Out-of-hospital cardiac arrest in high-rise buildings: delays to patient care and effect on survival
- CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
- Published almost 2 years ago
increasing number of people living in high-rise buildings presents unique challenges to care and may cause delays for 911-initiated first responders (including paramedics and fire department personnel) responding to calls for out-of-hospital cardiac arrest. We examined the relation between floor of patient contact and survival after cardiac arrest in residential buildings.
We measured size-resolved PNCs in the 5-560 nm range at two different types (4- and 3-way) of TIs in Guildford (Surrey, UK) at fixed sites (∼1.5 m above the road level), sequentially at 4 different heights (1, 1.5, 2.5 and 4.7 m), and along the road at five different distances (10, 20, 30, 45 and 60 m). The aims were to: (i) assess the differences in PNCs measured at studied TIs, (ii) identify the best fit probability distribution curves for the PNCs, (iii) determine vertical and horizontal decay profiles of PNCs, (iv) estimate particle number emission factors (PNEFs) under congested and free-flow traffic conditions, and (v) quantify the pedestrian exposure in terms of respiratory deposition dose (RDD) rates at the TIs. Daily averaged particle number distributions at TIs reflected the effect of fresh emissions with peaks at 5.6, 10 and 56 nm. Despite the relatively high traffic volume at 3-way TI, average PNCs at 4-way TI were about twice as high as at 3-way TI, indicating less favourable dispersion conditions. Generalised extreme value distribution fitted well to PNC data at both TIs. Vertical PNC profiles followed an exponential decay, which was much sharper at 4-way TI than at 3-way TI, suggesting ∼40% less exposure for people at first floor (4.7 m) to those at ground floor around 4-way TI. Vertical profiles indicated much sharper (∼132-times larger) decay than in horizontal direction, due to close vicinity of road vehicles during the along-road measurements. Over an order of magnitude higher PNEFs were found during congested, compared with free-flow, conditions due to frequent changes in traffic speed. Average RDD rate at 4-way TI during congested conditions were up to 14-times higher than those at 3-way TI (0.4 × 10(11) h(-1)). Findings of this study are a step forward to understand exposure at and around the TIs.
The WHO Consensus Document on the epidemiology of the SARS epidemic in 2003, included a report on a concentrated outbreak in one Hong Kong housing block which was considered a ‘super-spreading event’. The WHO report conjectured that the sanitary plumbing system was one transmission route for the virus. Empty U-traps allowed the aerosolised virus to enter households from the sewerage system. No biological evidence was presented. This research reports evidence that pathogens can be aerosolised and transported on airstreams within sanitary plumbing systems and enter buildings via empty U-traps. A sanitary plumbing system was built, representing two floors of a building, with simulated toilet flushes on the lower floor and a sterile chamber with extractor fan on the floor above. Cultures of a model organism, Pseudomonas putida at 106-109 cfu ml-1 in 0·85% NaCl were flushed into the system in volumes of 6 to 20 litres to represent single or multiple toilet flushes. Air and surface samples were cultured on agar plates and assessed qualitatively and semi-quantitatively. Flushing from a toilet into a sanitary plumbing system generated enough turbulence to aerosolise pathogens. Typical sanitary plumbing system airflows (between 20-30 ls-1) were sufficient to carry aerosolised pathogens between different floors of a building. Empty U-traps allowed aerosolised pathogens to enter the chamber, encouraging cross-transmission. All parts of the system were found to be contaminated post-flush. Empty U-traps have been observed in many buildings and a risk assessment indicates the potential for high risk cross-transmission under defect conditions in buildings with high pathogen loading such as hospitals. Under defective conditions (which are not uncommon) aerosolised pathogens can be carried on the airflows within sanitary plumbing systems. Our findings show that greater consideration should be given to this mode of pathogen transmission.
