Here’s a big dose of schadenfreude for your morning, if you are looking up at all those Pikettyscrapers housing the rich in New York, London and Toronto: the higher you are in those buildings, the more likely you are to die of a heart attack.

A recent study, just published in the Canadian Medical Association Journal, examined the death rate from cardiac arrests and came up with the disturbing results. The study looked at the rate of survival to hospital discharge and found significant differences between living low and living high:

During the study period, 7842 cases of out-of-hospital cardiac arrest met the inclusion criteria, of which 5998 (76.5%) occurred below the third floor and 1844 (23.5%) occurred on the third floor or higher. Survival was greater on the lower floors (4.2% v. 2.6%, p = 0.002). Lower adjusted survival to hospital discharge was independently associated with higher floor of patient contact, older age, male sex and longer 911 response time. In an analysis by floor, survival was 0.9% above floor 16 (i.e., below the 1% threshold for futility), and there were no survivors above the 25th floor.
Really, the numbers are pretty depressing wherever you live, with only 4.2 percent of people living on the first three floors, but it appears that if you live above the 16th floor your chances of survival are between 0 and 1 percent. It’s all about the time it takes to get the paramedics; the study notes that every one-minute delay to defibrillation reduces survival rate by 7 to 10 percent. According to the study’s lead author, paramedic Ian Drennan,quoted in the Star:

Building access issues, elevator delays and extended distance from the emergency vehicle to the patient can all contribute to longer times for 911-initiated first responders to reach the patient and start time-sensitive, potentially life-saving resuscitation.

And money won’t save you either; according to Dr. Laurie Morrison, another study author, “It doesn’t matter whether you’re poor, middle class or high class, it’s just the vertical that makes a difference.” Morrison notes that above the 25th floor, “They all died. It’s like the higher you go the more isolated you become.”

Some recommendations from the report were listed in a press release from Toronto’s St. Michael’s Hospital:

  • Improving the accessibility of AEDs by placing them on specific floors, in building lobbies or inside elevators so that they can be easily delivered to the floor of the cardiac arrest, saving precious minutes and ensuring rapid defibrillation.
  • Give paramedics a universal elevator key similar to what firefighters have, giving them sole access to elevators without public interference.
  • Find ways to alert building security to the fact 911-initiated first responders are en route so they can have easy access to the building and elevators waiting on the main floor.
Drennan is quoted in the release as well:
With a rapidly deteriorating heart rhythm, in the absence of bystander CPR and defibrillation, cardiac arrests that occurred on higher floors may have a lower probability of survival due to the delay to patient contact by 911-initiated first responders. This early period is essential for bystander interventions by a family member, friend or other willing person to improve survival.”

​So yet another reason to build at the Goldilocks Density, or at least to train the doorman in CPR.

Lloyd Alter (@lloydalter) Design / Urban Design