SPRINGFIELD — When someone experiences a heart attack, the emergency protocol is universal for all genders — first responders are supposed to place the patient on their back and their hands in the center of the chest, then push hard and fast.

Yet, women are 27% less likely to receive bystander CPR than men because of hesitancy to follow protocol, fueled by fears of inappropriate touching, exposing the chest or drawing accusations of sexual assault, according to the Journal of the American Heart Association.

House Bill 4788, sponsored by Rep. Maura Hirschauer, D-Batavia, aims to defeat this stigma, normalizing CPR performance on women by introducing female manikins in secondary school CPR training.

The idea for the legislation began with a Naperville High School student, senior Ashlynn Goldstein. “I had been CPR certified a lot of times — never in my life had I ever encountered a female manikin,” Goldstein said.

Her capstone project in high school examines why disparities exist in the performance of CPR between men and women, Illinois current statutes addressing CPR training, and how those policies are handled in schools.

“That was kind of where that idea of passing a bill for high schools came about, and Hirschauer took up the case,” said Goldstein, who drafted the bill with her teacher and proposed it to legislators.

The bill is currently assigned to the Education Policy Committee. It requires CPR training in secondary schools to include at least one female manikin for every two male versions, starting in the 2028-29 academic year.

Hirschauer, who said she is interested in “righting the wrongs of gender disparity,” emphasized the importance of introducing female manikins in high schools.

“I’m always a fan of reaching people at their earliest. … So it felt like a really good way to capture a lot of people, and then a really good way to break down the stigma of CPR on a female if we’re starting young,” she said.

State Rep. Katie Stuart, D-Edwardsville, was added as a co-sponsor to the bill Thursday.

With every Illinois high schooler required to receive CPR training, Goldstein also sees an opportunity to reach a wider audience.

“That is your next generation of adults,” Goldstein said. “They are the next people who are going into the workforce, going out into the world, and it’s more effective with the younger ages versus older.”

In the U.S., 40 states and the District of Columbia require CPR training in schools before high school graduation. There are no laws embedding the use of female manikins in school training curriculums. Such training can make a difference.

A 2024 study by the American Heart Association Journal, surveying 112 participants who received CPR instruction on both male and female manikins, concluded that the training increased confidence in performing CPR on women. Although 28.4% initially reported feeling either slightly or very uncomfortable using the female manikin, 81.6% said they felt more confident performing CPR on women after practicing with it.

“To date, most CPR training programs in the United States and globally continue to use the standard flat-chested manikin since training materials with secondary sex characteristics such as breasts have been lacking,” according to a recent study in ScienceDirect.

“Normalizing the female anatomy and allowing hands-on simulation practice with breasted manikins may reduce reluctance to perform (CPR) on women, dispel misconceptions and myths, and cultivate confidence among the public rescuers to engage in life-saving skills, regardless of gender,” the study said.

Bill faces hesitation over costs

Despite Hirschauer’s enthusiasm for the bill and the state’s past support of CPR training in schools, the bill faces headwinds.

The Illinois Principals Association expressed skepticism around the bill, citing concerns about burdening schools with the costs.

“We have other things that are kind of pressing on that financial button, if you will, and we always share those concerns with legislators,” said Alison Maley, the government and public relations director of the principals association.

Lauren’s Law, passed in Illinois in 2008, mandated CPR training in all of the state’s high schools but also became an example of how financial considerations can thwart good intentions. The law does not provide any additional funding for compliance, therefore making higher income districts better positioned to meet the requirements.

To bridge the gap, Illinois Heart rescue, an organization committed to improving outcomes when people experience cardiac arrest beyond hospital settings, got involved. It provides training, manikins and automated external defibrillators to lower-resource districts and schools that would otherwise struggle to finance the training themselves.

Illinois Heart Rescue has already introduced female manikins in their training programs.

“We made the decision as a program to use breasted manikins in all of our classes,’’ Courtney Schwerin O’Reilly, executive director of Illinois Heart Rescue, said. “It was mildly controversial, but it was important to me that we had that representation.”

Goldstein acknowledged the cost-related concerns in the drafting of her bill. Instead of compelling schools to purchase female manikins, which cost $800, the bill provides the option of installing chest covers on existing ones instead, which are priced at approximately $14 to $18.

The marketplace has begun to recognize the need for change as well. WorldPoint, a global distributor and one of the industry’s largest suppliers of CPR manikins, has developed two innovative, three-in-one manikins — CPR Taylor and CPR Tommi — each designed to convert between adult male, adult female and child. The products are released in light and dark skin colors.

“It shouldn’t be an add on, it shouldn’t cost more money, it shouldn’t be its own additional purchase thereby making it more expensive,” said ShellyAmato, executive vice president of WorldPoint. “It should be standard. You get a male and you get a female with every manikin.”

That fits into Goldstein’s goal of raising awareness on the issues surrounding CPR for women and seeing a broader impact in society. If the Illinois legislature can pass Hirschauer’s bill, perhaps it can serve as a model.

“My hope is, honestly, for other states to take inspiration from that,’’ she said.

Georgia Epiphaniou is a graduate student in journalism with Northwestern University’s Medill School of Journalism, Media, Integrated Marketing Communications, and a fellow in its Medill Illinois News Bureau working in partnership with Capitol News Illinois.

Capitol News Illinois is a nonprofit, nonpartisan news service that distributes state government coverage to hundreds of news outlets statewide. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation.