ROCHESTER, Minn. — People who hesitate to provide CPR on a stranger out of worry they are at risk of legal liability, it turns out, have it all backwards. In the presence of a person suffering a heart attack, the only claim for liability is against those who fail to act.

That's the finding of new research to be presented at the American Heart Association Resuscitation Science Symposium this weekend in Philadelphia.

"The basic concerns people seem to have are causing harm to a person, breaking ribs, 'what if it doesn't work,' or if someone will accuse them of doing it incorrectly," says Dr. Travis Murphy of the reasons why people might pause in coming to the aid of a stranger. Murphy, an emergency medicine physician at the University of Florida in Gainesville, has sorted the prevalence of these worries by age. "Kids and particularly elderly people are afraid of causing trauma, or of being blamed if there's a bad outcome," he says. "What we found in this research is that worry hasn't been borne out."

For their AHA poster presentation Murphy and his coauthors scoured 30 years worth of the national legal database Thomson Reuters Westlaw in search of wrongful death and personal injury cases stemming from CPR-related harm or negligence. Of 170 cases involving either delays or consequences of the chest compressions, 167, or almost all of them, stemmed from failure to provide CPR.

"A lot of them were at a swimming pool or fitness center or some kind of gathering place where someone had expected the staff to do something," he said of the negligence cases. "There were a couple which the negligence happened in public, but the people named were the owners of the property, not the individual."

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They identified just three cases alleged battery in the course of CPR. All were directed towards medically-trained personnel, and only one resulted in an award in favor of the plaintiff, a ruling for $121,250 after trained personnel began compressions on a patient with Do Not Resuscitate order. The conclusion: "No lay person has ever been successfully litigated for providing CPR in the United States."

As for the 167 cases of failure to provide CPR, the courts have returned rulings of over $620 million for plaintiffs.

The commonplace reticence to help others in distress identified in research is especially striking considering that all 50 states now carry Good Samaritan laws protecting persons from liability in the course of providing emergency assistance. Minnesota is one of just three states that have so-called Duty to Act statutes building on that protection in requiring trained personnel to provide CPR.

'The American Heart Association and Red Cross provide free events to learn CPR," Murphy says. "We encourage people to get educated or refresh their skills on how to provide CPR ... In situations like this, every second counts."

The study comes on the heels of another study this week reporting that cases of opioid-related cardiac arrest are emerging as a unique cause for CPR, one with its own clinical profile, an 80% higher likelihood of survival, occurring especially often in public places.

"Getting in there, getting involved, it's an intense thing," Murphy says of CPR. "But for the person doing the compressions, they always say just focus on that, don't focus on anything else. Just focus on pushing a hundred a minute."