sexual and Relationship Therapists |
It is clear to me that none of the actions involved in performing CPR, rescue breaths or using an AED could be considered ‘sexual’ in any way. In a sexual context, these actions would in fact be completely inappropriate. To emphasise, the touching involved in CPR, rescue breaths or use of an AED is not sexual in any way.
First Aid Trainers can help to address the stigma around female bodies (aka. Boobs) by making a womainkin, DIY female manikin or getting Prestan Female Accessories and starting a discussion with learners.
Finally, let’s talk about consent.
Sexual Assault: (B) does not consent to the touching, and (A) does not reasonably believe that (B) consents.
I DO consent to you performing CPR + rescue breaths on me if I am unresponsive and not breathing. I DO consent for you to cut my bra off to use an AED in an attempt to try and save my life. This is called implied consent. ‘If the person were conscious and able to make a decision, they would consent to the procedure’ CPR AEDs and the law (resus.org.uk) I am hoping that anyone reading this article will reasonably believe that I don’t want you to let me die because trying to save me could be considered undignified. In fact, I DO NOT consent to you leaving me die just because of my gender! This is discrimination under the Equality Act 2010.
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Gentlemen. Context matters. These actions are perfectly acceptable if they are undertaken in an effort to save someone’s life. Please don’t be more concerned with my dignity than my life if I am unresponsive and not breathing!
However, just in case there is any confusion here; implied consent is a medical term, referring to medical situations i.e. where someone is unresponsive and not breathing. You do not have implied consent to perform sexual acts on anyone who is unconscious. That’s not OK. If you were to kiss me or to engage in any other sexual act with me while I was asleep or unresponsive, this would be sexual touching that I did not consent and you had no reason to believe I consented to AKA Sexual Assault. And it’s actually a lot more common than you might think! Fifth of sex attack victims ‘asleep or unconscious’ | BBC News. You also do not have permission to go around touching women who are not unresponsive.
Some gentlemen may have concerns that performing CPR, rescue breaths or using an AED could be perceived as sexual assault by bystanders. I have noticed a tendency for gentlemen of my parents’ generation to be the most hesitant to perform this type of lifesaving care (especially on younger women) and the most concerned about sexual assault claims. I think it’s important that we take these concerns seriously and start the conversation with our family members and friends! It’s OK to #GiveMeCPR. It is NOT sexual assault.
‘It is very unlikely that someone in the UK who acted in good faith when trying to help another person would be held legally liable for an adverse outcome. No such action has ever been brought against someone who performed CPR and, in general, the courts in the UK look favourably on those who go to the assistance of others.’
FAQs: Basic Life Support (CPR) | Resuscitation Council UK
For any gentlemen who are still concerned, I would emphasize how important communication is during a First Aid emergency, to inform passers-by of the situation and what they can do to help. You don’t need to be First Aid trained to call an ambulance, fetch an AED, wait to meet and direct the first responder/ambulance, or to take over CPR with direction. If there are many passers-by, you could even consider shielding the casualty from view as demonstrated when footballed Erikson had a cardiac arrest.
The only First Aid context where it wouldn’t be appropriate to attempt resuscitation is if you are aware that the person in question has a DNR or ‘Do Not Resuscitate’ order. It is very unlikely you will come across someone with a DNR outside of a hospital context. If you attempted resuscitation without being aware of the DNR, you would have been acting in good faith to help another and not liable.
I think it’s really important that First Aiders understand these issues before they are faced with a real life emergency (involving boobs). For every passing minute without CPR and defibrillation, the victim’s chances of survival decreases by 10%. CPR Facts & Stats – Medical Emergency Training & Services. Any time spent hesitating as to whether it is appropriate to help a women is bringing her closer to her death.
| Survival Statistics Use of an AED within 1 minutes of collapse = 90% survival rate Use of an AED within 3 to 4 minutes of collapse = 74% survival rate CPR and no AED = 9% survival rate AED with no CPR = likely 0% survival rate by the time you’ve got the AED |
In Summary, making a joke about ‘kissing Annie’ is making a joke about sexually assaulting an unresponsive woman, consequently blurring lines around implied consent and sexual assault. Any lack of clarity around these boundaries in a life-or-death emergency could mean that a woman is more likely to be left to die, whilst a man receives lifesaving First Aid treatment. 27% more likely in fact.
