For people who suffer cardiac arrest outside of a hospital, the biggest difference between those who survive and those who don’t is that a bystander performed CPR on the survivors.

The difference is that stark. CPR can double or even triple the chance of survival. And for those who suffer cardiac arrest outside of a hospital, surviving often means getting CPR from a passing layperson who may not be a medical professional.

That’s why it’s so essential for everyone to get trained in CPR, and be willing to deliver it if need be. But the tragic thing is that cardiac arrest victims don’t get CPR from bystanders as often as they could. Bystanders are often reluctant to perform CPR—even if they’ve gone through training, and even though they could save a life.

Here are some common misconceptions and fears that keep people from providing lifesaving care when the chips are down.

Fear of hurting the victim.

Many people hesitate to perform CPR because they worry that they may do more harm than good. They may even break a rib.

The thing is, if you’re doing CPR right, it’s likely to break ribs. Compressions should be at a depth of about two inches on a full-grown adult in order to get the blood moving in the body. That takes about 60 pounds of force.

According to a 2015 study, as many as 86% of men and 91% of women experienced a bone injury in the chest after receiving CPR—including sternum fractures, rib fractures, and sternocostal separations.

However, these injuries are survivable. Cardiac arrest isn’t, unless the victim gets immediate lifesaving care. Most people would agree that a few broken ribs are preferable to death.

Fear of being sued.

That’s all well and good—but what if, after saving someone’s life by delivering CPR, that person turns around and sues you for your actions?

It’s possible, but unlikely. Good Samaritan laws vary by state, but all have protections for bystanders delivering CPR. It’s in the interests of the country to encourage people to provide CPR, and the law reflects that.

As long as you’re responding the way a reasonable person would, providing care according to your level of training, and are not being compensated for your actions, these laws should protect you from a lawsuit.

Fear of catching a disease.

It’s not unusual to have an instinctive ick-factor reaction when it comes to mouth-to-mouth resuscitation. For many, the possibility of catching a contagious disease stops them from helping a cardiac arrest victim—even when they know CPR.

You can contract bacteria and viruses through mouth-to-mouth contact with an infected person. Chances are low that this will happen during rescue breathing, but it’s possible.

However, you don’t need to give rescue breaths in order to deliver effective CPR. Recently, the AHA released new guidelines for hands-only CPR that require lay rescuers only to “push hard and fast in the center of the chest,” to the tune of “Stayin’ Alive” by the Bee Gees. You can skip the mouth-to-mouth part altogether.

Hands-only CPR has been shown to be just as effective as traditional CPR in bystander rescue situations. In some studies, it’s even more effective—possibly because people are more willing to give this type of CPR in the first place.

Fear of doing it wrong.

Studies have shown that about 70% of Americans don’t have the confidence to perform CPR in an emergency situation—and would be reluctant to provide it for this reason.

Again, that’s where hands-only CPR comes in. It’s far less complicated than the traditional version—there’s no need to try to remember the ratio of compressions to rescue breaths, or slow down your compressions to provide breaths.

Hands-only CPR is very easy to learn and administer—even for people with no medical training. There’s really only one step—push hard and fast in the center of the chest.

Today, anyone can learn and administer CPR—and the learning process only takes minutes.

Fear of inappropriate touching.

According to a study conducted by researchers at UPenn, women are less likely to receive CPR than men—because some rescuers are afraid to touch a female victim’s chest.

This has real-world consequences. The study found that men were 23% more likely to survive cardiac arrest than women, because rescuers were more reluctant to deliver CPR to women. In examining over 20,000 cases nationwide, the study found that only 39% of women in cardiac arrest outside of a hospital got bystander CPR—as opposed to 45% of men.

Over 350,000 people suffer cardiac arrest in America each year outside of a hospital setting. Approximately 90% of them do not survive. Those numbers could be improved with CPR training—and the knowledge to overcome these misconceptions.

BLS stands for Basic Life Support. In the United States, this type of certification is for those in the medical field. If you’re a healthcare provider or someone in a rescue profession, the CPR certification you most likely need is BLS.

Those who probably don’t need BLS certification—but who do need a form of CPR training—include teachers, coaches, personal trainers, childcare providers, and safety officers in various workplaces. In other words, people who may find themselves in a position where they’re responsible in case of an emergency, but whose job doesn’t normally include providing emergency care.

Here’s a look at some of the jobs you can get with BLS certification in more detail.

Doctors and nurses.

Everyone looking to become a doctor or nurse will need to get BLS certification. This isn’t always the highest level of emergency life support certification you’ll need; some medical professionals, especially those working in critical care and emergency medicine, also get the Advanced Cardiac Life Support (ACLS) certification. BLS, however, is the certification for medical providers across the board.

