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ESC102 Engineering Science Praxis II

Spring 2012

|Request for Proposal:

Reducing EMS Vertical Response Time for High-Rise

Buildings in Church-Yonge Corridor Neighbourhood

February 19th, 2012

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ABSTRACT

Toronto Emergency Medical Services (EMS) is the sole provider of ambulance service in the City of

Toronto1. This RFP identifies the exclusion of vertical response time, which is measured from arrival

on-scene to arrival at-patient, fromthe current definition of EMS response time. Furthermore, this

proposal investigates the key factors that increase vertical response time and explores the significance

of the need to reduce vertical response time which reduces patients‟ impairmentand increases the

survival rate of acute emergencies.

More specifically, this RFP focuses on addressing the issue of vertical response time in Church-

Yonge Corridor Neighbourhood, due to its high density of high-rise buildings2 and relatively high rate

of emergency department visits among its population, comparing to the rate of the entire City of

Toronto3. The high ratio of emergency department visits is due to high density of people who live is

high-rise buildings in this neighbourhood. The engineering problem is to provide a more accessible

solution for EMS to reach the patients who live on fifth floor or above. Through the interview with

EMS paramedics, the proposal confirms the genuine need of the community to reduce vertical

response time.

With the objective of reducing vertical response time, the design implementation must consider the

needs, positions, and actions of stakeholders, such as ambulance patient and EMS paramedics. The

solution must take into account the design‟s functionality with consideration of singly responsible

ambulance services, the safety of all the stakeholdersand the response time standard. With an

improved design, patients who live in high-rise buildings in Church-Yonge Corridor Neighbourhood

will have a lower risk of mortality.

References:

[1] Toronto Emergency Medical Services, "Toronto Emergency Medical Services Overview," 2012. [Online].

Available: http://www.torontoems.ca/main-site/about/ems-overview.html. [Accessed 15 February 2012].

[2] Statistics Canada, "Church-Yonge Corridor (75) Social Profile #3- Neighborhoods Families & Dwellings,"

2006. [Online]. Available: http://www.toronto.ca/demographics/cns_profiles/2006/pdf3/cpa75.pdf.

[Accessed 14 February 2012].

[3] Toronto Community Health Profile Partnership, "N75 – Church-Yonge Corridor Profile: Emergency

Department Care," 2009. [Online]. [Accessed 18 February 2012].

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Request for Proposal

Reducing EMS Vertical Response Time for High-Rise

Buildings in Church-Yonge Corridor Neighbourhood

1. Introduction

Toronto Emergency Medical Services (EMS) provides emergency ambulance service to the City of

Toronto [1]. In 2011, EMS receives over 334,000 calls, which had increased by 21.4% since 1998[2].

EMS response time is a key indicator of evaluating the performance of EMS [3]. According to

Ministry of Health and Long-Term Care, EMS response time is defined as the elapsed time from the

notification of the ambulance crew by the ambulance dispatcher of a patient requiring emergency

care, to the arrival of the ambulance crew at the scene[3]. However, this measurement does not

include vertical response time, which is defined as the time interval from arrival on-scene to arrival at

the patient‟s side in high-rise buildings. The purpose of this proposal is to identify the significance of

vertical response time in EMS and the need of reducing EMS vertical response time in buildings, in

order to increase accessibility to emergency medical attention and improve the survival rate of

ambulance patients. This proposal first examines the impact of vertical response time, identifies the

critical factors of this issue. Furthermore, based on the background information and existing problems

of the chosen community: Church- Yonge Corridor Neighbourhood, the proposal explores the genuine

need of reducing EMS vertical response time. Finally, it proposes project requirements and criteria for

this issue with reference to current solutions.

2. Framing as an Engineering System Problem

Based on our defined understanding of “engineering design”, this section identifies the significance of

evaluating EMS vertical response time, and investigates the main factors of vertical response time and

its subsequent issues in the City of Toronto.

2.1. Definitions:

Engineering Design: engineering design incorporates scientific and mathematical knowledge and

systematic approaches in order to develop structures, products, systems, methods and/or processes to

meet specific needs. It should be functional, practical, creative and comprehensible, subject to

constraints which may be governed by standards or legislation or customers' desires.

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Sustainability: the capacity to maintain and manage resources. This can be further broken down into

financial sustainability, social sustainability, and environmental sustainability. This proposal primarily

focuses on the two relevant divisions of sustainability, financial and social.

Financial sustainability of an implementation is its ability to operate with limited budget and

without additional financial reimbursement, as well as providing revenue or long-term

reimbursement. With respect to this proposal, the financial sustainability is attained when the

solution design proves to be a worthy investment for the long-term well-being of the

community, whereby the implementation cost for the design is more economical than risk

management expenditures for all stakeholders.

Social sustainability is the basis for the welfare of the people in the society. Some

components of social sustainability include human rights, health benefits, security, and

accessibility to social resources. One aspect of social sustainability the proposal focuses on is

the health welfare of the society, which relates to the life expectancy of the society. Increasing

the life expectancy of the society increases social sustainability and reducing the EMS

response time can increase the survival rate of the patient which leads to longer life

expectancy.

Also, while environmental sustainability is not a primary priority for this design, it is an

additional merit to the design if it does not in any way pollute the environment or

manufactured in a way it consumes natural resources irresponsibly.

These developed definitions of engineering design and sustainability will be the basis for the

engineering framing and scoping, as well as the specifications of project requirements in this

proposal.

2.2. Exclusion of EMS Vertical Response Time

EMS response time is defined as the interval from 9-1-1 call assignment to arrival of an emergency

medical response unit at the scene (street location)[3]. This does not, however, include any additional

time that it may take for emergency responders to get from the on-scene location to the patient‟s

side[4]. A study in 2005 from Pre-hospital Emergency Care shows that vertical response time is

significantly long and represents a substantial component of the total EMS response time interval,

especially among ambulance calls originating three or more floors above groundin Toronto

Downtown [5]. The standard EMS response time is 8:59 minutes. In 2010, Toronto EMS arrived at

the critical calls within 8:59 minutes 62% of the time[4]. However, the median patient access time is

2:44 minutes among calls from patients located three or more stories above ground compared with

1:15 minutes among those at lower levels[5]. Therefore, the vertical response time represented 12.2%

of the total EMS response time interval for calls originating from than three floors above or below

ground and 23.3% of those located three or more storeys above ground[5].

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EMS paramedics, Officers Brian and Joel

from Mount Sinai Emergency Medical

Services, said that the vertical response time

can range from 1 minute to 5 minutes or more,

due to various difficulties during patient

access (refer to Appendix C)[6].This

substantial time interval is crucial to the

patient‟s survival. For instance, in cardiac

arrest, which has only a survival rate of 2.5%

in Toronto [7], for each minute that passes

when sudden cardiac arrest (SCA) strikes, the

victim loses up to 10% chance of survival [8].

In SCA situations, reducing the response time

to 8 minutes increased the predicted survival to 8%, and reducing it to 5 minutes increased survival to

10-11%. Generally, the mortality risk is higher when EMS response time is longer, despite the fact

that in some emergency situations, the survival rate does not significantly decrease after 8 minutes

[8][9].

2.3. Factors Affecting Vertical Response Time

Vertical response time is related directly with various factors. Based on the interview with EMS

officers and study from Pre-hospital Emergency Care, some key factors of vertical response time

are[5, 6]:

Speed of the elevators:

Paramedics always take the elevators, if available, rather than stairs, according to EMS

officers, because they carry over 40-pound equipment and elevators are faster especially for

multi-storey buildings. However, the speed of elevators varies from building to building;

furthermore, there can other unexpected delays during the patient access interval, such as

other residents use the elevators at the same time. Direct measurement of speed of different

elevators is demonstrated as below[10]:

Table 2: Measurement of Different Elevators’ Travel Time

Arrive at 5th floor Arrive at 10th floor Arrive at 20th floor

Fastest Slowest Fastest Slowest Fastest Slowest

9.6 s 25.0s 18.2s 1min 4s 37.0s 1min 10s

Note: The measurement is taken in the ideal situation, which means there is no delay

during the travel and no interruption by other residents in the buildings. Also, due to the

time constraint and limitation of access to private properties, only a limited amount of

elevators are investigated. Sample taken from 10 elevators in high rise buildings within

Church-Yonge Corridor Neighbourhood by authors of RFP.

95% CI: 95% confidence interval

Note: data is measured in Toronto Downtown. [5]

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According to Table 2, the data of slowest elevators demonstrates that even in ideal situations,

the vertical response time can range from 10 seconds to more than 1 minute. Furthermore, for

buildings with more than 20 stories, vertical response time is longer. Therefore, vertical

response time can be much longer when unexpected delay happens, thus lengthening the

patient access time.

