What happened
During a practical assessment, a delegate refused to attempt chest compressions on a female-shaped manikin, purely because of its shape. The trainer running the course failed them. No exceptions were made, and none should have been.
A first aid qualification certifies that a delegate can respond competently to a casualty in cardiac arrest. It doesn't come with a get-out clause for casualties who happen to be women. If a delegate won't attempt a core assessed skill on part of the test, they haven't demonstrated the competency the certificate is meant to confirm. Failing them wasn't harsh, it was the only consistent outcome available.
The CPR gender gap is real, and it's measured
St John Ambulance's own research, published alongside its CPR Bra campaign, quantifies exactly this hesitation:
That gap doesn't come from a lack of knowledge. It comes from hesitation in the moment, exactly the kind of hesitation an assessment is supposed to identify and correct before it costs someone their life.
What Resuscitation Council UK's current guidance says
Resuscitation Council UK's updated 2025 Guidelines, the definitive standard for UK first aid training as of 2026, address this directly rather than leaving it to individual judgement on the day. The guidance is clear that life-saving action takes priority over modesty, and it sets out exactly how to act:
RCUK's current position on CPR and defibrillation for women
- Direct skin contact comes first. AED pads must be on bare skin to work properly. Exposing the chest when needed is not something to hesitate over.
- Adjust or remove a bra if it's in the way. An underwired bra that obstructs pad placement should be removed or cut off, since the wire can conduct electricity away from the heart or cause burns.
- "Scoop and lift" for correct pad placement. Breast tissue should be lifted so the pad sits flush against the ribs, not on top of it, since sitting on top increases electrical resistance and reduces shock effectiveness.
- Dignity is preserved after placement, not before it. Once pads are secured, clothing can be laid back over the casualty. It's sequenced after the life-saving step, not instead of it.
None of this is optional guidance for "if you feel comfortable". It's the current national standard, and it exists specifically because hesitation around women's bodies was costing lives.
Why the manikin itself is part of the problem
Academic research looking at CPR training equipment on the market found that of the manikins available, only a small minority were sold as female, and fewer still were built with breasts at all, meaning the overwhelming majority of training manikins in circulation are flat-chested. Anatomically, breasts don't change the compression technique. But if every manikin a delegate has ever practised on is flat-chested, the first time they encounter a real female chest is in an emergency, exactly the wrong moment to be improvising.
Separately, research into out-of-hospital cardiac arrests has found women are measurably less likely to receive bystander CPR than men. Training equipment that never reflects a female body isn't a minor gap, it's a direct contributor to that outcome.
Practice, practice, practice
The reason assessments include practical, hands-on CPR isn't box-ticking, it's rehearsal. Confidence to act without hesitation in a real emergency comes from having done it before, on equipment that actually reflects who you might be helping. A delegate who's only ever compressed a flat-chested manikin, and who's never had to think through pad placement, clothing or hesitation in a training room, is far more likely to freeze when the casualty in front of them is a real woman.
That's exactly why a trainer refusing to let a delegate skip that part of the assessment matters. It isn't about being strict for its own sake. It's the one place in someone's training where hesitation can be caught and corrected, before it ever happens for real.
Frequently asked questions
Is it correct to fail a delegate who refuses to practise CPR on a female manikin?
Yes. Assessment for a recognised first aid qualification checks whether a delegate can competently respond to any casualty. Refusing to attempt a core skill on part of the assessment means that competency hasn't been demonstrated, so a fail is the correct, consistent outcome regardless of the reason given.
Are women really less likely to receive CPR from bystanders?
Yes. St John Ambulance research found only 68% of women are likely to receive bystander CPR compared with 73% of men, with a third of men citing fear of being accused of inappropriate touching as a reason for hesitating.
What does Resuscitation Council UK say about performing CPR on women?
RCUK's updated 2025 guidance, the current standard for UK first aid training as of 2026, is clear that life-saving action takes priority over modesty. It covers direct skin contact for AED pads, when to adjust or remove a bra, and a "scoop and lift" technique for correct pad placement on the chest.