The higher you live in a Toronto highrise, the lower your chance of surviving a cardiac arrest.
In fact, on the highest floors of a building the survival rate from such a serious medical incident drops to zero, according to a medical study.
Two medical tools can mean the difference between life and death when someone’s heart stops beating: CPR and access to a defibrillator. The lack of quick access to either poses a serious danger in the tall buildings being added to Toronto’s skyline.
It’s why council’s planning and housing committee voted on Wednesday to look into whether the city can make it compulsory to have automated external defibrillators (AED) on-site in highrises.
The Heart and Stroke Foundation describes a cardiac arrest as an electrical problem, where the heart stops beating. A heart attack is more like a plumbing problem, in which blood flow to the heart is interrupted.
Retired paramedic Roberta Scott told the committee that without CPR and an AED being started before first responders arrive, any advanced medical interventions they perform become almost futile to preventing death or permanent disabilities.
“But very often when paramedics arrive at the scene of a cardiac arrest, no CPR is being performed and no AED is found or used,” Scott told committee.
Only 10 per cent of those who suffer a cardiac arrest outside of a hospital survive, but Scott, who is now the director of AED Foundation Ontario, said the general survival rate can increase to as much as 60 per cent with easy access to the devices.
Scott told the committee about being called to a downtown intersection years ago for an 18-year-old who had suffered a cardiac arrest.
She said he had no history of medical or heart problems. But Scott said she arrived too late: the young man died.
“CPR and a shock from an (AED) may have saved his life,” she said. “Those calls were some of my most difficult and heart wrenching.”
A 2016 study in the Canadian Medical Association Journal showed a person’s chance of survival drops dramatically in highrises because CPR and defibrillation are delayed as a result of elevator wait or travel times, locked lobbies, concierge access protocols and on-site AEDs that are hard to find.
According to the study, the survival rate for those below the third floor is 4.2 per cent compared to 2.6 per cent above the third floor. It drops further — to 0.9 per cent above the 16th floor and there are normally no survivors above the 25th floor.
When the heart stops beating and deprives organs of oxygen, Scott noted that every minute without CPR and defibrillation to restart the heart significantly increases the likelihood of death.
“Those first few minutes really matter. Within a few minutes alone, brain damage occurs,” said Dr. Lesley James, director of health policy and systems at the Heart and Stroke Foundation, in an interview. “And sometimes EMS can take seven, eight, nine minutes. In Toronto traffic it might be upwards of 20 minutes.”
Studies show most out-of-hospital cardiac arrests happen inside people’s homes.
Yet the majority of Toronto’s AED kits, costing about $1,000 to $5,000 each, are largely in schools, airports, recreation centres, libraries and municipal buildings on a voluntary basis.
Ontario currently only mandates the kits to be at construction sites. Other provinces, like Manitoba, have mandated the devices in high-traffic public spaces.
With residential buildings, “it’s really up to the landlord at this point or the condo board or the housing association,” James said. She pointed to cities like Los Angeles and Seattle where AEDs have been mandated in high density places, such as apartment buildings or subways, as having “really better” survival rates.
James noted when someone is performing CPR and using a defibrillator it doubles the chance of survival.
“That’s why it’s so hugely important to have AEDs on multiple floors in highrise buildings, so that a bystander can start using the (defibrillator) and start CPR until (paramedics) gets there and take over to do more work.”
Similar to fire extinguishers, AEDs come with layman’s instructions.
James said that after noticing the signs of a cardiac arrest — difficulty breathing, laboured breaths, sudden collapse — residents should call 911 and, thanks to the new provincial registry, a dispatcher can geolocate the nearest AED.
“So you start CPR, you start pressing on the chest, and apply the (defibrillator) pads. The machine makes an analysis and if there’s a shockable rhythm, the AED will do that,” James said. “It won’t shock someone if the shock isn’t needed. The AED makes that assessment and it’s really foolproof.”
James noted that Ontario’s Good Samaritan Law “thankfully” protects bystanders from liability and lawsuits if they intervene.
“If someone’s gone into cardiac arrest, you can’t do any more damage,” she said. “They’re already on the path toward death.”