Size of the elevators:

When the size of the elevator is too small and the stretcher cannot fit in, the paramedics have

to leave out the stretcher and thus they can only bring chairs to take the patient down. The

time for adjusting the equipment into the elevators increases vertical response time.

Entry code required:

Due to lack of communication in some emergencies, when paramedics arrive, they have to

buzz or force the entrance.

Absence of elevators:

When elevators are not available, paramedics have to take the stairs with the equipment of

over 40 pounds. Taking stairs with heavy equipment increases vertical response time as well.

Insufficient information to identify the patient’s location:

The EM dispatcher does not receive sufficient information regarding the specific location of

the patient. This usually occurs when the patient is unconscious, partially-conscious or

mortally wounded.

The affecting factors mentioned above will also be referred in this RFP as „access barriers‟.

2.4. Significance of the Problem

Immediate emergency medical services response is needed for acute medical events such as

respiratory distress, cardiovascular emergencies, and trauma [11]. Vertical response time is measured

from EMS arrival on-scene to arrival at-patient. It reflects the particular challenges associated with

reaching patients in multistory residential and office buildings [11]. However, this time interval is not

included in the measurement of total EMS response time, which implies that the actual EMS response

time for the patient is longer. As a result, this can mislead the public‟s understanding of EMS

performance as well. For patients who are not in acute medical events, decreasing vertical response

time can reduce their suffering.

Toronto EMS strives to meet the changing needs of the community for pre-hospital and out of

hospital care so that they can decrease suffering, improve the health of the community and save

lives[12].To achieve the goal of decreasing mortality rate, reducing vertical response time becomes

one of the crucial steps in providing rapid emergency pre-hospital medical services.

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3. Community and Needs4

High rise buildings represent the majority of new residential

developments built Downtown since 2001, almost one-third of

which are 30 storeys or taller. According to development records,

high- rise buildings account for almost all residential developments

constructed Downtown since 2001[13].

The geographical area being focused on in this proposal is Church –

Yonge Corridor Neighbourhood. The community in need of

reducing vertical response time is the residents, who live in high-

rise buildings in the Church-Yonge Corridor Neighbourhood. In

this scope, high–rise buildings are defined as buildings that have 5

storeys or more.

3.1. Background

Church – Yonge Corridor Neighbourhood is bounded vertically by

Yonge Street in the west and Jarvis Street in the east and bounded

horizontally by Bloor Street in the north and Front Street in the

south. According to Statistic Canada, the Church-Yonge Corridor

Neighbourhood has a high density of high rises. There are a total of

13900 private dwellings in apartment building that are five or more

stories which makes up of 89.0% of the 15630 total dwellings in the

area[14], as compared to 37.6% of high-rise buildings to the total

dwellings in City of Toronto[15].

3.2. Identification of Genuine Need

3.2.1. Reasons of Focusing on Church – Yonge Corridor Neighbourhood:

The amount of high-rise buildings:

89% of the dwellings in Church – Yonge Corridor Neighbourhood are five stories or more. A

larger amount of high-rise buildings increases the probability of patients locating in high-rise

buildings. Consequently, the probability of EMS accessing the building with longer vertical

response time is higher. Therefore, this neighbourhood with high density of high-rise buildings

will likely to have greater illustration of the benefit when vertical response time is reduced.

4 ‘Community’ and ‘Need’ as defined in Appendix A.

Figure 3.1 Church-Yonge Corridor

Neighbourhood[14]

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Health Profile of the Neighbourhood:

According to data from Toronto health profile in

2009, the rate of emergency department visits5 per

1000 population of this neighbourhood is 1.55 times

higher than the rest of city of Toronto(refer to Table

3)[16]. A total of 27.9% of the population in this

neighbourhood has at least one emergency visit since

2009 which is much higher than the 19.2% from the

total population of Toronto [16]. This implies that

this neighbourhood has a heavy distribution of

emergency medical cases within the city, and has

one of the highest demands for emergency medical

service in the city of Toronto.

Since the majority of the residents in this neighbourhood live in high rises, an implementation of a

solution to reduce vertical response time is needed in the community of residents who live in high

rises in the Church-Yonge Corridor Neighbourhood.

3.4.2 Genuineness of Need:

Based on the defined understanding of need (refer to appendix A), the community, Church-Yonge

Corridor Neighbourhood, has a genuine need of reducing vertical response time.