Medical assistants.

BLS-certified medical assistants are common in most hospital and healthcare settings. Medical assistants work alongside doctors and nurses, taking vital signs, administering medication, giving injections to patients, and discussing medical histories. While they aren’t usually the first line of response for emergency care, they’re likely to be on hand when that care is needed, and need to know how to provide basic life support in case of an emergency.

Dentists.

Dentists are required to complete a certain number of continuing education hours to renew their license every few years—the exact number of hours and years varies by state. BLS certification is required, and if the course is approved by the Dental Board in the state where you work, getting recertified may count as continuing education.

Paramedics and EMTs.

Medical professionals who are first on the scene of an accident will regularly be called upon to use their basic life support skills. BLS certification is usually the initial level of training for EMTs, with paramedics and advanced paramedics holding training in more advanced forms of life support and emergency care.

Firefighters.

Anyone in the “professional rescuer” field will need a BLS certification, as their job requires delivering lifesaving emergency care. That includes both professional and volunteer firefighters, who are usually required to hold an EMT qualification. Some fire departments require their professional firefighters to be certified paramedics.

Police officers.

Police officers aren’t medical providers, but they are often the first on the scene in volatile situations as well as accidents. Every second counts when it comes to lifesaving care, so police officers need to be able to provide it immediately as the first to arrive in an emergency.

The specific requirements vary by state, but police officers may be required to hold a CPR and First Aid certification or a BLS certification. If you’re not sure, the BLS certification is more advanced than general CPR, and would be accepted in all states.

If you’re in the medical field or in a rescue profession, the certification you’re likely to need is BLS. Every profession is different, of course, and requirements may be affected by state law, industry standards, or individual employers. If you’re in doubt, a BLS certification for healthcare providers should be accepted anywhere CPR knowledge is required.

It’s one of the biggest fears laypeople have about delivering CPR—what if you actually do more damage to the patient than good? What if you break a rib? It does happen—and more often than you’d think.

How common are broken ribs as a result of CPR?

Chest compressions need to be performed at a depth of about 2 inches in order to do the patient any good—in adult patients, of course. Any less than that and you won’t be moving the blood around the body effectively. However, it takes a surprising amount of force—about sixty pounds of it, to be exact—to compress a human chest that much.

So, yes—it’s actually fairly common for ribs to break during CPR. The conventional wisdom is that about 30% of patients suffer fractures or breaks during CPR. However, a 2015 study published in Resuscitation suggested that this percentage is quite a bit higher. The study analyzed autopsy data from 2,148 patients who received CPR for non-trauma-related cardiac arrest, and the statistics were as follows:

• Skeletal chest injuries were found in 86% of men and 91% of women.
• 59% of the men and 79% of the women had sternum fractures.
• 77% of the men and 85% of the women had rib fractures.
• 33% of the men and 12% of the women had sternocostal separations.

Who is most at risk of breaking a rib during CPR?

It’s clear from the above data that women are more likely to receive skeletal chest injuries than men. In addition, the study found that older patients were more at risk of these kinds of injuries than younger. Existing health conditions such as osteoporosis, which weakens the bones, can also result in a higher chance of injuries.

On the other hand, physically large, robust, and even obese patients are less likely to suffer broken bones during CPR than those with a smaller frame.

In a different study—performed in Korea in 2012—it was found that patients who received CPR from a bystander were more likely to suffer bone injuries than those who got their CPR from a doctor or paramedic.

What should you do if you feel a rib break?

When you are performing CPR, you may hear a cracking sound or feel something crack or give beneath your hands. This is usually the cartilage in the sternum or ribs breaking, and not the ribs themselves. However, the ribs may also break, and this can be disconcerting for the rescuer.

As disturbing as this experience is, however, it is generally not advisable to stop if you feel a rib break or hear a cracking sound. True, broken ribs and other skeletal injuries can be painful and add to the patient’s recovery time—but it’s better than being dead, which will certainly happen if you stop CPR.

The bottom line is this: fear of breaking someone’s ribs or causing other injuries should not stop you from delivering CPR. Broken ribs heal, and Good Samaritan laws throughout the country protect bystanders who deliver CPR. You are extremely unlikely to find yourself facing legal consequences if the patient doesn’t like the way you delivered CPR after the fact, provided the actions you took were non-compensated, in good faith, and in keeping with your level of training.

The truth is that CPR is a vigorous, sometimes violent procedure, and there is a high risk of injury to the patient—but injury is preferable than death. If your patient is lucky enough to survive after CPR, chances are they will thank you—and count a broken rib as a small price to pay for their life.