Living in high-rise buildings could influence the health of residents. Previous studies focused on structural features of high-rise buildings or characteristics of their neighbourhoods, ignoring differences within buildings in socio-economic position or health outcomes. We examined mortality by floor of residence in the Swiss National Cohort, a longitudinal study based on the linkage of December 2000 census with mortality and emigration records 2001-2008. Analyses were based on 1.5 million people living in buildings with four or more floors and 142,390 deaths recorded during 11.4 million person-years of follow-up. Cox models were adjusted for age, sex, civil status, nationality, language, religion, education, professional status, type of household and crowding. The rent per m(2) increased with higher floors and the number of persons per room decreased. Mortality rates decreased with increasing floors: hazard ratios comparing the ground floor with the eighth floor and above were 1.22 [95 % confidence interval (CI) 1.15-1.28] for all causes, 1.40 (95 % CI 1.11-1.77) for respiratory diseases, 1.35 (95 % CI 1.22-1.49) for cardiovascular diseases and 1.22 (95 % CI 0.99-1.50) for lung cancer, but 0.41 (95 % CI 0.17-0.98) for suicide by jumping from a high place. There was no association with suicide by any means (hazard ratio 0.81; 95 % CI 0.57-1.15). We conclude that in Switzerland all-cause and cause-specific mortality varies across floors of residence among people living in high-rise buildings. Gradients in mortality suggest that floor of residence captures residual socioeconomic stratification and is likely to be mediated by behavioural (e.g. physical activity), and environmental exposures, and access to a method of suicide.
The city of London, UK, has seen in recent years an increase in the number of high-rise/multi-storey buildings (“skyscrapers”) with roof heights reaching 150 m and more, with the Shard being a prime example with a height of ∼310 m. This changing cityscape together with recent plans of local authorities of introducing Combined Heat and Power Plant (CHP) led to a detailed study in which CFD and wind tunnel studies were carried out to assess the effect of such high-rise buildings on the dispersion of air pollution in their vicinity. A new, open-source simulator, FLUIDITY, which incorporates the Large Eddy Simulation (LES) method, was implemented; the simulated results were subsequently validated against experimental measurements from the EnFlo wind tunnel. The novelty of the LES methodology within FLUIDITY is based on the combination of an adaptive, unstructured, mesh with an eddy-viscosity tensor (for the sub-grid scales) that is anisotropic. The simulated normalised mean concentrations results were compared to the corresponding wind tunnel measurements, showing for most detector locations good correlations, with differences ranging from 3% to 37%. The validation procedure was followed by the simulation of two further hypothetical scenarios, in which the heights of buildings surrounding the source building were increased. The results showed clearly how the high-rise buildings affected the surrounding air flows and dispersion patterns, with the generation of “dead-zones” and high-concentration “hotspots” in areas where these did not previously exist. The work clearly showed that complex CFD modelling can provide useful information to urban planners when changes to cityscapes are considered, so that design options can be tested against environmental quality criteria.
The bacterial community structures in four Japanese split-type air conditioners were analyzed using a next-generation sequencer. A variety of bacteria were detected in the air filter of an air conditioner installed on the first floor. In the evaporator of this air conditioner, bacteria belonging to the genus Methylobacterium, or the family of Sphingomonadaceae, were predominantly detected. On the other hand, the majority of bacteria detected in the air filters and evaporators of air conditioners installed on the fifth and twelfth floors belonged to the family Enterobacteriaceae. The source of bacteria belonging to the family Enterobacteriaceae may have been aerosols generated by toilet flushing in the buildings. Our results suggested the possibility that the bacterial contamination in the air conditioners was affected by the floor level on which they were installed. The air conditioner installed on the lower floor, near the ground, may have been contaminated by a variety of outdoor bacteria, whereas the air conditioners installed on floors more distant from the ground may have been less contaminated by outdoor bacteria. However, these suppositions may apply only to the specific split-type air conditioners that we analyzed, because our sample size was small.
Conventional seismic rehabilitation methods may not be suitable for some buildings owing to their high cost and time-consuming foundation work. In recent years, viscoelastic dampers (VEDs) have been widely used in many mid- and high-rise buildings. This study introduces a viscoelastic passive control system called rotary rubber braced damper (RRBD). The RRBD is an economical, lightweight, and easy-to-assemble device. A finite element model considering nonlinearity, large deformation, and material damage is developed to conduct a parametric study on different damper sizes under pushover cyclic loading. The fundamental characteristics of this VED system are clarified by analyzing building structures under cyclic loading. The result show excellent energy absorption and stable hysteresis loops in all specimens. Additionally, by using a sinusoidal shaking table test, the effectiveness of the RRBD to manage the response displacement and acceleration of steel frames is considered. The RRBD functioned at early stages of lateral displacement, indicating that the system is effective for all levels of vibration. Moreover, the proposed damper shows significantly better performance in terms of the column compression force resulting from the brace action compared to chevron bracing (CB).
