Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Tuesday, January 19, 2016

High Life-Risk Living In High-Rises

"This is something people often think about when they get out to rural settings — 'OK, it’s going to be a bit of a delay for help to get here if I need it'. But people in high-rises think, 'well, I’m still within the city so I should be OK.' There is a little bit of a delay that I think people should be aware of."
"Availability of a universal [elevator] key seems like a simple intervention, but it has remained unaddressed for decades."
"It’s pretty well-shown throughout the literature that bystander CPR can almost double survival from cardiac arrest in some situations."
Ian Drennan, paramedic, York Region, paramedic services, Rescu researcher, St.Michael's Hospital, Toronto
If you have a heart attack, it pays to be close to the exit.
THE CANADIAN PRESS/Darryl Dyck/Files    If you have a heart attack, it pays to be close to the exit

One other thing to think about when people live in high rises; the view may be nice but it doesn't compensate for complicated accessibility and delay lags in exiting the building when you're on the top floors. Not when your suite is located above the third floor, in fact. And if you're living in a building where the elevators are slow, the problem is compounded hugely. First responders to emergency situations would feel a lot better if they could access a universal elevator key to keep an elevator monopolized, and if defibrillators were seen as necessary and common devices to be kept in places handy to swift access.

Mr. Drennan was the lead author of a research team investigating survival rates of individuals who are suddenly struck by cardiac arrest. Their study results published in the Canadian Medical Association Journal, they looked at 7,842 out-of-hospital, adult cardiac arrests that occurred in private residences -- apartments, condos, townhouses and houses within Toronto and neighbouring Peel Region in a five-year period. They concluded that 77 percent of those emergencies took place below the third floor, while the remainder happened above.

Survival rates floor-by-floor presented a kind of central-urban horror story showing that while 4.2 percent of patients experiencing a cardiac arrest below the third floor survived, 2.6 percent of those on the third floor or above survived; their chance of survival much diminished by the time it took to collect them by emergency personnel and speed them off to hospital. Of the 216 people living above the 16th floor in the study, only two survived. As for the 30 patients living above floor 25, none lived to see another day.

A heart attack occurs when the blood supply to a part of the heart is blocked. It can lead to a lethal rhythm and finally cardiac arrest. But cardiac arrest is not a heart attack; cardiac arrest happens when electrical impulses in the heart become erratically rapid or chaotic, a situation that causes the heart to suddenly cease beating. Only five percent of Canadians survive a cardiac arrest that occurs outside a hospital setting, according to the Heart and Stroke Foundation.

According to the study, paramedics in Toronto took 4.9 minutes to reach people on the third floor or higher of high-rises, as compared with three minutes to reach those living below the third floor, experiencing cardiac arrest. By the time paramedics arrived on scene, a smaller proportion of people on the elevated floors still had a shockable rhythm that might lead to their survival. The chance of surviving cardiac arrest however, diminishes by roughly ten percent for every one-minute delay in treatment.

In high-rises, the study identified one of the most problematical barriers in survival to be lack of swift access to an elevator. "I've been on calls with police", explained Garrie Wright, deputy chief of Toronto Paramedic Services "and they're pushing the superintendent buzzer or the apartment buzzer like we are, wanting to get into the building". Additional elevator stops in highrise residences where a patient is being taken out of the building presents a nightmare scenario to paramedics since each stop adds 54 seconds to the time of arrival at the patient's side, and subsequent departure from the building.

Fire departments have a similar problem of course, but they most often have a universal elevator key allowing them sole elevator access, while for paramedics this is a rare protocol, while for obvious reasons it should not be. Mr. Drennan feels emergency alerts to building staff should become a standard feature ensuring that elevators are in waiting mode as paramedics arrive, and that defibrillators placed in lobbies, elevators or on various floors would help immeasurably to reduce the number of fatalities.

And if residents could be persuaded to volunteer for CPR training it would represent an additional boost to survivability. "Bystander CPR can almost double survival from cardiac arrest in some situations" stated Mr. Drennan, citing Singapore, where most people live in high-rises and a public campaign has been initiated to enroll resident committees as volunteer first responders.


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