This Special Report for JEMS was published in the October, 1984 issue.

The fifty-first floor of a skyscraper may not seem very remote, but when ambulance crews encounter building access problems, elevators that stop at each floor, and no on-floor guidance to the patient, response times can rival those more normally associated with rural areas.

Large commercial buildings are actually small, vertical communities. They may contain 100 to 10,000 people who work for one or hundreds of different companies. When one employer occupies a building, there is often an established emergency medical plan, perhaps even a response team. However, in multi-tenant buildings, there is little interaction between companies, especially in the event of a medical emergency.

In response to this problem, the New York Business Group on Health (NYBGH) has created an innovative program to bring the spirit of volunteerism to buildings with multiple tenants through the Health Emergency Life-support Program (H.E.L.P.). The program is being cosponsored by the New York City (NYC) EMS. Even though New York has dramatically improved its average response times in the last few years, response times anywhere can be misleading because they don't reflect how long it takes an ambulance crew to navigate a large building to a patient's location.

According to H.E.L.P. project coordinator Michael Kaen, ‘In a multi-tenant building, a medical emergency that would occur in one company would just be dealt with by that one company. With the project, we hope that the tenants’ building service personnel, building owners and operators will all work together during a medical emergency. If there's an over-abundance of medically trained people in one company and none in another company on another floor, one company will benefit another."

Project H.E.L.P. does not intend to get into first-aid_training. Instead, one premise of the program, according to NYBGH executive director Leon J. Warshaw, MD, is that ‘‘in the average building where there may be five or ten thousand people working, there are people already trained in first aid and CPR out of their own good graces. The attractiveness of this is that it deals with the people working in the building as if it was an isolated community."

An important aspect of the plan incorporates personnel from building management, maintenance, and security, and their unions. Someone at a centrally located and consistently staffed position will coordinate the programmed response when needed. Upon being notified of a medical emergency, the doorman or security guard will call 9-1-1, if it hasn't already been done. This person will have received training in the importance of including such additional information as which entrance to use. Revolving doors will be unlocked to accommodate the stretcher, and an elevator for the paramedics will be secured. At the same time, the building's volunteer first responders will be notified via a ‘‘control phone’’ of the location of the emergency; basic first aiders will reach the patient within moments or minutes. Also, a first responder will go to the building lobby to guide the responding crew to the patient.

Thus, the three basic goals of project H.E.L.P. are: to improve the quality of 9-1-1 notification through training conducted by NYC EMS; to improve the response times of the ambulances accordingly; and to provide in-house first responder help.

Three commercial buildings have now been selected for the 18-month pilot program in NYC. One building has 15 tenants and 2000 occupants, and primarily contains light industry. The second has 12 tenants and 275 occupants, and the third, 25 tenants and 500 occupants. According to Kaen, if the idea proves feasible in general, residential buildings also conceivably could institute the plan.

During recruitment of first responders from the first building, Kaen found four EMTs and several people with CPR training. An additional 15 to 20 people are willing to take first aid and/or CPR training, to be provided by other agencies already oriented to first aid and CPR training. (Recruitment for the other two buildings is scheduled for late summer or early fall.)

If the H.E.L.P. program is deemed successful, a handbook, to be written by the NYBGH, will be made available to others interested in implementing H.E.L.P. in their local highrise communities. Once the handbook is complete, according to Warshaw, NYBGH hopes to hand off administration of the program to health-oriented, non-profit service organizations in order to make the program more widely available.

The pilot project is funded by grants from the New York Community Trust and the New York State Prevention Block Grant program, as well as being under-written by NYBGH (which is a coalition of 200 businesses and organizations) and NYC EMS. There is no expense to the buildings involved in the initial project.

Any time a group of people congregate, whether it's on the horizontal expanses of the Great Plains or along the vertical lines of our large cities, a self-contained community exists. Just as quick-response units in backwoods towns in Idaho know their territory, helpers in complex buildings also know their way around their concrete mazes. The response principles are not different — just the circumstances. The New York Business Group on Health has identified the needs reflected by those changed circumstances, and has innovated a good approach to a common problem in EMS: first aid within four to six minutes.

Anyone interested in knowing more about the H.E.L.P. program should contact Mr. Michael Kaen, Project Coordinator, New York Business Group on Health, 1633 Broadway, 46th Floor, New York, New York 10019; 212/397-1260.