So what can we do about it?
First Aid Trainers:
Call out any sexual jokes about Annie manikins. As a trauma-informed trainer, it is important that all of your clients feel comfortable and safe in your course. What are your tips for calling out (or calling in) gender-based discrimination and sexual harassment jokes? Please share in the comments. Calling In and Calling Out Guide
Teach students about the difference between sexual assault and implicit consent. Raise awareness of gender-based discrimination in the provision of First Aid Care. I hope to develop a Lesson Plan on this topic at some point; please feel free to share any material you currently use below.
Get or make a female manikin to normalise the female body e.g. womainkin, DIY female manikin or getting Prestan Female Accessories
First Aiders and members of the public:
Don’t hesitate to provide unresponsive not breathing women the same standard of care as you would provide a man. A paramedic would not hesitate so why should you?
Communicate during an emergency to make it clear what you are doing and what help you need.
Spread the word: #GiveMeCPR #BraOffDefibOn #RespectConsent #ImpliedConcent #CPRIsNotSexualAssault #BoobsOutOrDie
Remind yourself how to help a casualty who is unresponsive and not breathing, regardless of their gender (See below for guidance or sign up to a First Aid course, feel free to contact me for recommendations)
How to help a casualty who is unresponsive and not breathing
Those of you who have completed First Aid training recently, may remember ‘the chain of survival’. The idea behind the chain of survival is that completing each link of the chain in the correct order can improve the outcome for the casualty. Any link of the chain missed out will reduce the casualty’s chance of survival. The chain of survival emphasises that time is of the essence. Don’t forget to take a deep breath before starting to Overcome Adrenaline.
- Early recognition and call for help
DR ABC Watch this video from the British Red Cross to see how to carry out these checks and actions
- Danger – 360 degrees danger check. Are you sure it’s safe? What can you do to make it safe?
- Response – Are they alert? Do they respond to your voice? Do they respond to pain? Are they unresponsive?
- Airways – Tilt head back and chin up to open a casualties airway.
- Breathing – 10 second check, with airway open. Not sure if it’s normal breathing? Speak to 999
- Circulation check – are there any severe bleeds that could be life threatening?
Call for help. Call 999. Shout for help! Are there any passers-by who can help you? Ask someone to get you an AED quickly.
Watch this video to see what happens when you call 999.
Early CPR
Buy the casualty some time by manually pumping their blood around their body. If using rescue breaths, complete 30 chest compressions before delivering rescue breaths. Please note the procedure is different for children and babies.
Learn more about paediatric First Aid on the free British Red Cross Babies and child First Aid App.
- Early defibrillation
Restart the heart with an Automated External Defibrillator (AED). An AED will analyse the casualties heart rhythm and if there is a shockable rhythm, deliver a controlled shock to the casualty. Never leave a casualty alone to look for an AED. Remember to ask for an AED at the ‘call for help’ stage.
Watch this video from St John Ambulance to learn how to use an AED
- Post-resuscitation care
Specialist care from paramedics through to A&E professionals and cardiac rehabilitation staff can help to restore the casualties quality of life following a cardiac arrest. Professional care starts with a call to 999 at the ‘call for help stage’.
Whilst all the stages of the chain of survival need to be completed to best promote the casualties chances of survival, the following diagram emphasises the relative importance of early recognition and call for help, followed by CPR.
Do be aware that not all casualties survive a cardiac arrest; the British Heart Foundation estimate that less than 10% of people in the UK survive and Out of Hospital Cardiac Arrest. By carrying out the chain of survival, you can improve a casualty’s chance of surviving a cardiac arrest – BHF.
Providing First Aid to someone who is unresponsive and not breathing can be traumatic. Do rember that there is support available for you after providing CPR, regardless of the outcome. See Post Traumatic Self-Care – Trauma Informed First Aid, Support if you’ve given CPR – BHF and Bereavement – Sudden Cardiac Arrest UK.
References:
#GiveMeCPR #BraOffDefibOn #RespectConsent #ImpliedConcent #CPRIsNotSexualAssault #BoobsOutOrDie
Trauma Informed First Aid 
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