Michael Abt, a 12-year-old middle-schooler from Vero Beach, Fla., Josh Miller, a high-school middle linebacker from Barberton, Ohio, and Connecticut lawyer Michael Sage, 29, all died when their hearts suddenly stopped beating.
But though their hearts also abruptly went still, Mary Tappe, a 45-year-old executive from Denver; Richard Strain, a financial officer from Canton, Ohio; and Claire Dunlap, a 15-year-old high-school softball centerfielder from Boynton Beach, Fla., survived.
Each was stricken by sudden cardiac arrest when they were nowhere near a hospital. None knew that he or she was at risk from a heart-rhythm problem that kills more than 350,000 people in the United States each year, according to the American Heart Association.
The difference: Those who survived had a chance at life because there were people around them ready and willing to quickly intervene -- and a nearby automated external defibrillator, or AED, that could shock the heart back to normal rhythm. The American Red Cross estimates that as many as 20,000 of those deaths a year could be prevented if AEDs were more prevalent across America.
Dunlap calls herself "living proof of what an AED can do." The athletic trainer at the field where she collapsed in 2008 quickly determined that she needed an AED and delivered three shocks to her chest before her heart began beating again.
"I would not be here if it was not for that," she said.
Ken Miller's son, Josh, might still be alive if an AED had been nearby, but there was none at the field.
Miller says he knows "the helplessness of seeing my son pass away in front of my eyes. There's a good chance of saving kids in the same situation if they just have the AED."
Josh Miller, who died in 2000, was an athlete – a wrestler and football player who never flunked a physical. "You would never, ever think he had a problem, and he did," his father said.
Sudden cardiac arrest is different from a heart attack, which usually is caused by blocked arteries. In cardiac arrest, which strikes young and old alike with little warning, the heart stops when the electrical pulses that tell it to beat, misfire. Only the "reset" from an electrical shock gives it a chance to resume normal function.
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First used in hospitals in the 1950s, defibrillators gradually became small enough to be carried by paramedics. In the 1990s, several manufacturers came out with backpack-sized AEDs that required no medical training, and the devices began to be placed in public spaces. Today, they're even smaller and smarter.
AEDs save lives by saving time. If an AED delivers a shock within the first three to five minutes after a person's heart stops, studies show, the odds of survival are 60 percent to 70 percent.
That is far shorter than the time it usually takes emergency medical personnel to arrive. In much of the country, EMS response time averages nine minutes. In many big cities and rural areas, it can take 15 or 20 minutes or longer for an ambulance to arrive. So the availability of an AED, and a bystander to use it, is, literally, a matter of life and death.
The Red Cross says its goal is to have every person in America within four minutes of an AED and someone prepared to use it. Other experts say an AED ideally should be within 300 feet of a victim. Those goals remain far off.
Despite two decades of efforts to expand public access to AEDs, the devices remain unevenly distributed, often hidden away under lock and key, subject to a daunting patchwork of state regulations, mandates and laws, and tens of millions too few in number.
About 2.5 million AEDs are scattered across a country of more than 300 million people; experts calculate that 30 million of the devices are needed just to cover all major metropolitan areas.
And even if your office building or church is equipped with an AED, you might not know it. Unlike fire extinguishers, which are a familiar sight in buildings, AEDs often are not prominently visible and identifiable, and are frequently kept under lock and key.
Finding one can be a matter of happenstance. In some states and cities, lists of the locations of AEDs are kept, but the information is rarely publicly accessible or used by 911 operators. In 19 states, there are no registries at all.
Overall, the AEDs that are in place are mainly deployed in places like schools, fitness centers, transit hubs, arenas and government buildings, often because state laws mandate them. But unlike for fire extinguishers in workplaces and commercial vehicles, there are no federal regulations requiring AED placement, testing or training, except for in federal buildings and commercial airliners.
Where an AED is placed is often a matter of good will and luck, driven mainly by volunteer efforts and the decisions of business and government leaders.
and even local officials remain leery of hosting AEDs due to liability concerns.
"In many companies, the insurers and risk-management guys still seem to think they're better off not having AEDs than having them,'' said Linda Campbell, a retired nurse and manager of aeromedical issues for American Airlines who helped found the company's AED program in the mid-1990s, and is now on the board of the Sudden Cardiac Arrest Association.
Critics say some property owners may be put off by complex and inconsistent state and local rules on where and how AEDs are placed and maintained, even though every state has "good Samaritan" laws intended to shield those who provide or use the devices to try and save a life.
Cost is also cited as an obstacle, as the devices can run $1,000 and up, plus money for maintenance and staff training.
