High-Rise Buildings Present Challenge in Cardiac Arrest

Disneyland. (Dr. Noorali Bharwani)
Disneyland. (Dr. Noorali Bharwani)

If there is a life-threatening emergency in a high-rise building then it is longer to rescue the people trapped in the building. In case of fire there are problems related to evacuation, accessibility, smoke movement and fire control.

What happens if you have a heart attack (cardiac arrest) in a high-rise building?

A study shows patients residing on higher floors of high-rise buildings in Toronto had lower survival after out-of-hospital cardiac arrest. Most out-of-hospital cardiac arrests occur in residential areas, and these cases are associated with poorer outcomes than nonresidential cardiac arrests, says an article in the Canadian Medical Association Journal (CMAJ).

Studies have shown that the mean time from ambulance arrival on scene to patient contact was 2.8 minutes for people on the first two floors but 3.1 minutes for those on the 3rd to 9th floors and 3.3 minutes for those on the 10th floor or higher.

Cardiac arrests on higher floors had longer rescue times, which contributed to poorer outcomes.

There are a number of issues which affect access in a high-rise building. For example:

  • Lack of witnesses to provide immediate help, CPR (Cardio Pulmonary Resuscitation) or call to paramedics.
  • There are barriers to elevator access. Studies have shown additional elevator stops happened in 18.6 per cent of high-rise residential calls. Elevators were not easily accessible in 33.9 per cent of all paramedic calls to apartment buildings.
  • Requirement for an entry code to a building (67.6 per cent of all access barriers), lack of directional signs (82.6 per cent) and inability to fit the ambulance stretcher into the elevator (67.9 per cent).
  • CPR in elevators is challenging.

What would help?

  • Train the family members of those at risk to do CPR.
  • Place automated external defibrillators strategically in certain residential locations.
  • Smartphone technology can link residents who are trained first responders to defibrillators in their neighbourhoods and to victims of cardiac arrest in apartments.

Recently another article in CMAJ (January 18, 2016) discussed this subject. During the study period, 7842 cases of out-of-hospital cardiac arrest met the inclusion criteria. Of these 76.5 per cent of patients had cardiac arrest below the third floor and 23.5 per cent of the patients had cardiac arrest on the third floor or higher.

The authors found survival was greater on the lower floors (4.2 per cent v. 2.6 per cent). They also found survival was 0.9 per cent above floor 16, and there were no survivors above the 25th floor. Wow, that can make you nervous!

Their conclusion: “In high-rise buildings, the survival rate after out-of-hospital cardiac arrest was lower for patients residing on higher floors. Interventions aimed at shortening response times to treatment of cardiac arrest in high-rise building may increase survival.” This kind of action can alleviate other disasters like fire.

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