Church-Yonge Corridor Neighbourhood has a total of 11,050 Emergency Department (ED) visits in

2009 [16], whose ED visit ratio is 1.55 times higher than the city of Toronto rate. In particular, two

population age groups: 5 – 19 years old and 45 – 64 years, have ED visit ratio 2.69 and 2.03 times

higher than the city of Toronto rate [16]. Therefore, this neighbourhood requires more frequent

emergency medical services and immediate pre-hospital support than other Toronto neighbourhoods.

The ultimate goal of Toronto Emergency Services is to minimize the mortality rate of ambulance

patients. Reducing vertical response time, which decreases the actual total response time of reaching

the patients, can increase the chance of survival by receiving more immediate medical care [1].

Therefore, for an increasing trend of emergency cases in the community [4], a need of reducing

vertical response time is essential to the ambulance patients, since increasing patients‟ life-expectancy

enhances the sustainability of the community based on the definition of sustainability.

Furthermore, the investigation of current state of various elevators indicate that slow operation (refer

to Table 2 in section 2.2) can increase the vertical response time. Also, some other potential barrier

access problems exist in the buildings in the community, such as the size of elevator is too small for a

5 This data is based on visits due to community based ambulatory care.

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stretcher to fit and there is no elevator available for some old 5-storey buildings. Therefore, the need

to address these issues and reduce vertical response time is genuine.

In the interview with EMS paramedics (Officer Brian and Officer Joel), they verified that calls can

come from anywhere and without the specific data the officers believe that there is not a particular

neighbourhood in Toronto where they receive most calls from[6]. However, the officers confirm that

the Church – Yonge Corridor Neighbourhood is one of the geographical areas that have the most need

to reduce vertical response time due to the high density of high rises in this neighbourhood.

4. Stakeholders

The following constitutes the primary stakeholders:

1. Ambulance patients within the Community: people who need and seek medical attention

from EMS. Reducing vertical response time is important because patients need to be attended

to quickly as possible to ensure the well-being of their health. However the timing is the most

critical to patients under life-threatening circumstances and who need immediate medical

attention, such as people suffering from cardiac arrest and stroke. According to data from

EMS Toronto, sudden cardiac arrest kills over 30,000 Canadians each year and survival rate

is less than 5% [7]. The average response time is 8.1 minutes, in which only 2.5 % survive

within that response time interval [7]. Since the vertical response time can add in between 1 to

5 minutes to the arrival response time, this will greatly decrease the survival rate of the patient

under critical condition.

2. Toronto EMS Paramedics: their duty include reaching the patient in the short time interval

as possible, attending to the patient on site, and transporting the patient to the hospital.

Paramedics need a fast vertical response time once arrived at the building; however, they are

unable to control the vertical response time as it is affected by external factors such as the

access barriers6. They also carry emergency medical equipment which weighs about 40

pounds when attending to a patient.

3. Emergency Medical Dispatchers (EMD): a 911 operator receives the 911 call from either

the patient, patient family, or someone addressing the patient, and redirects the call to an

Emergency Medical Dispatcher at the Toronto EMS Communication Centre[2]. The EMD

will continue to ask some scene-specific questions (e.g. entrance location) and then provide

the caller with instructions on how to help the patient prior to the arrival of paramedics. The

EMD is responsible to deploy paramedics to the scene and provide information to the

paramedics.

The remaining stakeholders are the secondary stakeholders, which will be concerned or affected by

the development of the solution design, whether directly or indirectly.

6 Access barriers as previously defined in Section 2.3.

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1. Patient’s family member: are interested in the well-being of the patient being attended by

the EMS and wants the paramedics to arrive as fast as possible. In the case where the family

member is the caller addressing the patient, they are responsible for assisting the patient

during paramedics‟ pre-arrival, according to the instructions by the EMD. They should also

make sure some of the access barriers do not hinder the paramedics‟ operation, including

providing the information of the location of the patient in the building, helping the paramedics

getting into the building if an access card or key is required, and making sure the door is not

locked.

2. Mount Sinai Hospital Emergency Care Unit: being the hospital with closest proximity to

the Church-Yonge Corridor that provides emergency care, the unit‟s medical staffs attend to

the patient once the EMS arrives at the hospital. They are interested in the well-being of the

patient‟s health and want to attend to the patient as fast as possible, especially for life

threatening injury in which the response time is critical for the survival rate.

3. Building manager/security/concierge: the personnel who can help assist paramedic access

the building and reach the patient as quickly as possible.

