Every year, emergency medical services receive 36 million calls for Americans suffering health crises, from injuries to heart attacks. Despite the fact that 185,000 medical emergencies occurred in public — and that's not even including traffic accidents — the majority of victims received no aid at all while they waited for EMS to arrive.
"It’s taken me a while to digest this because it’s been so surprising," Erin York Cornwell, the lead author of a new study on the subject and an assistant professor of sociology at Cornell University, told The Huffington Post. "It's incredibly striking and upsetting to see."
According to Cornwell's study, published this month in the American Journal of Public Health, only 2.5 percent of people facing a medical emergency in public received help from strangers. For one minority group, the outlook is even gloomier: Just 1.8 percent of black people received emergency aid from bystanders.
The study relied on data from nearly 22,500 patients in the 2011 National Emergency Medical Services Information System who suffered non-transportation-related medical emergencies on public streets and sidewalks.
In the context of the study, amateur emergency aid could be something as simple as waiting with an injured victim while an ambulance is on its way, offering a jacket to a person suffering from hypothermia, or diverting traffic to stop oncoming cars from hitting someone who is lying in the road.
In other words, amateur emergency care doesn't require specialized training -- just a basic ability to recognize an emergency and lend a hand before specialists arrive.
Previous research on the topic has largely studied bystander response rates related specifically to cardiac arrest and CPR. According to a study published in the New England Journal of Medicine in 2012, 29 percent of people who went into cardiac arrest outside of a hospital received CPR from bystanders. Similarly, the new AJPH study found that 23 percent of people having cardiac arrest received bystander support.
Since CPR requires intimate contact with the victim, as well some degree of training, the researchers expected the response rates for more mundane emergencies to be higher. Instead, it was lower. Much lower.
Part of this disparity could be because of the so-called bystander effect, when individuals avoid intervening in an emergency because there are other people around. A 2011 analysis published in the journal Psychological Bulletin found that people are more likely to overcome the collective apathy of the bystander effect when they perceive the emergency to be dangerous or physical (a category in which we imagine cardiac arrest would fall).
If you're black, it's unlikely that a stranger will help you in an emergency
"It’s kind of puzzling and shocking that [the number of non-cardiac arrest bystander respondents] is so low," Cornwell said. And while there's some room in the new research for error -- it's possible that bystanders weren't present in some emergency situations, or that emergency medical professionals didn't record cases of strangers who sat with victims but didn't actively administer care -- that doesn't fully explain the exceedingly low response rates.
"The more dismal view is that this is sort of apathy, lack of wanting to connect with people," Cornwell said. "The other really key piece is the disparity. Even seeing these very, very low rates, the rates are even lower for African-American patients," she said, noting that black patients were less than half as likely as whites to be helped.
“There exists a stereotype that a black person may represent a greater threat,” Rachael Sharman, a psychology researcher at the University of the Sunshine Coast in Queensland, Australia, who wasn't involved in the study, told Reuters.
Because bystanders may decided whether or not to jump in during an emergency based on their own perceived safety, Sharman says increasing bystander response rates is a particularly difficult problem to solve.
Sadly, all this tracks with what we already know about the health disparities that black Americans face, namely that such disparities permeate almost every measurable metric of health from heart attack and stroke risk to HIV infection rates to increased infant mortality.
A study published in the Proceedings of the National Academy of Sciences in March found that those disparities aren't limited to worse health outcomes -- black patients face bias at the hands of doctors in training from the moment they enter the health care system. The study reported that 50 percent of white medical students and residents believed false facts about biological differences between white and black patients. In one of the most egregious examples, a full 40 percent of first-year white medical students and one in four white residents believed that black patients have thicker skin than white patients.
Turning the tide on bystander help
From a personal responsibility angle, there are some simple preparation measures you can take to be prepared in case of an emergency. These include making sure EMS professionals don't have to wait for an elevator if you work in an office building, learning the Heimlich maneuver, and making sure your school or office has a defibrillator on site.
In Cornwell's mind, however, part of the equation is a failure of education.
"How much education is still going on in schools about basic forms of first aid and basic helping?" she asked. As it turns out, 29 states have laws or requirements on the books to make CPR instruction a condition for high school graduation in coming years, according to the American Heart Association.
Beyond CPR, having a frame of reference for how to think about providing aid in an emergency could be one way to build our collective response knowledge and help make strangers more comfortable helping out in emergency situations. (Teaching students to ask themselves questions like "What do I look for?" and "What could I do?" could be a good start.)
Of course, that assumes the low level of bystander response is a lack of training issue, rather than an apathy or racism issue. For now, Cornwell hopes the new study will spark a conversation about race.
"I think it comes back to the community side," she said. "How do we reduce implicit bias that makes us interact differently with people from different backgrounds?
"I’m hoping that this will emphasize the need to think more about the ways that African Americans are treated in our communities."