What the Research Actually Shows

In 2016, researchers at St. Michael's Hospital in Toronto published a landmark study in the Canadian Medical Association Journal (CMAJ). Led by Ian Drennan, a paramedic with York Region Paramedic Services and a researcher with the Rescu program at the Li Ka Shing Knowledge Institute, the team analyzed more than five years of emergency response data covering 8,216 cardiac arrest cases in private residences across Toronto — one of the most vertically dense cities in North America.

The overall survival rate to hospital discharge across all floors was 3.8%. That number is already sobering. But the floor-by-floor breakdown is what demands attention from every condo board in the country:

Why Is This Happening?

The mechanism is straightforward, even if the consequences are severe. Cardiac arrest is not like most medical emergencies. After the heart stops, a person has roughly four to six minutes before irreversible brain damage begins. For every minute without defibrillation — the electric shock that restores a normal heart rhythm — survival odds fall by approximately 7 to 10 percent.

The key distinction the Toronto study uncovered is not the 911 call-to-dispatch time, which is largely consistent across a city. It is the gap between when paramedics arrive at the building and when they reach the patient. Navigating a lobby, waiting for an elevator, riding up twenty floors, and locating the unit adds minutes. In cardiac arrest, those are not recoverable minutes.

As the study's authors put it: "The 911 response time, from emergency activation to arrival of first responders on scene, will remain relatively constant — however, the time from arrival on scene to initial patient contact may increase as more of the population comes to live at or above the third floor."

In plain terms: paramedics are arriving at your building on time. The building itself is slowing them down.

The Nuance: It Is Not the Whole Story

Science, to its credit, is rarely a single headline. A more recent nationwide population study in South Korea — a country where high-rise apartment living is even more prevalent than in Canada — found a more complicated picture. Published through the National Library of Medicine, this study examined 29,729 cardiac arrest patients drawn from the South Korean Out-of-Hospital Cardiac Arrest Surveillance database.

Its finding was counterintuitive: patients on higher floors actually had slightly elevated survival rates despite longer EMS access times. When researchers applied multivariate analysis — controlling for age, whether the arrest was witnessed, heart rhythm type, and whether spontaneous circulation returned before hospital arrival — floor level emerged as a less decisive factor than anticipated. The more powerful predictors were whether someone witnessed the arrest, whether a defibrillator was used immediately, and the patient's age.

This does not contradict the Toronto study. It contextualizes it. South Korea has invested heavily in public CPR training, building-level defibrillator placement, and community first-responder programs. In buildings where residents are trained and equipment is accessible, the floor-level disadvantage narrows significantly. The Korean data is, in effect, a proof of concept: the death gap created by vertical distance can be partially closed by human preparation at the building level.

The lesson for Canadian condo communities is not that floor height doesn't matter. It is that what your building does before the paramedics arrive matters just as much.

The Anatomy of a Lost Minute

To understand why four minutes can become eight in a high-rise, it helps to walk through a realistic scenario.

A 68-year-old resident on the 19th floor of a Toronto condominium collapses in the kitchen at 7:45 p.m. His wife calls 911 at 7:45:30. Paramedics are dispatched. They arrive at the building's front door at 7:51 — a six-minute response time, which is considered good performance by urban EMS standards.

Now the internal clock begins.

The lobby door requires a fob or intercom buzz-in. The elevator must be summoned from a upper floor. The ride up takes over a minute. Locating the specific unit adds more time. First patient contact may not occur until close to 7:54 or later. That is roughly three minutes of delay after arrival at the building — during which the patient has been receiving no intervention.

Total time from collapse to first contact: potentially nine minutes or more. The window for survival without brain damage: four to six minutes. The math is unambiguous.

This scenario is not presented to alarm, but to illustrate the nature of the problem — and why the conversation about preparedness belongs in building boardrooms, not only in emergency rooms.

What This Means for Condo Boards

Boards govern more than finances and bylaws. They govern the environment in which people live — and, increasingly, the environment in which people survive emergencies. The research on vertical response delays raises questions that boards are well-positioned to begin asking.

Are there gaps between when paramedics arrive at the building and when they can reach the patient? What conversations have been had with qualified emergency-response professionals about the building's current readiness? What does the community's demographic profile suggest about the likelihood of a cardiac event, and is the building's preparedness level proportionate to that risk?

These are not questions with simple universal answers. Building age, layout, local fire code, municipal bylaws, insurance requirements, and condominium legislation all shape what any given board can and should do. Emergency procedures, building access systems, AED deployment, and resident information practices should be reviewed with qualified legal, medical, privacy, fire-safety, and emergency-response professionals to ensure compliance with local laws, codes, and operational requirements.

