Why People with Breasts Are Less Likely to Receive CPR and How Better Training Can Help
Updated: Sep 12
When somebody collapses in cardiac arrest, their chance of survival can depend on whether the people around them recognise what has happened, call 999, begin cardiopulmonary resuscitation and use an automated external defibrillator as soon as one becomes available. Under Resuscitation Council UK’s 2025 sequence, 999 should be called as soon as a person is found unresponsive, before the rescuer assesses breathing while waiting for the call to be answered. None of those actions should depend on the shape of the casualty’s chest. Yet research has repeatedly found a disparity in the treatment received by people recorded as female in cardiac-arrest studies, particularly when the collapse happens in public.
The language needs care because sex, gender and anatomy are related but they are not interchangeable. Not every person with breasts has the same identity, and not every person placed in the same research category has the same anatomy. This article therefore uses the term people with breasts when discussing practical matters such as chest compressions, clothing, exposure and defibrillator-pad placement. Where research has divided its data by recorded sex, that limitation is acknowledged rather than turned into an assumption about every individual.
The central message is reassuringly straightforward. CPR on a person with breasts is still CPR. The correct compression position remains the centre of the chest, on the lower half of the breastbone, and an AED should be used promptly with its pads attached to bare skin in the positions illustrated on the device. The difficulty is not a different resuscitation technique. It is the hesitation that can arise when training has never allowed a learner to encounter realistic anatomy, clothing or the need to expose part of another person’s chest in order to save their life.
What the Research Actually Shows
Research into out-of-hospital cardiac arrest does not produce one universal percentage that applies to every country, setting and population. Studies vary in how cardiac arrests are witnessed, recorded and adjusted for factors such as location, age, initial rhythm and the relationship between the casualty and the bystander. The responsible conclusion is therefore not that every person with breasts is a fixed percentage less likely to receive CPR. It is that a persistent disparity has appeared across a substantial body of evidence and deserves a practical response.
A 2024 study of 4,491 bystander-witnessed cardiac arrests in New South Wales found that people recorded as female were less likely to receive bystander CPR in both homes and public places. The difference was greater in public, and reduced recognition of cardiac arrest explained part of that public disparity. This matters because a rescuer cannot begin the correct response until they recognise that the person is in cardiac arrest rather than fainting, sleeping, intoxicated or experiencing a less urgent problem.
A systematic review and meta-analysis published in 2025 found considerable variation between studies, which means the findings require cautious interpretation. Even with that uncertainty, the review found moderate-certainty evidence of a lower probability of bystander AED-pad application among people recorded as female. A separate global scoping review identified a recurring set of possible barriers, including reluctance to expose or touch the chest, fear of causing injury, concern about accusations of inappropriate contact, cultural expectations and mistaken assumptions about who is likely to experience cardiac arrest.
These studies cannot tell us that breasts alone cause the disparity. Cardiac-arrest location, recognition, access to an AED, social expectations and differences elsewhere in the chain of survival may all contribute. They do, however, give training providers a clear reason to examine whether conventional teaching prepares learners for the bodies they may actually encounter.
The Problem May Begin Before the Emergency
For decades, the familiar CPR manikin has usually been a smooth, flat-chested adult torso. It is a practical teaching tool, but repeated exposure to only one body shape can quietly establish that shape as the expected emergency. The learner becomes familiar with a bare, unobstructed breastbone and clearly illustrated pad positions, often without clothing, breast tissue, jewellery or the social discomfort of touching a stranger.
Real cardiac arrest rarely arrives in that tidy form. A person may be wearing several layers, a uniform, sports clothing, a dress, religious clothing or a bra. Their breasts may move naturally towards the sides of the chest when they lie flat, or their size and position may make one of the AED-pad locations less immediately obvious. The person may have scars, implants, body jewellery or other features the rescuer has never encountered in training. None of these details changes the need for urgent action, but unfamiliarity can turn a simple decision into a moment of hesitation.
Research published in Health Promotion International in 2024 examined adult CPR manikins available from nine manufacturers. Of the 20 manikins included, most were flat-chested and only one had a breast overlay available. The study did not prove that changing manikins will automatically change real-world survival. It did expose how narrow the representation in resuscitation training has been and argued that greater diversity should be treated as an equity issue rather than a cosmetic extra.
That distinction is important. A manikin with breasts is not needed because the mechanics of chest compressions are different. It is needed because competence includes being able to apply the same lifesaving principles to a body that does not resemble the traditional training torso. Representative equipment allows questions to surface in a safe classroom, where they can be answered calmly, instead of appearing for the first time beside a person in cardiac arrest.
CPR Technique Does Not Change Because a Person Has Breasts
If a person is unresponsive, call 999 immediately and assess their breathing while waiting for the call to be answered. If they are not breathing normally, assume cardiac arrest and begin CPR. Occasional gasps, slow irregular breaths or noisy agonal breathing are not normal breathing. The ambulance call handler can help with recognition and provide instructions while help and an AED are being arranged.
