For CPR Awareness Month, the Department of Family Medicine and Community Health is spotlighting research on bystander intervention and sudden cardiac arrest. Maddie Morrison, a senior cultural anthropology major at Duke University, is exploring how everyday people understand and perform CPR — and what holds them back from acting in emergencies.
During a bike ride last July, Morrison’s father collapsed in a park in Portland, Maine. Two bystanders immediately stepped in, performed CPR, and called 911. After emergency responders shocked him four times with an AED, he was transported to the hospital, where he received a life-saving stent.
After learning how rare survival from sudden cardiac arrest can be, Morrison wanted to understand how these outcomes could be improved. In this student spotlight, Morrison reflects on her family’s experience, her research, and why she believes more people should feel empowered to step in to help.
Q: What led you to study CPR from an anthropological perspective?
A: As I started reading public health literature, I noticed that most CPR education focuses heavily on teaching the skill itself. Yet in order for my father to survive, the people around him didn't just need to know how to perform CPR, they needed to choose to act. They had to recognize an emergency, feel a sense of responsibility toward a stranger, and override a lot of social instincts that might have told them to wait for someone more qualified.
The gap between knowing a skill and using it in an emergency felt deeply cultural to me. Bystander CPR is a physically transgressive act. It involves sustained, forceful contact with someone’s body, and 25% of the time, it occurs in a public space where no one has formally assigned you authority. Questions about who feels empowered to act, whose body we instinctively move toward, when we unconsciously assume someone else will help, are all questions that those in the field of anthropology are uniquely equipped to ask. I wanted to understand the social and cultural forces that shape whether someone intervenes, not just whether they technically could.
Q: How did faculty mentorship shape your work?
A: Working with Audrey Blewer, PhD, MPH, an associate professor in Family Medicine and Community Health, was especially valuable because she investigates many of the same health inequities I wanted to understand culturally. While my thesis focused on the social and cultural dimensions of bystander CPR, her work provided a public health and epidemiological perspective on those same inequities, allowing me to situate my anthropological analysis within a broader conversation about improving outcomes.
She pushed me to make sure the cultural arguments I was developing were in conversation with the public health evidence and helped me think critically about CPR education itself. It moved me toward examining how knowledge, confidence, and intervention are interconnected. Dr. Blewer also looped me into broader CPR education efforts at the Duke School of Medicine, including allowing me to volunteer during Duke’s statewide attempt to break the world record for the most people trained in hands-only CPR in one day as part of the Randomized Cluster Evaluation of Cardiac Arrest Systems (RACE CARS) trial. This helped me think about how CPR education functions across different communities.
Q: CPR Awareness Month focuses on empowering bystanders. What did your research reveal about why people hesitate to perform CPR?
A: There are well-documented barriers, including a lack of training, fear of causing harm, and uncertainty about liability. I researched some of the cultural barriers that may be harder to see but are just as consequential. Training and instructional materials often depict the "default patient,” a white, lean, flat-chested person in need of rescue. This quietly narrows who bystanders instinctively recognize as a victim and the way they practice the embodied skill. Dr. Blewer's work revealed that women are significantly less likely to receive bystander CPR in public. Discomfort with chest contact, particularly in a training environment where the default patient is often imagined as male, may be one part of that story.
Q: What surprised you most in your research?
A: CPR is technically, physically, and emotionally demanding. You're pressing hard into someone's chest with no formal authority and no guarantee of success. This is an act that would traditionally be viewed as violent but is reframed as care during an emergency. I began interpreting it anthropologically as a "moral inversion." What surprised me was how much that tension lives on in the embodied act even after formal training. That discomfort doesn't disappear just because someone knows the steps. People hold deeply to the fear of inappropriate touching or hurting someone.
I was also struck by the history and aesthetic image of the imagined patient. My research found that CPR training materials have historically portrayed a very narrow picture of who needs rescuing, and that image correlates with bystander recognition in real emergencies. When the person in front of you doesn't match the body you practiced on, or the face in the campaign poster, uncertainty can enter in a moment when there's no time for uncertainty.
Q: What do you want others to take away from your experience?
A: While my father survived because of the actions of strangers, most cardiac arrests occur at home, meaning the person who may need CPR is often someone you know and love. I hope people walk away believing that they are already the right person to learn the skill of CPR and they feel empowered to act. Not when they have more time for a full certification, not once they feel more confident, but right now. The decision to take the time to brush up your skills, and act in the moment is available to all of us. Learning the skill of CPR is far simpler than most people realize.
I also hope my story makes the stakes feel real. Survival statistics can be abstract. But when I tell you that my dad came home, even though every statistic said he shouldn’t, I want that to resonate. CPR is the best skill you can have that you hope you never have to use. The best time to learn is before you need it.
Q: Looking ahead, how do you see this research influencing your path as a future physician?
A: This project taught me that clinical care and health outcomes are always embedded in culture. The type of care a patient receives, who receives it, and who feels empowered to seek it, are all shaped by forces that exist well outside the exam room. As a future physician, I want to bring this awareness into my practice. I want to ask not just what is medically indicated, but what systemic and social forces might be shaping the health outcomes in front of me.
I want to advocate for training and public health infrastructure that reaches all communities. And I want to be the kind of doctor who understands that healing happens in a social context. Medicine and culture are not separate domains, but deeply intertwined ones.
Q: Where should someone start if they want to learn CPR?
A: Hands-Only CPR requires no medical background and can be learned and practiced in minutes through free online resources or by using household materials. You can easily access educational infographics and short instructional videos from the American Heart Association or American Red Cross on social media. Remember two basic steps: call 911 and push hard and fast in the center of the chest to the beat of a familiar song like "Stayin' Alive.” Use an AED if available.