Health risk of populations dwelling in the hospital has been a global concern, but has not been adequately examined. PM2.5 and PM1 samples were collected in two indoor locations (outpatient department and inpatient department) and one outdoor location (courtyard) of the hospital in Shanghai. The concentrations of size-fractionated trace metals and the morphology of single particles were determined to accurately assess the health risk for populations in the hospital. The results indicated that the mean concentrations of PM2.5 and PM1 were in the order of outpatient department>courtyard>inpatient department. The mean concentrations of PM1 decreased with floors (first floor: 78.0μg/m(3), second floor: 64.1μg/m(3), fourth floor: 48.4μg/m(3)). However, the mean PM2.5 concentrations were in the order of first floor (124.0μg/m(3))>fourth floor (91.4μg/m(3))>second floor (90.6μg/m(3)), which was likely associated with the number of patients. The PM2.5 and PM1 concentrations have begun to increase rapidly from 9:00am and decreased after 15:00pm in the first floor, whereas they remain relatively stable in the second and fourth floor. The abundance of Mg, Ca, Al and K in the fine particles and coarse particles were both higher than other elements for all floors. The concentrations of trace metals (e.g., Zn, Ba, Fe, Mn, Cr, Ca, Ti, Na, and K) except Mg and Al in the coarse particles (>2.5μm) decreased with floors, whereas Zn, Ba, Fe, and Cr in the fine particles (<2.5μm) displayed opposite variation. Trace metals in the first floor were mainly concentrated in the >2.5μm and 1-2.5μm, whereas they chiefly peaked at 0.25-0.5μm and below 0.25μm in the second and fourth floor. Single particles analysis showed that mineral particles, soot, and Fe-rich particles were mainly concentrated in the first floor, indicating the impacts of walking of patients, traffic emissions, and food cooking, respectively. Sulfate particles were internally mixed with soot, fly ash and Fe-rich particles in the second floor, which suggested that these sulfate particles probably underwent aging processes during the atmospheric long-range transport. In the fourth floor, fly ash, sulfate particles, Zn-rich particles, and biogenic particles were identified under the transmission electron microscopy (TEM). Higher abundance of sulfates and absence of chlorate hinted existence of heterogeneous reactions during long-range transport with the Cl(-) replaced by SO4(2-). The index of average daily intake (ADI), hazard quotient (HQ), and carcinogenic risks (CR) indicated that Cr pose carcinogenic risks to the surrounding populations, while non-carcinogenic risks of Mn, Zn, and Cr were not remarkable.
- Environmental science and pollution research international
- Published 12 months ago
Diesel exhaust (DE) emissions from a parking garage located in the basement of a school were characterized during spring and winter using direct reading devices and integrated sampling methods. Concentrations of CO and NO2 were evaluated using electrochemical sensors and passive colorimetric tubes, respectively. Elemental and total carbon concentrations were measured using the NIOSH 5040 method. Particle number concentrations (PNCs), respirable particulate matter (PMresp) mass concentrations, and size distributions were evaluated using direct reading devices. Indoor concentrations of elemental carbon, PNC, CO, and NO2 showed significant seasonal variation; concentrations were much higher during winter (p < 0.01). Concentrations of the PMresp and total carbon did not show significant seasonal variation. Pearson correlation coefficients were 0.9 (p < 0.01) and 0.94 (p < 0.01) between the parking garage and ground floor average daily PNCs, and between the parking garage and first floor average daily PNCs, respectively. Since DE is the main identified source of fine and ultrafine particles in the school, these results suggest that DE emissions migrate from the parking garage into the school. Our results highlight the relevance of direct reading instruments in identifying migration of contaminants and suggest that monitoring PNC is a more specific way of assessing exposure to DE than monitoring the common PMresp fraction.
Out-of-hospital cardiac arrests (OHCA) in high-rise buildings experience lower survival and longer delays until paramedic arrival. Use of publicly accessible automated external defibrillators (AED) can improve survival, but “vertical” placement has not been studied. We aim to determine whether elevator-based or lobby-based AED placement results in shorter vertical distance travelled (“response distance”) to OHCAs in a high-rise building.