Another major hindrance to life-saving is the reluctance of bystanders to use AEDs.
Unfamiliarity with the devices' simplicity and general ease of operation -- one study showed that sixth-graders mastered them quickly -- leaves some bystanders intimidated and afraid they will make a mistake and hurt the victim. The odds that bystanders will use an AED on a cardiac-arrest victim who collapses in public are about 2 in 100, according to one large study published by the American Heart Association several years ago.
"Companies and governments fear getting sued; the public is afraid of using them because they're scary," said Craig Goldfarb, a West Palm Beach, Fla., attorney who specializes in cases arising from sudden cardiac arrest.
But doctors and other experts say such fears pale against what AEDs offer: A shock to the heart gives the victim a fighting chance to live.
"It's kind of blunt, but the bottom line is when you're in (cardiac) arrest, you're dead before you hit the ground. There's no way you can cause that victim any more harm using that device. You're trying to bring them back," said Greg Slusser, vice president for Minnesota-based Defibtech, one of a half-dozen manufacturers of AEDs in the U.S.
Contrary to decades of television medical dramas, AEDs come with no clunky paddles, shouts of "clear" or jolts that cause patients to jump off stretchers. AEDS are small and consumer-friendly.
Rescues feature simple instructions from the machine, attachment of two adhesive electric leads to the chest, a few seconds for the machine to analyze the patient's condition, and then, if needed, a shock that scarcely makes the patient's chest muscles twitch.
"They're made to be used by people with no training. An AED talks you through what to do. The devices cannot hurt you," said Dr. Jonathan Reiner, a professor of cardiology at George Washington University in Washington, D.C.
Even so, AEDs are advanced medical tools with parts that can fail.
There have been more than 45,000 AED failures reported to the U.S. Food and Drug Administration in the seven years, including more than 1,100 incidents in which patients died. The agency recently announced plans to impose higher safety standards on manufacturers.
Some businesses have gone against convention to install the devices. American Airlines, for example, started putting AEDs on planes in 1995, nearly a decade before the Federal Aviation Administration required them.
"When we took this to our legal and insurance people and laid out the costs for the devices and training 27,000 flight attendants, (then-American Airlines President) Robert Crandall basically said (to) forget the pocketbook, this is the right thing to do,'' said Campbell, who helped develop the airline's program.
Adding two AEDs to the tools at Kumler Collision & Automotive garage on the outskirts of Lancaster, Ohio, was an easy decision for owner Dean DeRolf. His company's readiness for medical emergencies took on new urgency last year after a veteran worker suffered a stroke.
"We'd been talking about whether we knew what to do, could we save someone who went down. I never thought about the liability or the cost that much, just whether we could take care of our people or a customer."
Far more frequently, though, cardiac arrest comes where there is no AED close by. There were none in the law offices where Michael Sage died in 2011, and none when 15-year-old Caleb Hannink collapsed in gym class at Centennial High School in Bakersfield, Calif., last November.
Caleb's death eventually ended a six-year quest by the mother of an earlier young Bakersfield cardiac-arrest victim to convince Bakersfield education officials to install AEDS in schools.
Corrine Ruiz, who leads the local Sudden Cardiac Arrest Association chapter, has been working to raise awareness about the condition and for more AED access in schools since the 2004 death of her daughter, 14-year-old cheerleader Olivia Hoff. The teen's heart stopped at home due to an undiagnosed defect.
Until her daughter died, Ruiz had never thought much about cardiac arrest or the device that might have saved Olivia's life. But like many parents and other
family members of sudden-cardiac-arrest victims, she has sought to honor Olivia's memory trying to prevent more deaths.
She began advocating training and pushing Bakersfield education officials to install AEDS in schools. But it took Caleb Hannink's death eight years later to finally prod the district to act.
"We didn't give up; we made a breakthrough, although it took another tragedy,'' Ruiz said.
To Dr. Bentley Bobrow, a Phoenix-based emergency doctor and American Heart Association spokesman, there is no excuse for such tragedies to occur.
"This is a major public-health problem that's not being addressed," said Bobrow, who researches cardiac deaths and rescues.
"We need a different approach. It should be unacceptable anywhere in this country for someone to collapse of apparent cardiac arrest in a public place and not get basic quality CPR and someone at least try to find them an AED,'' Bobrow said.
Mary Tappe, the Denver cardiac-arrest survivor and advocate, says she's always on the lookout for the nearest AED. "I don't need it to save me -- I have one implanted," she said. "But I just couldn't stand it if someone collapsed in front of me and I didn't have the tool I needed to try and save them."