The ambulance may arrive on time, but elevator delays pose new dangers.
As the high-rise population grows, the number of emergency calls to such dwellings is increasing, presenting 911 responders with unique challenges.
Building access issues, elevator delays and extended distance from the responding vehicle to the patient can all cause delays in the initiation of resuscitation.
In Toronto, Canada, high-rise residences are now home to 40% of over-65s, a population at high risk for a number of serious medical conditions, including cardiac arrest.
In North America, more than 400,000 out-of-hospital cardiac arrests occur annually. Despite efforts to improve resuscitation care, survival to hospital discharge in most communities remains below 10%.
Rapid defibrillation and high-quality cardiopulmonary resuscitation (CPR) are essential for survival. For each 1-minute delay to defibrillation, the chance of survival drops by 7-10%.
The higher the floor, the lower the chance of survival
Previous studies have measured response time between the call to 911 and arrival of an emergency vehicle on scene, but not the time required to make patient contact once there. This can take more than 4 minutes, or up to 28% of the total time from the 911 call to patient contact.
Reasons for delays include additional elevator stops in 18.6% of high-rise residential calls, adding 54 seconds per stop to the interval from arrival on scene to patient contact. Access barriers delayed 33.9% of paramedic calls, and 67.6% of calls required an entry code. Poor signage impeded 82.6% of calls, and inability to fit the ambulance stretcher into the elevator hindered 67.9% of cases.
Ian Drennan and coauthors looked into the relationship between floor of patient contact and survival after cardiac arrest in residential buildings in Toronto, focusing on the time from arrival of the vehicle to patient contact.
Of 8,216 cardiac arrest patients in private residences who were treated by 911-initiated first responders, 3.8% survived to be discharged from the hospital; the further the patient's location from the ground floor, the lower the survival rate.
Of the 5,998 (73%) patients living below the third floor, 252, or 4.2%, survived. On or above the third floor, only 48, or 2.6%, of the 1,844 patients survived. Above the 16th floor, only 0.9%, or 2 out of 216, survived; and above the 25th floor, none of the 30 who had arrests survived.
The use of automated external defibrillators (AED) was "very low."
"As the number of high-rise buildings continues to increase and as population density rises in major urban centers, it is important to determine the effect of delays to patient care in high-rise buildings on survival after cardiac arrest."
As more people take up residence at or above the third floor, the time from arrival on scene to initial patient contact will become more significant.
New interventions needed to shorten cardiac arrest response time
The researchers call for interventions aimed at shortening response times to treatment of cardiac arrest in high-rise buildings, and they outline several solutions to improve time to patient contact.
Suggestions include giving 911-initiated first responders sole access to elevators for emergency service without public interference - as during a fire - as well as emergency alerts to building staff before the arrival of first responders and better placement of defibrillators to increase bystander use.
In a linked comment, Associate Prof. Marcus Eng Hock Ong, of Singapore General Hospital, and coauthors suggest CPR/AED training for residents of high-rise apartments, a national online registry of public-access defibrillators linked to first-responder applications and using smartphones to activate volunteer first responders for patients with cardiac arrest.
Ong notes that Singapore has a multipronged approach to these situations, including a large public campaign to enroll residents' committees as first responders and to train 1 million people over the next 5 years.
Medical News Today has previously reported that bystander CPR can save lives.