For adult chest compressions, place the heel of one hand in the centre of the chest, on the lower half of the breastbone, place the other hand on top and interlock the fingers. Keep the arms straight and compress the chest at the depth and rate taught in current adult basic life support guidance, allowing the chest to recoil fully after each compression. Breast tissue may need to be allowed to fall naturally to the side or moved sufficiently to identify the centre of the chest, but the compression point remains on the breastbone rather than on breast tissue.
The practical priority is to start. A bystander should not delay compressions while trying to make the scene look dignified or perfectly organised. Dignity still matters, but it is protected alongside treatment. If other people are present, one can call 999 and retrieve the AED while another begins CPR. A coat, blanket or willing bystander can help screen the person from unnecessary public view, provided that this does not obstruct care or introduce delay.
Using an AED on a Person with Breasts
The Resuscitation Council UK 2025 adult basic life support guidance tells rescuers to use an AED as soon as it is available, follow its prompts and attach the pads to the person’s bare chest according to the positions shown on the AED or its pads. Usually, one pad is placed on the upper right side of the chest and the other on the left side of the chest below the armpit. The pictures supplied with the particular device should guide the rescuer.
The adhesive surface must make full contact with bare skin. A pad must not be placed over breast tissue, clothing or a bra. For the side pad, breast tissue may need to be lifted or moved so that the pad can be applied against the chest wall in the illustrated position. Once the pad is attached, follow the AED’s spoken and visual instructions.
Current UK guidance is deliberately practical about bras. If correct pad placement and contact with bare skin can be achieved quickly without removing the bra, it may remain in place. If it prevents the rescuer from finding the correct position, obstructs the pad, or slows the application of the AED, it should be removed. Rescuers should not allow concern about exposing the chest to delay a lifesaving intervention.
If more than one rescuer is present, CPR should continue while the pads are prepared and attached. Nobody should touch the casualty while the AED is analysing the rhythm or delivering a shock, and chest compressions should restart immediately when the device instructs the rescuers to continue. An AED will not shock simply because its pads have been attached. It analyses the heart rhythm and only advises or delivers a shock when an appropriate shockable rhythm is detected.
Why Hesitation Is Understandable, but Must Be Addressed
It is easy to tell people that embarrassment should not matter in an emergency. That statement is true, but by itself it is not very useful. A first aid course should create room for the learner to examine why they might hesitate and then give them enough realistic practice to replace uncertainty with a plan.
Some learners worry that moving clothing or touching a stranger’s chest could be misunderstood. Others fear causing injury, particularly when the casualty looks older, frail or physically different from the manikin they used years ago. A public emergency may also attract onlookers and mobile phones, making the rescuer feel watched at the very moment they must act decisively. These concerns should never outweigh the need to attempt resuscitation, but pretending they do not exist leaves the barrier intact.
Good training deals with the issue directly. The instructor explains why chest access may be necessary, demonstrates how to preserve dignity without delaying treatment and allows learners to practise the actions themselves. The language should remain clinical, respectful and unambiguous. The purpose of moving clothing or breast tissue is to locate the correct compression or pad position and provide emergency care. Once that purpose has been discussed and rehearsed, the action becomes less socially unfamiliar and more recognisably part of resuscitation.
How Representative Manikins Improve the Conversation
At DTMK Training Services, we deliberately use a varied collection of CPR manikins rather than treating one flat-chested torso as a complete representation of the public. Our equipment includes adult, child and infant Laerdal QCPR manikins in different skin tones, Practi-Man Advance models fitted with the manufacturer’s female chest skins, and Simulaids manikins representing older and bariatric casualties. They are complemented by fully updateable Laerdal training AEDs and several other AED trainer models.
The reasoning behind that investment is explored in our feature on why DTMK chose realistic and inclusive CPR manikins. The equipment does not make the course inclusive by itself. Its value comes from how it is used: learners practise compressions, ventilations, clothing management and AED-pad placement while an instructor can challenge assumptions, answer awkward questions and reinforce the same clinical priorities across different bodies.
Readers who want to see the wider collection can also meet the CPR manikins used at DTMK. The point is not to turn equipment into a showroom. It is to make realistic differences ordinary enough that they do not become obstacles during a real emergency.
Real World Examples
A Collapse in a Milton Keynes Shopping Area
A person collapses near a busy entrance and does not respond. Their breathing is irregular and gasping. Several members of the public stop, but nobody initially kneels beside them because the situation is mistaken for a faint and people are uncomfortable about touching their chest. One bystander calls 999, follows the call handler’s instructions and begins compressions while another retrieves an AED. The person’s coat and top are opened only as much as necessary, and another bystander holds up a coat to reduce public exposure without obstructing CPR.
The important change is not a specialist technique. It is recognition followed by purposeful action. Training has given the rescuers permission to treat abnormal gasping as a warning sign, to expose the chest when required and to protect dignity without sacrificing speed.
An AED in a Workplace
A colleague is found unresponsive in a staff area. CPR begins while the workplace AED is brought to the scene. The casualty is wearing a bra, but the illustrated pad positions can be reached quickly and both pads can make complete contact with bare skin without removing it. The rescuers attach the pads, follow the prompts and continue compressions while the pads are being applied.
