Residential High-Rise Buildings : Addressing Vertical Challenges for Cardiac Arrest Survival

Introduction: Living in high-rise buildings offers many conveniences but also presents unique challenges during emergencies, particularly during cardiac arrests. As the number of people residing in high-rises continues to rise, so does the importance of understanding and mitigating the factors that may impede timely emergency medical response. In this short article, we delve into a recent study examining the impact of vertical response times on survival rates in residential high-rises.

Understanding the Challenge: Emergencies such as cardiac arrests demand swift intervention, yet the verticality of high-rise buildings introduces complexities for first responders. Building access issues, elevator delays, and the distance from the response vehicle to the patient can all contribute to prolonged response times, ultimately affecting patient outcomes. While efforts have been made to improve response times to the building, traditional metrics often fail to account for the crucial interval between first responders' arrival and patient contact, which can significantly delay life-saving interventions.

The Study: Recent research has shed light on the critical role of response times in high-rise settings. A retrospective observational study conducted in Toronto analyzed data from over 7,800 cases of out-of-hospital cardiac arrest occurring in residential buildings between 2007 and 2012. The findings revealed a stark contrast in survival rates based on the floor of patient contact, with significantly lower survival rates observed on higher floors.

Key Findings: Of the cases examined, 76.5% occurred below the third floor, with a notably higher survival rate compared to those on higher floors. Adjusted survival to hospital discharge was inversely associated with the floor of patient contact, emphasizing the impact of vertical delays on patient outcomes. Notably, survival rates dropped below the 1% threshold for futility above the 16th floor - with no survivors recorded above the 25th floor.

Implications and Solutions: These findings underscore the urgent need for interventions to improve response times and enhance survival rates in high-rise settings. Addressing vertical delays through strategic measures such as improved building access, streamlined elevator protocols, and enhanced coordination between EMS staff and building management can be instrumental in optimizing emergency response. Additionally, promoting the widespread use of automated external defibrillators (AEDs) by bystanders in private residences, or building staff can further improve outcomes by facilitating early intervention.

Moving Forward: Their are numerous mitigation efforts available to building Owners & management teams through the development of emergency procedures for both residents and building staff, having an AED in the building alongside trained building staff. Another solution is technology, that actually includes your local emergency services. Safe Buildings, a rapidly growing tech developed right here in Toronto, serves to mitigate the challenges posed by vertical response times to ensure that all residents, regardless of their floor level, have access to timely and life-saving medical care during emergencies.  Safe Buildings provides a secure platform for building Owners and emergency services to truly collaborate and take occupant safety to unprecedented levels. Either way, tech, additional resources and AED's, or enhanced policies and procedures, more needs to be done to address these known delays to care.

Conclusion: The study's findings shed light on the critical impact of vertical response times on survival rates during out-of-hospital cardiac arrests in high-rise buildings. By addressing the challenges posed by vertical delays and implementing proactive measures to enhance emergency response, we can work towards improving outcomes and safeguarding the well-being of residents in residential high-rises.

To learn more of the Safe Buildings program and how your high-rise community can mitigate vertical response times; https://www.safebuildings.ca/

 REFERENCES

Out-of-hospital cardiac arrest in high-rise buildings: delays to patient care and effect on survival

Canadian Medical Association Journal

Ian R. Drennan, Ryan P. Strum, Adam Byers, Jason E. Buick, Steve Lin, Sheldon Cheskes, Samantha Hu and Laurie J. Morrison; for the Rescu Investigators

The ‘‘Vertical Response Time’’: Barriers to Ambulance Response in an Urban Area

Robert A. Silverman, MD, MS, Sandro Galea, MD, DrPH, Shannon Blaney, MPH, John Freese, MD, David J. Prezant, MD, Richard Park, MD, Raymond Pahk, BA, Djorge Caron, BS, Sonia Yoon, BA, Jonathan Epstein, MD, Neal J. Richmond, MD