The downside of high rise living

The ground floor of a condo may not be the most scenic. But it may be safest place for your heart's sake.

The National Housing Survey says condos are now home to more than 1.6 million households. A large and growing number of seniors live in high-rises.  Heart disease is the number one killer of older Canadians, which means the system is handling a growing number of 911 calls from on high. A study just published in the Canadian Medical Association Journal says those living arrangements come with a potential health risk.

For those who call 911 from a high-rise, the odds of survival from cardiac arrest depend on what floor the patient lives. That's the main conclusion of an intriguing study by a paramedic and doctors with Rescu, a university and hospital research program in Toronto that focuses on patients who suffer heart and other life threatening emergencies outside of hospital.

Researchers looked at the 911 records of more than 8200 people in Toronto who suffered cardiac arrest at a private residence.  Four point two per cent of the nearly six thousand of them who lived on the first or second floor survived a cardiac arrest.  Just 2.6% of the 1844 people living on or above the third floor survived.  A dismal 0.9% of those who resided above the 16th floor lived; for those who lived above the 25th floor, the chance of survival was zero.

There was nothing otherwise different about the patients who reside on higher floors.  They weren't older or otherwise more prone to heart attacks than those who live on the first two floors of a high-rise. The only factor that could explain the difference in survival is the extra time needed by paramedics to take the elevator from the lobby to the floor where the patient resides. A previous study by one of the authors found it takes an extra 90 seconds to reach patients on the third floor or higher.  

Even that tiny a difference in response time can have a huge effect on survival.  In the first ten minutes following cardiac arrest, each one-minute delay defibrillating or shocking the heart decreases the odds of success by seven to 10 per cent 

Although we're talking high-rise buildings, the conclusions have implications for smaller apartments and walk-ups. Traditionally, when researchers talk about response time to 911 calls, they mean the time it takes from the moment the call is placed until paramedics arrive on the scene.  Shorter response times mean greater chances of survival.  But those studies mislead us when they don't count the extra time it takes to reach the patient.  With high-rises, the delay may be due to the elevator ride.  If the walk-up has no elevator, the delay comes from paramedics having to carry equipment up several flights of stairs, and have to carry both the patient and the equipment to the ground floor.

I'm not aware of any published studies comparing survival from cardiac arrest in office buildings compared with high-rise apartments and condos.  The same issues apply.  Survival depends on how long it takes paramedics to reach the patient.  I think there's been a greater push in offices than in apartments to install automatic external defibrillators or AEDs.  These devices save lives – but only when co-workers are trained to pull them off the wall and use them. Unlike high rises – which are occupied day and night – office buildings are occupied primarily during the day. The most common time of day for cardiac arrest is early morning between 6 and 10 am.  That makes me think a disproportionate number of cardiac arrests take place at home or en route to work.  Offices got AEDs before residential high-rise buildings but the gap is closing.

If you are wondering what can be done to increase survival in skyscrapers, the main thing is to speed things up once paramedics arrive at the lobby of the building.  As pointed out by the authors, firefighters have a universal access key that gives them sole access to the elevator.  They suggest that paramedics get the same access.  As well, they suggest that the superintendent as well building security be included in emergency alerts so they can do things like have an elevator on standby when paramedics arrive.  

Singapore has mounted a public campaign to enrol fellow residents to act as first responders, which will close the survival gap by getting help long before paramedics arrive.  All of these will improve survival.

With more and more Canadians moving to high occupancy buildings, expect issues of quick access to patients in cardiac arrest to become more common.  It's sensible to take action now to prevent unnecessary harm.


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