title: Delays in the EMS response to and the evacuation of patients in high-rise buildings in Singapore.
abstract: BACKGROUND
  Singapore is a highly urbanized and cosmopolitan city situated at the crossroads of Southeast Asia. High-rise buildings and "vertical living" are common, and the city serves as a major business, financial, and industrial hub in the region. More than 80% of the population live in high-rise apartments. This poses unique problems and challenges for emergency ambulance services personnel in the access to and evacuation of patients.
  
  
  OBJECTIVE
  To estimate the arrival-to-patient contact delay when accessing patients in high-rise buildings and evacuating them to the hospital, compared with accessing patients in ground-level premises.
  
  
  METHODS
  This was a prospective study carried out from February 2 to March 1, 1998, for emergency calls from two of the busiest fire stations. The first 150 consecutive cases were enrolled into each of the two groups. Cases of road traffic accidents were excluded because these did not require the crew to get into a building. The times were clocked by one of the paramedics, using a stopwatch. A high-rise building was defined as one where the crew had to ascend at least one flight of stairs. A ground-level building did not involve any stair climbing. We set forth to determine whether the interval between the following was statistically significant when comparing high-rise vs ground-level premises: 1) time when the ambulance arrives at the scene (taken as the time when the driver turns the engine off) and time of arrival at the patient's side; 2) time of leaving the dwelling with the patient and time when the ambulance starts its journey to the hospital (taken as the time when the driver starts the engine). Data analysis was done with the use of SPSS, and the one-tailed unpaired Student's t-test was used for significance testing, with the alpha error rate set at 0.05. Results. One hundred fifty runs were analyzed for each group. The mean delay from arrival to patient contact was 2.49 +/- 0.98 minutes for the high-rise group compared with 1.02 +/- 1.41 minutes for the ground-level group (difference was statistically significant with 95% CI: 1.20, 1.74 minutes; p = 0.0106). The mean delays from the time of leaving the building with the patient to the time when the ambulance turned its engine on to start its journey to the hospital were 3.24 +/- 1.58 minutes and 1.27 +/- 0.71 minutes for the two groups, respectively (difference was statistically significant with 95% CI: 1.68, 2.04 minutes; p = 0.0098).
  
  
  CONCLUSIONS
  There were significant delays present when accessing patients in high-rise buildings and evacuating them to the hospital. Modification to buildings and increasing public awareness and education have been suggested to help minimize these delays.
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore. f_lateef@hotmail.com
authors.forename: F
authors.initials: F
authors.lastname: Lateef
authors.forename: V
authors.initials: V
authors.lastname: Anantharaman
mesh_terms: D000552:Ambulances / Q000706:statistics & numerical data*; D003625:Data Collection; D004607:Elevators and Escalators; D004632:Emergency Medical Services / Q000379:methods*; D004779:Environment Design; D005160:Facility Design and Construction; D006798:Housing; D006801:Humans; D011156:Population Density; D012846:Singapore; D013997:Time Factors; D013996:Time and Motion Studies; D019037:Urban Health Services