Late for SCA's in high rises?

[Dwight]

I'm an AED consultant trying to get a handle on whether EMS can fairly be expected to reach an arrest pt in a high rise, inside the best-before time of 4 minutes.

If not, I see a PAD in the lobby as a way to take some hurry heat off of vehicluar EMS.

What can you tell me of SCA's in towers, etc. ?

[Chief1C]

I'd say, if it's a high rise, they should have an office-size medical kit and AED on every floor. You have to account for the time it takes 9-1-1 to be called, the time it takes for the call to be taken, transferred and dispatched; and the time it will take EMS to arrive (traffic, weather, call volume). Then the size of the building, is it transferring elevators to reach upper floors, or one straight shot? I'd say every floor, or one every couple floor.s They're fairly inexpensive these days.

An office size medical kit, including oxygen. Many AED companies sell cabinets with said items right in the same spot.

People die everyday, from sudden cardiac arrest. Can't predict when or where they will happen. All you can do is be prepared. "Office Responders" are a good place to start.

[lpndj6]

Ive long been a proponent of Public Access Defibrillators for a long time now. At one time I know they were more money but the price of portable AEDs anymore is well under 2k. It amazes me you see them in Malls in some cases but many other places you dont. Personally I think all multiunit housing facilites should have them accessible (1 per floor) same in high rise facilites. What really blows my mind is that healthcare facilites that arent acute care dont have them. After yrs in Pre hospital and now working as a nurse it blows me away that even Long Term Care or Asst Living Facilites dont have AEDs (but yet in many cases their crash carts include a suction machine) uhh ok. AED is standard training anymore in HCP CPR classes that are required for Health Care workers so its BEYOND me why they have yet to be mandated by law in such facilities. (Youd be surprised the lack of availablity even in multiclinical care clinics (large group practice health care groups which have many specialties under one roof) I mean somebody explain how a cardiac physicans office has a EKG machine but given the high risk of their own population they treat they dont even have a single AED.. Anyway Ill get off my soapbox now but to me the issue of PAD is the big weak link in the chain of survival now I believe. With the now push (no pun intended) for even hands only bystander CPR by anyone we still know that it still takes a kick start to break VFIB/Puseless VTach and reboot the heart and until PAD becomes much more common it will continue to be the weakest link in what truly is the chain of survival.

[usmc_chris]

Ive long been a proponent of Public Access Defibrillators for a long time now. At one time I know they were more money but the price of portable AEDs anymore is well under 2k. It amazes me you see them in Malls in some cases but many other places you dont. Personally I think all multiunit housing facilites should have them accessible (1 per floor) same in high rise facilites. What really blows my mind is that healthcare facilites that arent acute care dont have them. After yrs in Pre hospital and now working as a nurse it blows me away that even Long Term Care or Asst Living Facilites dont have AEDs (but yet in many cases their crash carts include a suction machine) uhh ok. AED is standard training anymore in HCP CPR classes that are required for Health Care workers so its BEYOND me why they have yet to be mandated by law in such facilities. (Youd be surprised the lack of availablity even in multiclinical care clinics (large group practice health care groups which have many specialties under one roof) I mean somebody explain how a cardiac physicans office has a EKG machine but given the high risk of their own population they treat they dont even have a single AED.. Anyway Ill get off my soapbox now but to me the issue of PAD is the big weak link in the chain of survival now I believe. With the now push (no pun intended) for even hands only bystander CPR by anyone we still know that it still takes a kick start to break VFIB/Puseless VTach and reboot the heart and until PAD becomes much more common it will continue to be the weakest link in what truly is the chain of survival.

You know what's worse than not having AED's at adult care facilities? I have been told by staff at several of these facilities that are formally designated as Adult Homes rather than SNF's that they could actually get in trouble for doing CPR from the state. We've all seen our share of shitty adult care facilities, but the ones I reference are ones that I would generally be willing to put my own relatives in, should the need arise. I tried to find the law, but just found endless confusing regulations. Knowing the state, however, since in none of the laws/regulations that I found are resuscitative efforts specifically permitted, they would be default be prohibited. I truly hope this isn't actually true, please, somebody point me in the correct direction (so I can provide supporting documentation to these folks if I run into them again) that shows that assisted living staff in NYS can provide CPR to residents. Certainly by the time that the staff even find the patients, they're often beyond help, but if they have to wait for EMS to show up, we can be assured that there's nothing can be done.

[emtannie]

I, as others who have already posted, am also a proponent of AED's in any public place. (OK, I sell them too, so I am biased).

That being said, given the scenario of the OP, one in the lobby would probably not be enough, due to the lag times of the elevators in some highrise buildings. It may take 4 minutes to get to the lobby, and another 4 to get back upstairs. One on every floor would be a much better idea. Convincing the building owner that the cost of one AED per floor is worth the risks will be the biggest hurdle.

