A Relatability Thought Experiment

Exploring the "How, What, and Why" of CPR Instruction and pitching ideas to increase action among members of the public.

A Relatability Thought Experiment
April 2018 Panoramic shot of a VFB Stuttgart Bundesliga match I attended with my Dad. They beat Werder Bremen and stayed in the league that year!

If you haven't already been primed by last week's introduction to Self-Determination Theory (SDT), I really encourage you to give it a quick read.

To try and summarize the relevant parts of SDT for this post:

  1. Intrinsic motivation is powerful, intrinsic motivated actions have better outcomes and fewer negatives vs. purely extrinsic motivators
  2. There are ways to bring about identity/integration of a person with extrinsic motivators that can cause benefits/outcomes to be similar to intrinsic motivators.
  3. This can happen when someone understands the worth of an action (autonomy), has the competency to complete the action (competency), and understands or experiences a connectedness to the action's goal (relatedness).

It's a broad over-simplification, but it'll do in a pinch!

How, What, and Why of CPR Training

I want to focus this week on that last one, relatedness, and instead of summarizing the works of others I'd like to approach this as a thought experiment and offer some of my own thoughts on the topic as well.

Autonomy, Competency, and Relatedness share some similarities with CPR instruction to the public. We're trying to convey how important it is to follow these instructions in order to save a life. In my head, they match up this way.

  • Autonomy : What - CPR is a person's best chance at life in a sudden cardiac arrest, which requires all these elements of the chain of survival for the best outcome, so this is what you are to do.
  • Competency : How - These are the signs of a cardiac arrest, this is how good quality chest compressions take place, this is how you deliver breaths (if applicable), this is how easy it is to use an AED.
  • Relatedness : Why - It's good to save a life

That last point is intentionally weak and may cause you to argue I confused it with Autonomy. The two do share some similarities, but are fundamentally different in that Autonomy is the ability to voluntarily chose to do an act because you understand its importance, whereas Relatedness is influenced by how you see yourself related to an action.

If it seems confusing, think of it this way. You're likely more motivated to save the life of a family member you witness go into sudden cardiac arrest than a stranger at a sporting event. All other things equal, you may still opt to step in and help that stranger, but the ties between you and your family, friends, coworkers, congregation, or group will have a multiplication factor on your decision to act, and you will likely have a greater intrinsic reward from saving your family member than you would ever have saving that stranger.

Why the Why Matters

In my experience, during CPR instruction, a sales pitch of "why" we need to do CPR usually goes as follows:

If you see someone suffer a sudden cardiac arrest, you must act to save their life

We take for granted that someone will want to do this, and spent much of the remaining training on helping them internalize the chain of survival with how to perform the various skills. Maybe we show a video with someone exercising and suffering a cardiac arrest, or in a workplace/warehouse and falling over. Sure, we may have a diverse cast in the video, but it isn't necessarily someone the audience relates to.

Then we see reports about low bystander CPR rates among minority communities.[1] Maybe we increase bystander rates among that workplace, or that particular organization, but if we want to increase interventions among public or lay rescuers, we need to keep strengthening that "why" component.

Nathan's Thought Experiment

First, in CPR training, what if we changed our initial sales pitch from selling action to selling vulnerability. The pitch should go, "Cardiac Arrest can impact people of all ages, races, genders, both in and out of the home and workplace. If you suffer a cardiac arrest, in order to save your life, someone will have to perform CPR on you and defibrillate your heart as soon as possible."

Maybe, by changing this language, we can better increase that connection from rescuer to rescuee. One changed sentence won't immediately build a connection, but it'll help. Putting a personal spin on it may train empathy, vs the usual loss of empathy that takes place with medical training.[2]

Maybe we can also "tease" CPR more. Now, I know there are some who believe telling people to learn CPR must include a course in hands only CPR at a minimum. Then they get trapped in the "what if" loop of trying to figure out how they're going to be sued for omitting information on how bystanders should treat the soaking wet patient laying against a metal guardrail in an active domestic violence situation.

I wonder, though, what the impact would be with 10-15 second PSAs or print ads in multiple languages, integrated into sporting events, church bulletin space, etc. Imagine a "we're one team" scoreboard broadcast before kickoff that communicates the importance of bystander aid if something seems wrong. Make one mascot rescue the opposing team's mascot.

It's easy to intervene when it's someone on your "team." I think, to truly increase survivability, we have work to do to increase people's understanding of how teams can't play if there is no league in which to compete.

  1. https://www.cnn.com/2022/10/27/health/cpr-racial-disparity-study-nejm/index.html ↩︎

  2. https://www.psychologytoday.com/us/blog/the-couch/201810/can-empathy-be-taught ↩︎