Rise and Shock: Optimal Defibrillator Placement in a High-rise Building.

OBJECTIVE: 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.

METHODS: We developed a model of a single-elevator, n-floor high-rise building. We calculated and compared the average distance from AED to floor of arrest for the two AED locations. We modeled OHCA occurrences using floor-specific Poisson processes, the risk of OHCA on the ground floor (λ1 ) and the risk on any above-ground floor (λ). The elevator was modeled with an override function enabling direct travel to the target floor. The elevator location upon override was modeled as a discrete uniform random variable. Calculations used the laws of probability.

RESULTS: Elevator-based AED placement had shorter average response distance if the number of floors (n) in the building exceeded three quarters of the ratio of ground-floor OHCA risk to above-ground floor risk (λ1 /λ) plus one half (n ≥ 3λ1 /4λ + 0.5). Otherwise, a lobby-based AED had shorter average response distance. If OHCA risk on each floor was equal, an elevator-based AED had shorter average response distance.

CONCLUSIONS: Elevator-based AEDs travel less vertical distance to OHCAs in tall buildings or those with uniform vertical risk, while lobby-based AEDs travel less vertical distance in buildings with substantial lobby, underground, and nearby street-level traffic and OHCA risk.