Distrust of law enforcement, language barriers, lack of information about cardiac arrest and financial concerns are the major barriers keeping the poor, Latinos and other minorities from calling 911 for help, according to a new study.

Using focus groups and interviews, investigators explored why people in five low-income Latino neighborhoods in Denver, Colorado, called – or didn’t call – 911. The conclusions, published in the Annals of Emergency Medicine, is crucial information because previous research shows people who live in neighborhoods that are primarily Latino, African-American or poor are two to three times more likely to have cardiac arrest outside of a hospital, and when they do, are 30 percent less likely to receive bystander cardio-pulmonary resuscitation. That cuts their chances of survival.

“Time is essentially brain,” said Dr. Comilla Sasson, an emergency department physician and lead author of the study published last month. “The longer you don’t have oxygen supply to your brain, the less you have a chance to survive.”

Sasson has worked in emergency rooms in Atlanta, Ann Arbor, Chicago and, now Denver at the University of Colorado School of Medicine, where she has seen the same pattern. “Time and time, again I’d have African-Americans and Latinos, who came In with cardiac arrest, and their families wouldn’t do CPR or wouldn’t call 911 or, worse, they would wait until a family member came to pick them up.”

The report, based on six focus groups and nine interviews, with a total of 64 participants identified seven cultural barriers that get in the way of bystanders willingness to perform CPR: age, sex, immigration status, language, racism, strangers and fear of touching someone.

“It wasn’t that they weren’t performing it because they didn’t want to,” said Sasson, who is the national director of Community Markets and Programs for the American Heart Association’s Emergency Cardiovascular Care program. “It’s eye-opening. I do a lot of community-based work working with Latinos and African-Americans. I had never thought that people in our own community would fear calling 911 because they were unsure if police and paramedics would want to help them.”

Multiple study participants said they were concerned about police first-responders asking for documentation and identification before the victim would be assisted. Participants also generally bundled 911 services into their general distrust of law enforcement and said they didn’t want to call 911 for others because they were afraid to get involved, especially if illegal activities were occurring in the neighborhood or within their own house.

“I think in order to avoid getting involved with problems with the law, or any other things,” one study participant said, in explaining hesitancy to call for emergency help. “I think that it’s one of the first fear(s) one can have. If I get involved, they’ll think I did something to them.”

“If they had to give their name and would they be afraid that they would check; you know, we do have a lot of undocumented people who live in our neighborhood who are around here that are afraid, you know,” another participant said. “The law enforcement is not positive.”

As suggested solutions, participants suggested increasing the availability of tailored education in Spanish, increasing the number of bilingual 911 dispatchers, and several policy-level changes, including CPR as a requirement for graduation and strengthening Good Samaritan laws, which offer legal protection to people who give reasonable assistance.

The AHA already has several resources to help dispel some of the concerns. A series of five YouTube videos, entitled “CPR Myth,” are about the perceptions and barriers of calling 911. They are currently being translated into Spanish. “It helps tell the story that people can’t get in trouble if you are doing the right thing,” she said.

It also has a Spanish-language website at heart.org/cpr with training materials and a 60-second video that people can watch to learn how to do hands-only CPR.

In addition, there is Hands-Only CPR Program (www.heart.org/handsprogram), AHA’s national program that targets the highest risk neighborhoods in the country and works with community partners to culturally tailor programs, messaging and education about CPR. The first phase, based on what health workers learned from this recent study, was in Denver. The second phase was just completed in Chicago; Columbus, Ohio; and Tampa, Florida. Organizers are researching the next sites.

Language barriers, for example, can add delays of up to 10 minutes to a 911 call, and every minute without CPR decreases survival by 10 percent. So, outreach workers are encouraging callers to begin by saying “heart stopped and Spanish interpreter,” so dispatchers know right away it is a medical emergency and they need language help.

“We are getting to the bottom of what’s happening, and it’s exciting that we are working to fix it,” Sasson said. “As a medical community, we often talk about health disparities. It’s about time we are getting out there and fixing them.”