Arrests in high-rise buildings - EMS vs AED PADs

[ElevAED]

I'm an AED consultant with a focus on high-rise buildings, which I consider to be needlessly dangerous places to have a sudden cardiac arrest (SCA).

Why are they dangerous? Because EMS can't reliably get there in time, what with city traffic, address confusion, entrance and elevator security, etc. I don't think that situation will ever change - traffic and the human heart won't, for sure.

So I separate EMS vehicular rescues from AED in-house events. There is every prospect that a shock will be delivered in time if the AED is already in the building. From there I see EMS as consolidating the rescue.

I'd like to see FF's adopt AEDs as part of their inspection routine, and I have proposed to the International Fire Code secretariat that they include a provision for AEDs in every elevator lobby by 2013. See my website for the details - an alliance with FF's & the AED industry makes sense for me. You guys need an expanded health safety mandate (no?), and we need IFC support to get AEDs deployed intelligently. Where the public can see, learn about, and access them independently.

Is the "four minute limit" needed for successful AED shocks being met at all, in your experience, by EMS crews?

Your suggestions here would be much appreciated - I do want to understand vehicular SCA rescue realities - if I'm up on a high horse please let me know...

[nmfire]

Well obviously the AED industry would be in favor of this. It would be billions of dollars in income.

When you say every elevator lobby, so you mean every elevator lobby of every floor or just the main lobby floor? And the inevitable next question is.......... Who do you propose pay for those thousands of new AED's and their repetitive maintanence requirements?

[DeputyMarshal]

I'd like to see FF's adopt AEDs as part of their inspection routine, and I have proposed to the International Fire Code secretariat that they include a provision for AEDs in every elevator lobby by 2013

While I don't disagree that having more S/AEDs in public building areas would be a Good Thing(TM)*, I think you're barking up the wrong tree.

S/AEDs -- and where they should be located -- its really a bit outside of the ICC's mandate (ICC is the code agency that writes the IBC & IFC). (It's also outside of the mandate of many fire departments and fire inspection officials.) I don't think you're going to get much traction with the ICC on this.

*(Provided someone comes up with a plan for who is going to license them, maintain them, and accept liability for them...)

[ElevAED]

Well obviously the AED industry would be in favor of this. It would be billions of dollars in income.

The AED industry needs to rationalize its deployment issues and be more efficient. The public needs to know where these are and learn about them. Otherwise the industry risks erosion of its reputation as a cost-effective device.

When you say every elevator lobby, so you mean every elevator lobby of every floor or just the main lobby floor?

Just the main lobby. Serves the whole building, good security, visible and accessible to the building residents and workers.

And the inevitable next question is.......... Who do you propose pay for those thousands of new AED's and their repetitive maintanence requirements?

The building owners, the same way they pay for fire extinguishers. The repetitive maintenance is about the same, every two years. I would hope that firefighter administration could inspect their tags the same way as extinguishers.

[ElevAED]

While I don't disagree that having more S/AEDs in public building areas would be a Good Thing(TM)*, I think you're barking up the wrong tree. *(Provided someone comes up with a plan for who is going to license them, maintain them, and accept liability for them...)

Can you suggest a tree that would be promising? And please, not the same ones all the politicians are peeing on. There's not enough money in this business to interest them, fund lobbyists or earmarks. Dealing with the Fed/States/Counties/Municipalities across 50 states? That's what we do now..

Better to try with fire people who understand these buildings, and engineers, and work from the bottom up. Then it can be copied worldwide, and the public will associate elevator lobbies with AEDs - a huge step forward.

The industry takes care of licensing and maintenance. Liability is higher now if you neglect AED adoption.

S/AEDs -- and where they should be located -- its really a bit outside of the ICC's mandate (ICC is the code agency that writes the IBC & IFC). (It's also outside of the mandate of many fire departments and fire inspection officials.) I don't think you're going to get much traction with the ICC on this.

On page 1 of the 2009 IFC code, it begins:

101.2 Scope. This code establishes regulations affecting or
relating to structures, processes, premises and safeguards
regarding:
1. The hazard of fire and explosion arising from the storage,
handling or use of structures, materials or devices;
2. Conditions hazardous to life, property or public welfare
in the occupancy of structures or premises;

So we are discussing "Safeguards..Conditions hazardous to life, property or public welfare in the occupancy of structures or premises."

What is the hazardous condition here, to life or public welfare? It's late defibrillation, which can arise for two reasons:

a) Vehicular EMS cannot reach SCA victims under four minutes reliably.
b) There is no AED in-house.

THE ICC/IFC are sticklers for wording. If you don't say it, in plain English, it won't happen, because the codes have to all be congruent with each other. So here is my wording:

“408.12.1" Public Access Defibrillation. Elevator lobbies shall include one automated external defibrillator (AED) in an approved location.”

OTOH, Scope item 2 above clearly supports AEDs if they are out of range, outside a 2 minute radius, because then your chance of surviving an SCA, killing 360,000 Americans a year - is near zero.

So I think the IFC examiners will have to ask themselves one thing:

Are AEDs are of such little value that one $2000 PAD is too much to impose on the building owners, or fire dept inspection - one device protecting hundreds of people - if so, what are they good for?

And before that they have to ask themselves: what is it costing us to arrive late to arrests, ladder trucks through heavy traffic, multiple ambulances? In other words, is anybody else protecting these people properly if we decline this addition to the code?

Their answer will affect many lives, I can tell you.

The fire infrastructure in this country is a hundred times the size of the AED industry, and SCA's take a hundred times more lives.

I think this situation points to the fire people expanding their mandate a little into health safety, to do for hearts what they've done (with the IBC) for fire risk.

[islandfire03]

The problem as I see it is even if you require an AED in every building they require someone present to go get it and use it on the victim of SCA. At the same time hopefully someone has started compression only CPR to keep the blood circulation to the brain and heart muscle.

You are correct that not having one in a large occupancy building may increase liability, but so would having one and nobody trained and certified to use when needed.

You can't count on bystanders to apply and use an AED or to do CPR.

[ElevAED]

You are correct that not having one in a large occupancy building may increase liability, but so would having one and nobody trained and certified to use when needed.

There is no training or certification required.

You can't count on bystanders to apply and use an AED or to do CPR.

If one is always in the lobby the AED will draw attention to itself, its "vertical community" will embrace the device as an amenity that is there for such moments.

I do agree that the present lack of AEDs does leave them outside most people's radar entirely - something that will change when it's there to discuss while you await the elevator.

It's up to safety professionals like ourselves to assess these risks for them, to see that people in towers are isolated from EMS, and to move the critical device in tighter for them.