4. Media: in occurrence of emergencies, often mass media provide coverage of the event. These

emergencies often include the EMS to provide medical attention to victims involved. The

media help the public to examine and evaluate the performance of Toronto EMS. They are

also interested in any technological development implemented for the Toronto EMS.

Also, the solution design highly probably would involve innovation of the elevator. In that case, three

more stakeholders came into consideration:

5. Residences in the building: they can possibly delay the process of the paramedics getting to

the patient. If the paramedics are taking the elevator it is possible for other residence in the

building to delay the elevator by stopping at other floors which can increase significant

vertical response time to the operation.

6. Owner of high rise building: any changes to the building that involves capital expenditure

will concern the owners of high rise buildings. They will want to evaluate the solution

design‟s financial impact, but at the same time they value the safety of their tenures.

7. Elevator maintenance personnel: the performance of the elevator can greatly impact the

process of getting to the patient. The elevator maintenance personnel have to make sure that

all elevators in the building are operating at the fullest capability. According to EMS officers,

they would always choose to take the elevator if possible so the performance of the elevator is

crucial to the response time.

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5. Reference Designs

The need of reducing the vertical emergency response time is a priority; therefore there have been

several presently available solutions that are developed to address this problem:

5.1 SkyLoc Floor Localization System[17]

This design developed in cooperation by researchers of University of Toronto and Intel Research

attempts to overcome the problem of paramedics being unable to locate the patient in high rise

buildings. This access barrier occurs when insufficient information is provided to the EM dispatcher

regarding the specific location of the patient – usually occurs when the patient is collapsed,

disoriented or incapacitated.

When a mobile user dials 911, a key to prompt arrival at the emergency scene is to know the location

of the mobile user. The SkyLoc is a GSM fingerprinting-based localization system that runs on a

mobile phone and identifies the current floor of the caller in a multi-storey building.

As the SkyLoc works on the Global System on Mobile Communication (GSM), which is the most

widespread mobile telephony standard in the world, it does not require the retrofitting of mobile

phones of users. This system too uses feature selection technique to the localization domain, as

opposed to the naive localization approach, in which doubles the localization accuracy. This system is

also overcomes the lack of direct line-of-sight limitations of triangulation-based localization method

such as GPS.

This design is currently in testing phase and has not yet been implemented for the EMS services.

5.2 Elevator Service Key[18]

The elevator service key allows personnel to operate an elevator car with a

key and which override any signal from other floors and allow the operator

to have total control of the elevator. This allows the operator to get to the

level of destination as fast as possible without having to stop in between

floors due to exterior signals.

This reference design is widely used by the fire department, which has been using it since as early as

the 1900‟s it has not been implemented for the EMS. From the interview with EMS Officer Brian, the

EMS staffs has always suggested the access key because they also believe it would help to reduce the

vertical response time in a high rise building; however, no such key has been authorized yet. From the

reference design of the elevator access key of the fire department, an engineer would understand that

solution to the proposed problem exists and it is possible for first year engineering students to

implement such solution.

Figure 5.1 Sample picture of Elevator

Service Key

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6. Project Requirements

The following section will provide the specifications for the Solution Vendors in order to come up

with a proposed solution in response to this Request-for-Proposal. The objectives to be achieved and

the specified constraints are based on the genuineness of need of the community. The effectiveness of

the design will be measured against specified criteria to measure how well a design approaches the

accomplishment of the objectives of the design.

The proposed solution design may be in the form of a modular device, an engineering system, a

retrofit of already-present system, or introducing (a) new process(es) or method(s).

6.1. Objectives:

To reduce the vertical emergency response time from in high-rise building, i.e. from time

emergency call is received to the time paramedics arrive at the patient.

To develop a solution design that sustainably improves the quality of life of the community

in-need as defined in Section 3.0.

6.2. Overview of Constraints:

The design of the solution must adhere to the following constraints:

Functionality: solution must not require any more than one (1) paramedic7 to operate[19].

Safety: solution must not compromise the safety of any stakeholders during its operation.

(metric: compliance to the National Occupancy Competence Profile for EMS [20])

The vertical emergency response time must not exceed the median8 of patient access time

interval[5]. (metric: time, in minutes and seconds)

6.3. Overview of Criteria:

The following are the criteria involved in determining the merit of the solution design. The design

should maximize its coverage to each criterion stated, but it is not compulsory to do so.

A larger reduction in the vertical emergency response time is preferred. (metric: time, in

minutes and seconds)

7The minimum number of Toronto EMS Paramedic manning an Emergency Response Vehicle is one. The

number of paramedic manning the primary emergency vehicle (Type 3 Ambulance) is two people.