In a different body shape or garment, the bra might obstruct a pad position and need to be removed. The correct decision is the one that achieves rapid, accurate placement and complete skin contact. Training should prepare learners to assess that reality rather than remember a rigid rule detached from the person in front of them.
A Cardiac Arrest at Home
A family member becomes unresponsive in a bedroom. Because the collapse is private and the casualty is known to the rescuer, some of the social barriers associated with a public event may be reduced, but recognition can still be delayed if the breathing is mistaken for snoring. The rescuer calls 999, switches the phone to loudspeaker and begins CPR as directed. When a neighbour arrives with a nearby AED, clothing is moved and the pads are applied according to the diagrams.
This scenario shows why the issue cannot be reduced to embarrassment alone. Recognition, access to equipment, confidence and the circumstances of the collapse all influence the response.
Why This Matters in Milton Keynes
Cardiac arrest can happen in a home, workplace, school, sports facility, place of worship or public space anywhere across Milton Keynes and the surrounding counties. An AED may be available nearby, but the device can only help if somebody recognises the emergency, retrieves it and feels able to attach its pads correctly.
The people using our workplaces, shopping areas, leisure venues, community organisations and neighbourhoods do not share one age, body shape, skin tone or anatomy. First aid training should reflect that ordinary diversity because the first person to respond may be a colleague, relative, volunteer, coach or stranger.
For members of the public and community organisations, DTMK’s Basic Life Support, AED and Anaphylaxis course for all ages provides practical experience with CPR and defibrillation. Employers can explore the regulated Emergency First Aid at Work course or the more comprehensive First Aid at Work qualification, depending on the findings of their workplace first aid needs assessment.
Frequently Asked Questions
Is CPR Performed Differently on a Person with Breasts?
No. Adult chest compressions are still delivered in the centre of the chest, on the lower half of the breastbone, using the rate and depth in current adult basic life support guidance. Breast tissue may need to move naturally aside or be moved sufficiently to locate the breastbone, but the underlying technique does not change.
Do I Have to Remove a Bra Before Using an AED?
Not automatically. Resuscitation Council UK guidance says correct pad placement and contact with bare skin are the priorities. If these can be achieved quickly without removing the bra, it may remain in place. If the bra obstructs either pad position, prevents full adhesive contact or causes delay, remove it and attach the pads as shown on the AED.
Can an AED Pad Be Placed on a Breast?
The pad should be attached to bare chest wall in the position illustrated on the device, not laid over breast tissue. The side pad may require breast tissue to be lifted or moved so the adhesive can contact the chest wall below the armpit. Follow the diagrams and spoken prompts supplied with the AED.
What If I Am Worried About Exposing the Person?
Expose only what is necessary to provide effective care, ask bystanders for help and use a coat or blanket as a screen if this can be done without delay. The person’s immediate need for CPR and defibrillation takes priority. Protecting dignity means limiting unnecessary exposure while care continues, not withholding the care itself.
Could I Hurt Someone by Starting CPR?
Chest compressions can cause injury, but a person in cardiac arrest urgently needs blood flow to the brain and heart. Resuscitation Council UK advises laypeople to start CPR for presumed cardiac arrest without being deterred by concern about harm. If the person is unresponsive, call 999 immediately and assess their breathing while waiting for the call to be answered. If they are not breathing normally, begin CPR and follow the call handler’s instructions.
Why Does the Type of Training Manikin Matter If the Technique Is the Same?
The technique is the same, but the learner’s confidence may not be. Practising only on a flat, unclothed torso cannot reproduce every real emergency. Varied manikins allow learners to encounter breast anatomy, different body sizes, varied skin tones and realistic clothing in a controlled setting, so those features are less likely to cause surprise or hesitation later.
Summary
Research continues to identify disparities in bystander CPR and AED use among people placed in female categories within cardiac-arrest data, although the size and causes of those disparities vary between studies. Anatomy is only one part of a complicated picture that also includes recognition, location, social expectations, fear, training and access to defibrillation.
For a first aider, the practical message is much simpler. Call 999 immediately for any unresponsive person and assess breathing while waiting for the call to be answered. If breathing is absent or abnormal, begin CPR and use an AED as soon as possible. Breasts do not change the correct hand position for chest compressions. AED pads must be attached to bare skin in the illustrated positions, with breast tissue or clothing moved as necessary to achieve correct placement and complete contact.
Training cannot remove every pressure from a real cardiac arrest, but it can prevent realistic anatomy from being an unfamiliar complication. By discussing these concerns openly and practising on representative manikins, learners can develop the confidence to act with urgency, competence and respect.
First Aid Training in Milton Keynes with DTMK Training Services
DTMK Training Services provides practical first aid training from our centre in Bletchley, Milton Keynes, including regulated workplace qualifications and courses for clinical, community and specialist settings. Our approach combines current guidance, realistic scenarios, objective QCPR feedback and a deliberately varied range of training manikins.
You can view and book forthcoming first aid courses in Milton Keynes, or contact DTMK to discuss private training for a workplace, community group or organisation. The aim is not simply to remember the sequence in a classroom. It is to leave able to recognise cardiac arrest, begin effective CPR and use an AED on the person who actually needs help.
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