Late for SCA's in high rises?

[Richard B the EMT]

Addendum to my previous post: In the project buildings, which are usually 6 to 13 stories high, sometimes they only have one elevator. Numerous times, the elevator can be out for months at a time.

While a nice idea to install an alarmed AED storage box by the elevator on the lobby, most times, there's nobody in the lobby to see or hear. Also, who is to say the thief lives in the building, let alone that particular project complex? No connection to whatever civic pride may be in existence in the tenant association.

[Dwight]

Addendum to my previous post: In the project buildings, which are usually 6 to 13 stories high, sometimes they only have one elevator. Numerous times, the elevator can be out for months at a time.

While a nice idea to install an alarmed AED storage box by the elevator on the lobby, most times, there's nobody in the lobby to see or hear. Also, who is to say the thief lives in the building, let alone that particular project complex? No connection to whatever civic pride may be in existence in the tenant association.

Hi Richard;

I do agree that there are scenarios that are a little too exposed to be realistic for open cabinets. In the buildings you cite, there may be an apartment manager on site, and in that instance he/she might have a key to a locked enclosure, or be the keeper of the AED itself.

In the latter case, that building would lose much of the educational value of having a visible PAD, but at least it would be there. Hopefully it wouldn't add more than a minute to the response time. The people in such straits must take some responsibility as well - this is not a big money issue.

There are tens of millions of well-heeled people right across America right now, living and working in fancy tower buildings with much less protection than a grouchy old landlady can provide.

So it's not a problem just for the poor, it's an endemic failure to properly deploy a device we all have a right to access in a crisis.

[Eydawn]

I also vote for AED availability and think it would be feasible. Real crux is, are you going to be providing or advocating community responder training in these buildings? If there's nobody around who knows what an AED is, let alone where to find it or a general gist of how to use it... I know they're designed to be idiot proof, but lack of confidence deters many from stepping in to help, especially in our lawsuit-happy society.

***Mini thread hijack...****

On the assisted living note, look at it this way-- the people working in independent living and assisted living settings are often given no-to-minimal training in proper lifting technique or medical assessment. Do you really want high school Suzie, whose job is mostly to help put shoes on and fetch things, trying to lift your loved one off the ground? She could definitely do more harm than good, especially if there's one of those hip fractures that doesn't manifest itself until grandma tries to bear weight... you definitely want someone to know how to gently get them back to the ground or into a chair at that point...

As far as the CPR goes, many "non-skilled" facilities have been sued because the care providers did CPR and grandma died anyway or survived, but with broken ribs. Why were the suits successful? Because a facility that provides CPR should also be able to provide assessment by a nurse in order to provide proper care... so the logic goes... It's all a game of dodge the lawyer. Everyone living in said facilities signs a waiver stating that they understand that staff do not provide CPR and that community emergency response times may be long enough that even if you are full code it may do no good.

I've yet to hear someone freaking out about it, and it took me a LONG TIME to get used to the idea in my building (I work in a no-CPR, minimal lift assisted living... we can get 'em off the floor but only if nobody lifts more than 50 pounds and the person is helping you to get them off the floor in some way.) We have LPNs during the day... and to be honest, I'm not sure if they do CPR either. We certainly don't have any suction, and can't initiate any O2 on anyone (or change the setting on their concentrator) without a direct doctor's order... so the fastest way to get any of that is usually to call 911.

What really chaps me, is that I'm considered an "unskilled" provider and therefore, not supposed to take vitals, yet I'm a night shift manager. (It's just my assisted living that feels this way, others in my area allow non-nursing staff to do vitals). I have no nurse at night. Therefore, when I call EMS, I end up having to explain to them "no, folks... I have no vitals for you, it's technically out of my scope." I am allowed (wink wink, nod nod) to use the pulse oximeter, so that's usually the only thing I have. If it's something iffy enough that I'm having trouble making up my mind on whether the person needs to go out, I take a full set of vitals protocols be damned, but you bet I don't chart them...

Boy, that's a fun grey zone to be playing in...

**returning thread from hijack**

Wendy

CO EMT-B

[Richard B the EMT]

Dwight, I must presume you are unaware of how the NYC Housing Authority works. They might have one office in a complex of 10 or more buildings, opened from 9 to 5, week days only. If there is a problem outside those hours, you have to call a central number, where, if lucky, someone answers, and then responds the nessesary personnel and equipment. Said repair personnel might not even be from the same county within the city.

FYI, NYC consists of 5 counties (we call them boroughs).

[Dwight]

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?

I advocate elevator lobbies because they have maximum security, often video, and are public. After that it becomes a community character problem, which I have no alternative to as yet. An audible alarm is pretty effective, beyond that dial-out cellphone calls form another security layer.

Between these safeguards, and the eventual familiarity that AEDs will earn among these 'vertical communities', I think they'll be ignored like fire extinguishers, as a target of curiosity, in good time. But education must soak in first.

I also vote for AED availability and think it would be feasible. Real crux is, are you going to be providing or advocating community responder training in these buildings? If there's nobody around who knows what an AED is, let alone where to find it or a general gist of how to use it... I know they're designed to be idiot proof, but lack of confidence deters many from stepping in to help, especially in our lawsuit-happy society.

Wendy

CO EMT-B

When I have delivered AED PADs to customers I am always struck by the reverence they have, and express upon their arrival. They indicate their gratitude to me, but I am just the dashing installer dude. They are moved by this heart-partner sentinel now in their midst.

From there the AED makes its own friends - through awareness, discussion, and the Web. Nothing like keen amateurs.