Fear of intervention
Sometimes bystanders are afraid to get involved. But their actions can only help.

Research suggests that bystander action in medical emergencies is complex. Key factors affecting bystander intervention are described below.

Factors that decrease the likelihood of bystander intervention

  • Public location of arrest: Compared to healthcare professionals, laypersons are significantly less likely to offer help in emergencies that occur in public places.
  • Ignorance and confusion: When people do not understand what is happening or are confused about the unfolding situation, they are less likely to intervene.
  • Difficulty in recognizing medical emergencies: It is difficult to perceive that a medical emergency is occurring because indications often are ambiguous. Consequently, bystanders often delay in deciding to call EMS for help.
  • Lack of confidence and competence: A person who does not feel competent to deal with an emergency is unlikely to offer even minimal help. CPR can be difficult to learn and CPR skill retention is poor when these skills are not used regularly. (Hands-only CPR may improve the likelihood to act.)
  • Presence of other bystanders: The presence of others leads to a diminished sense of personal responsibility.
  • Unpleasant physical characteristics: Regurgitation, blood, dentures and other characteristics of the victim encountered during rescue breathing tend to dissuade bystanders from intervening.
  • Fear of harming the patient: A lack of knowledge and skills inhibit CPR use among families of high-risk patients.
  • Fear of using AEDs incorrectly: People unfamiliar with AEDs tend to be fearful of using them incorrectly.

Factors that increase the likelihood of bystander intervention

  • Size of the community in which the bystander lives or grew up: Individuals who grew up in rural areas are more likely to help than individuals from urban areas. People from non-metropolitan areas are more likely to help than their counterparts.
  • Presence at the time of the event: Bystanders who witness the emergency are more likely to help than those who arrive after the emergency has occurred.
  • Previous emergency training and positions of responsibility: People with CPR training or other emergency training and people with positions of responsibility in their organizations are more likely to help in SCA.
  • Availability of AED: When AEDs (automated external defibrillators) are available, bystanders are more likely to initiate CPR.

Inconsistencies in the research

  • Fear of disease transmission: Some research indicates bystanders are concerned about contracting infectious diseases such as Hepatitis B virus and AIDS. Other research, however, has found the fear of disease transmission is not a deterrent to bystander intervention.
  • Fear of liability risks: Some research suggests fear of liability risks are barriers to intervening in SCA. Other research indicates such fears have no bearing on willingness to help.
  • Emotional stress: Studies among healthcare professionals suggest unsuccessful resuscitation efforts can lead to emotional stress. Research among laypersons, however, suggests that levels of stress among laypersons who intervene during SCA are relatively low, due to a sense of altruism and reported psychological “resilience."

By Mary Newman, MS, President and CEO, Sudden Cardiac Arrest Foundation, in consultation with Allan Braslow, PhD, Sudden Cardiac Arrest Foundation Advisor, both co-authors of the DOT National Standard Curriculum on Bystander Care

For information on related SCAF research, click here.

For research article on prearrival care, click here.

For more information, search website for "Bystander intervention."