8 2.38 minutes for apartments, 1.89 minutes for office buildings,(with 95% confidence interval) based on the

study from Pre-hospital Emergency Care. „Vertical emergency response time‟ as defined in this RFP refers

to„patient access time‟ as defined in the study.

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Cost: a lower capital expenditure is preferred, and should the solution is implemented by City

of Toronto Emergency Medical Services, the cost should be within the allocated operating

budget for Toronto EMS within reasonable9 projected financial years to come. The allotted

budget is available in City Budget 2012 for Emergency Medical Services[21]. Note that City

of Toronto‟s recommended budget for “other expenditure categories” is $31,200. (metric:

Canadian dollars)

Implementation time: should the solution require retrofitting of the EMS fleet or building

design, a shorter time of implementation is preferred. (metric: time, in months)

Additional EMS training hours: the solution, if not requiring zero additional training time,

should add as minimum as possible, to the minimal training time for a Level I Paramedic. A

standard Level I Paramedic undergoes 1400 hours of primary care training[22].(metric: time,

in hours)

The extent10

to which access barriers are reduced or nullified. Access barriers refers to

doors requiring access keys, unavailability of elevators, slow elevators, inability to locate

patients inside building, and limited mobility11

for emergency medical equipment in building.

Solution Vendors are allowed to propose a solution for a justifiable access barrier(s) other

than specified above.

9 „Reasonable‟ implies the Solution Vendors are allowed to propose a cost beyond the Toronto EMS yearly

allocated budget for Program Development, spanning to several years, with proper justification.

10

Solution is expected to either reduce or completely eliminate; of one or more of the specified access barriers.

11

Common mobility issues include equipment not fitting into the elevator and unavailability of stair chairs.

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Appendices

Appendix A: Definitions

Access Barriers: an obstacle or hindrance that stops or slows down one‟s accessibility to a

destination. The access barrier for EMS paramedics entering a high rise building may include entry

code, unavailability of elevator, lack of directional signs, small elevator which cannot fit a stretcher.

Community: a group of people living in a common geographical region, or people who shares

common interest.

Constraints: a set of requirements that has to be met by an engineering design.

Criteria: a set of indicators that measures how well a design approaches the accomplishment of the

objectives of the design.

Engineering design: as defined in Section 2.1.

Need: a necessary objective in the community to upgrade the sustainability of each individual in the

community and community as a whole.

Quality of Life: an indicator of the fulfillment of needs and wants of an individual or community, and

with respect to engineering design, how much a product/process/method/system satisfy those

requirements. Often quality of life act as a metric for assessing the performance of an engineering

design against objectives involving needs.

Retrofitting: the addition of new technology or features to older systems.

Sustainability: as defined in Section 2.1.

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Appendix B: Images

Figure B.1: The floor indicators do not light up, making it difficult to estimate the elevator

arrival time.

Figure B.2: Absence of floor indicator at the elevator lobby.

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Figure B.3: Stairs as alternative path when elevators are unavailable. Note that paramedics have to carry 40 lb

of EM equipments along these, inclusive of stretchers.

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Appendix C: Notes from Interview in Mount Sinai Emergency Center

Interviewee:

EMS Officers Brian & Joel from Mount Sinai Emergency Center

Community: Church-Yonge Corridor neighbourhood

Problem: Reduce Vertical Response Time in High-rise

Buildings

Key points for interview in Mount Sinai on Feb 17, 2012:

(EMS officers: Brian and Joel)

- EMS receive 800 – 1000 calls per day

- They only include vertical response time in cardiac

arrest

- Emergency calls come from everywhere

- They can’t control the vertical access time

- Usually paramedics need to take 40 pounds equipment,

so they always take the elevators if available.

- Yonge-Church neighbourhood has a lot of high rise

buildings, which is related to our concern and thus they

confirmed it is a community in need.

- Emergency happens on everyone, not just mainly seniors

and children. (Therefore no need to talk about

dependency ratio in the decision of community.)

- The vertical access time can range from 1min to 5mins

or more.

- Some factors of vertical response time:

1. Size of elevators: sometimes when the stretchers do

not fit in, they have to leave out the stretchers and

use chairs to take the patients down.

2. Speed of elevators varies

3. Sometimes they have to buzz or force the entrance

4. Insufficient information to find the patient

(sometimes)

- Suggestions: EMS key, similar to fire keys.

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