Kerry Fraser, Resuscitationand Simulation Specialist at Unity Health, with CPR manikins that have been outfitted with breasts and bras for training.

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Studies have shown that when cardiac arrest occurs outside the home, men are more likely than women to receive cardiopulmonary resuscitation (CPR) from a bystander—and are more likely to survive.

After coming across this research, for Unity Health Toronto’s Simulation Program, it wasn’t a complete surprise.

CPR is the program’s most frequently taught training, but in most CPR classes, people are only ever exposed to male-appearing manikins. A Canadian research study has also suggested breast tissue is a perceived barrier to providing quality CPR.

“As health care workers, for years we have not been trained to do CPR on people with breasts and that is unacceptable,” says Lindsay Beavers, Manager of the Simulation Program at Unity Health. “We need to be the change.”

Unity Health’s Simulation Program hosts more than 5,000 interprofessional health profession learners, hospital administrators and support staff every year. The program supports hospital teams with creating realistic learning environments to practice various skills. Simulation activities use different types of manikins to support training in CPR, intubation, defibrillation, etc., for resuscitation.

With a desire to be more inclusive and representative in their training of clinical teams, the simulation team set out to outfit some of their CPR training manikins with breasts, as they previously only had male-representing manikins.

When Kerry Fraser, Resuscitation and Simulation Specialist, and her colleagues began to reach out to vendors, they discovered the option to add breasts to their manikins either wasn’t available or it came at a significantly high cost.

Fraser says they had to think creatively. Through brainstorming, the team looked for inspiration and learnings from the transgender community and began doing market research for a prosthetic. They needed an option that was cost effective, durable enough to stand up to the rigor of compressions, yet thin enough to ensure that all of the mechanical sensors on the manikins would still give accurate readings so the training quality wasn’t compromised.

“Through research and trials to ensure we could do proper colour matching to our manikins’ skin tones, we were able to find a much cheaper alternative – a breast prosthesis similar to a sleeve – and we updated half of our fleet of manikins,” Fraser says. “The response has been overwhelming.”

Fraser has been conducting research to look at the program’s CPR training evaluation forms before and after implementing breasts on the manikins. Without changing the evaluation forms, Fraser says there is a notable difference in the feedback post-implementation where staff are remarking positively to the ability to train on manikins with breasts and the improved representation.

The improved representation has also opened the door to helpful teaching conversations with clinical teams around CPR techniques – like attaching the pad from a defibrillator or hand placement for compressions, known as land marking – on people with breasts.

The team has also taken the step to add bras to the manikins. This is to address the discomfort in removing a bra to provide CPR, which has also been identified in some research as a barrier that contributes to people with breasts being less likely to have CPR performed on them in the community.

“If I went into cardiac arrest, I would want someone to perform compressions on me and not feel like, ‘What do I do with the bra?’ And call someone else to take care of it,” Fraser says.

“So we often tell people in training to sit in the discomfort, which usually comes from simply not being exposed to it. Walking our clinicians through that and seeing those shifts and ‘aha’ moments in class, I think is going to be practice changing and we can hopefully then see that reflected in the community as well.”

Beavers notes that the team’s ingenuity has led to other hospital simulation programs in the city reaching out for advice on updating their manikins and has inspired the Simulation Program to take on other projects to develop in-house solutions that support greater inclusivity and diversity.

By Danielle Pereira. Photo by Yuri Markarov.

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