Question and Answer Sheet: Heart Safety in High Rises

Jan 22nd, 2012 | By | Category: Response Times

FAQ: Heart Safety in High Rises

Q: What is the issue here?

A: Our advocacy and safety agencies must address one salient fact – that thousands of people are dying needlessly in high rise residential and office buildings each year in the US, largely because EMS (Emergency Medical Services) simply can’t get to patients in time to successfully resuscitate them.

Q: Can you explain the problem in more detail?

A: Sudden cardiac arrest (SCA) is the major killer of adults in the Western world, with more than 300,000 deaths in the US alone each year. An SCA is invariably fatal unless the victim can be promptly defibrillated, within 3-5 minutes to be successful and avoid severe damage.  After 8 minutes the victims have lost their last chance to live – and the cost to their families and society is incalculable.

Q: So the problem is that the ambulance and fire services are too slow?

A: Not at all.  It is the absence of an AED (automated external defibrillator) in high rises and office towers, with support people there, that makes them the most dangerous place to live or work in cities.  So an AED must be used in less than 5 minutes. If EMS arrives at the 10 minute mark, they can consolidate the rescue and transport the patient, while initiating after-care and preparing the ER for the incoming patient.

Q: The MOST dangerous place?

A: Yes, because heart ‘events’ are our biggest killer, and high rises have less than a 8% survival rate for SCA’s, nationally, when it could be 60% or more.  High rise buildings are the fastest-growing demographic in cities around the world, and without an AED  they are the least safe.  It’s not an incremental improvement at stake – this measure enables a lifesaving heart treatment for the first time.

Q: So who is addressing this problem?

A: Our heart advocacy agency – the American Heart Association’s  focus is on legislation for public buildings, which is laborious and takes years. The building & fire code people, who have emerged as the relevant safety agency for effecting this haven’t yet mandated or defined AED deployment either. These municipal codes, for many reasons, offer the best solution.

Q: So it’s not really an ambulance and fire service issue…??

A: It’s widely seen and approached as such, but those are rescue agencies. They are not public policy adjudicators or lawgivers, and they are constrained both physically and budget-wise.  EMS responders face multiple issues (9-1-1 delays, vehicle availability, traffic congestion, building security etc. ) that cannot reliably be resolved within 3-5 minutes from onset, which is all that dying people have to contribute.  The solution does not lie within EMS,  it’s for the code and property management people to establish a standard across all cities. It is incumbent on urban societies to implement this safety provision now.

Q: So we need to get those AEDs into building complexes?

A: Yes, these miraculous devices are produced for one single purpose – to bridge the time until EMS arrives, who then take over the resuscitation – following up on the life-saving, timely shock delivered by in-house volunteers, or even bystanders. This safety architecture we call Tandem AED/EMS.

Q: Who would keep or look after the AED?

A: It is contracted to a specialty AED monitoring firm, which places the PAD on the Internet with a fixed IP address.  The gross monthly lease costs less than $4 per suite.  The PAD’s (Public Access Defibrillator)  location will then be fixed, so that people can be trusting of its presence – just as with fire extinguishers.

Q: Where should it be kept then?

A: The optimum location is in elevator main lobbies because these are the most visible and secure areas, and the AED’s presence helps to educate the building residents, workers and visitors. The elevators allow building managers to leverage a single advanced AED installation at little cost, and save everybody precious time when accessing and delivering it to a suite.

Q: How would you find volunteers?

A: Every year thousands are trained in CPR (cardiopulmonary resuscitation) and then under-utilized, when they could become continuing guardians of public health with specific roles.  Some have advanced certification that would be extremely useful in many emergencies within these complexes.  And it’s not all about SCA’s – there are many forms of heart and stroke incidents and other emergencies  – overdoses, bleeding, accidents –  that could greatly benefit from prompt in-house expertise.  Those residents with existing health issues may be especially motivated to participate, to enhance their own emergency resources.

Q: Good idea, but how are these people alerted in an emergency?

A: Via cellphones and texting, voice calls – using the new m2m cell networks.  When the AED cabinet is opened, it sends a text or voice message immediately to as many as ten volunteers and stakeholders (monitoring service, 9-1-1, doctors, building management, security, volunteers etc). The monitoring service filters it first, in real time, as specialists in cardiac emergencies, and to control unwarranted calls to 9-1-1 dispatchers.

Q: AEDs can call or text people?

A: No – but their enclosures/cabinets can,  through a cellular connection. These next-gen PADs reduce the need for active AED registries, which can become medical data depositories instead.  Since EMS and 9-1-1 operators will be fully aware of each PAD’s exact location and status – the PADs effectively anchor AED deployment and protect adjoining buildings too, if they are within a 2 minute radius and participate in the volunteer structure.

Q: What if nobody sees that heart ‘event’ or accident – who’s going to open the AED cabinet?

A: Residents and workers will be offered a cellphone ‘app’ that can alert that same resuscitation team directly.  The app states the suite number etc. and can also reference pre-existing health issues.  So if a victim senses a heart attack, stroke or an SCA coming on – even if they have only a few seconds of consciousness left – they may be able to hold the cellphone button down long enough (3 seconds)  to trigger the app, and then be rescued in time. At present fully 50% of SCA’s go unwitnessed, so this is fertile ground for heart safety pioneers.

Q: Too cool! How would I volunteer or get my building set up?

A: Talk to your building management firm about installing a PAD, do take some CPR training, then volunteer as a responder.  We needn’t wait for the safety code mandate – the cell technology (and our lives) are good to go right now – let’s roll!

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