As well as the issues already raised by other posters regarding seniors residences, we have a significant problem where I work. Apartment complexes for unassisted living and minimally assisted living (they can page a personal care assistant - not a nurse) in our area are monstrous buildings, with multiple entrances, and the majority of the elevators do not fit a full stretcher. Our response time is supposed to be less than 8:59 minutes, 95% of the time. There are many situations where we can be curbside in 4 minutes, but from the curb to the apartment can take as much as 12 minutes, by the time we get the elevator, go to the designated floor, and make our way through the maze to the apartment we are supposed to get to. One facility we get called to has parking almost a 4 minute walk to the front door! There is no way to park closer than that, as it is raised wall landscaping on a slope to the entrance - very nice for seniors (rolls eyes). The people who design these buildings should have to ride for a month with EMS, to see what we have to deal with to get to the residents. (I feel the same way about community developments where every street is named something similar - we have a section of town with 12 streets starting with "Rossland" and 16 streets starting with "Somerset." - the developer should be slapped)

Malls are another story - the biggest mall in our city has a seniors walking program every morning.... and no AED..

To the OP - your thoughts are headed in the right direction - we need WAYYYY more access to AED's than what is currently available. The biggest step we can take is education - teaching people that those first few minutes are what makes the difference, and that they can be the ones to make that difference. High rise buildings are just one small part of where we need to put more public access defibrillators.

[Chief1C]

I don't consider myself biased, since I won't sell an AED to ppl w/ corporate doctors, prescriptions, etc... Just EMS Services. I will, however, sell them disposable oxygen units (yes, they make real, disposable, oxygen tanks) and excessively over priced reusable resuscitators. $7.99 average, before mark up to like 11.99 for a bvm, generic. But most non-ems folks, that may use it once every 10 years, if ever.. Actually want a silicone, reusable device, for $230... Which is perfectly fine w/ me, btw.

[Richard B the EMT]

My home area/Primary Area of Response has many public housing developments. It is my pessemistic view that the few evil folks there, who give everyone there a broadstroke bad name, would steal any AED so placed, as I have already seen where stolen standpipe fire hoses and fire extinguishers used to be, replaced, and stolen again.

[Dwight]

My home area/Primary Area of Response has many public housing developments. It is my pessemistic view that the few evil folks there, who give everyone there a broadstroke bad name, would steal any AED so placed, as I have already seen where stolen standpipe fire hoses and fire extinguishers used to be, replaced, and stolen again.

First, my thanks to those who have replied so far, a real eye-opener onto a situation that I suspected was there but is largely unreported. So full of absurdities, like that 4 minute walk and the medical and longterm care buildings with no AED in them.

My mother was in an 'indepenedent living' facility and they were no allowed to even help her up if she fell down. Call 9-1-1? Ridiculous.

As for the theft threat cited above, I think that is a barrier that has to be acknowledged when deploying AEDs. If there's one on every second floor, etc. then the likelihood of theft and vandalism, misuse, unreliability - it's just too high. The meth guys will have a field day selling them for $20 down at the bar.

OTOH, one in the main elevator lobby, where there is much better security, often including video - I think we can hold that fort, and only one device is at stake. Add a good alarm, an enclosure that can dial out to cellphones, that should keep things under control. Also, the residents walking by it every day, discussing it while awaiting the elevator, that would generate a lot of awareness, education, ownership as stakeholders, in an amenity for their personal safety like no others. Lobbies also standard the their location and could build a 1:1 association in the public's mind as where these things are in a crisis - which is needed.

Personally I think that retrieving one in four minutes by elevator is do-able, in my tests it works 90% of the time. With 2 stage elevators you'd need one at each landing, of course.

My own company has applied to place them in the Fire Code beginning 2013, for high rises, and if that passes I think the AED promise will largely be met for big buildings. It's going to be interesting seeing who opposes them.

[Chief1C]

Reason to steal industrial fire hose: Brass couplings. The nozzles are either plastic, adjustable; or smooth brass. Still make them.. They're made to leak, lose pressure, and just be a device to help you exit, not stay and fight the fire.

[usmc_chris]

As to the theft of AED's, they make cabinets to hold them that, when opened, sound an audible and visual warning, as well as placing a 911 call indicating that the AED has been accessed. I know this may not help figuring out who took it, but it certainly indicates that somebody took it. And the audio/visual alarm may be enough to scare off the would-be theft. There are several schools and other facilities in my area that have their AED's linked into 911 in this way.

Whenever a cabinet with an alarm likes this is opened in my area, it generates an Echo level 911 call, with PD, Fire, and EMS all dispatched for the potential cardiac arrest, the run card notates that is the cabinet that has been opened, no call yet to confirm. Another cost, I know, but maybe a deterrent to "misappropriation" of the devices?

Edited April 6, 2011 by usmc_chris