What boards can do on their own, right now, is start the conversation — and make sure it reaches the right professionals.

What This Means for Property Managers

Property managers sit between the board's policy decisions and the day-to-day realities of building operations. In a building emergency, they are often the most informed person on the scene — and sometimes the only one who knows where critical equipment is located.

That knowledge gap itself is part of the problem. Buildings where emergency preparedness lives in one person's head, rather than in documented, accessible, and regularly reviewed procedures, are buildings that are one staffing change away from being dangerously unprepared.

Property managers are well-placed to identify which questions need to be asked and to bring together the right professionals to answer them. What does the building's emergency access look like from the perspective of a first responder? What is the current status of any life-safety equipment in the building? Are staff roles and responsibilities in an emergency clearly defined and regularly practiced?

Again, the specific answers depend on local requirements and building-specific conditions. The role of the property manager is not to make those determinations unilaterally, but to ensure they are made — with the right experts at the table.

What This Means for Residents

Individual residents are not passive actors in this equation. The South Korean data makes clear that the single most powerful variable in high-floor cardiac arrest survival is whether the arrest is witnessed and immediately treated by someone already in the room.

No building policy, however well-designed, can replace the person who is already standing next to someone when they collapse.

CPR training is the most direct thing a resident can do. The Heart and Stroke Foundation of Canada offers in-person and online certification. A course takes a few hours. The skill can take seconds to apply and meaningfully change survival outcomes before paramedics arrive. For residents on upper floors — where the data shows the steepest survival decline — this is worth serious consideration.

Knowing where your building's life-safety equipment is located is equally basic and equally undervalued. If your building has an AED, you should know where it is before you need it. If you don't, ask building management.

Talking to your neighbours is a form of community preparedness that no policy can mandate and no equipment can replace. Buildings where residents know each other are buildings where someone notices when something is wrong. That awareness has saved lives.

Residents with significant medical concerns may wish to ensure emergency contact information is current and that trusted neighbours or family members are aware of their needs.

The Bigger Picture: Vertical Living Requires Vertical Thinking

Canada's housing landscape is changing. Dense urban cores, rising land costs, and an aging population mean that more Canadians than ever are living on high floors — and doing so at an age when cardiac emergencies become statistically more likely. The infrastructure of emergency response was largely designed for a low-rise world. The research from Toronto and Seoul is telling us, plainly, that the system has not fully caught up.

This is not a reason to panic, or to choose a building based solely on floor level. It is a reason for the people responsible for these buildings — boards, managers, developers, and residents — to take the data seriously and engage the right people to act on it thoughtfully.

The floor someone lives on should not determine whether they survive. But right now, in too many Canadian condominiums, the evidence suggests it does. That is a problem worth solving — carefully, collaboratively, and with the right expertise.

Starting Points, Not Prescriptions

The following are areas where further professional guidance is worth seeking. They are offered as conversation starters, not directives.

For Boards

• Engage qualified emergency-response and fire-safety professionals to assess your building's current preparedness relative to its height and resident profile

• Consult legal counsel on the board's duties and liabilities as they relate to life-safety in a high-rise context

• Ask your property manager what emergency-related questions remain unanswered — and make a plan to answer them

For Property Managers

• Identify which local emergency-response professionals and agencies are available as resources for building assessments

• Ensure any life-safety equipment in the building is subject to regular, documented professional maintenance

• Work with the board and legal counsel to ensure emergency-related procedures are clearly documented and appropriately reviewed

For Residents

• Consider CPR and first aid training through a recognized provider such as the Heart and Stroke Foundation of Canada

• Ask building management about the location of any life-safety equipment in the building

• Raise emergency preparedness as a topic at your next AGM — an informed community is a safer one

This article is published for general informational and educational purposes only. It does not constitute legal, medical, fire-safety, or professional advice of any kind, and should not be relied upon as such. Emergency procedures, building access systems, AED deployment, and resident information practices should be reviewed with qualified legal, medical, privacy, fire-safety, and emergency-response professionals to ensure compliance with local laws, codes, and operational requirements. Every building and jurisdiction is different; what applies in one context may not apply in another.

Bern Management is committed to raising the standard of condominium governance across Canada. This article is part of our Building Excellence Series, dedicated to evidence-based education for boards, managers, and the residents they serve.

Sources: Drennan et al., "Out-of-hospital cardiac arrest in high-rise buildings: delays to patient care and effect on survival," CMAJ, 2016; "The Influence of Cardiac Arrest Floor-Level Location within a Building on Survival Outcomes," PMC/National Library of Medicine, South Korea national surveillance database study, 2023.