Bethesda resident David Belkin went into cardiac arrest while playing basketball eight years ago. Another player, who happened to be an emergency physician, started CPR and sent others to look for an automated external defibrillator.  “You do kind of live your life thinking about how precious life is—because you never know,” Belkin says. Photo by Ben Tankersley

DAVID BELKIN, a longtime Bethesda resident, doesn’t recall any symptoms or warning signs before his cardiac arrest. He remembers waking up on a basketball court at Lakeside Elementary School in Honesdale, Pennsylvania, thinking that he had passed out. He was embarrassed, and didn’t want to interrupt the pickup basketball game that his son-in-law had brought him to near his family’s vacation home.

“I felt a little nauseous and dizzy, and I figured, OK, I just was dehydrated, I collapsed, I’m fine—just take me over to the bench,” says Belkin, a consultant to nonprofit organizations. “That’s when they told me that my heart stopped, and I said, ‘Come on, you’re crazy.’ ”

An ambulance arrived minutes later, but Belkin actually had an emergency physician to thank for his survival. Roman Matlaga, a regular at the Sunday morning game, usually has nurses, EKG monitors and other equipment when he treats a patient in cardiac arrest, but in this case, his quick actions on the court are the reason Belkin can sit in his East Bethesda home with his wife, Ellen, and talk about the events of February 2007, just days after his 65th birthday.

When Belkin fell to the court just after nailing a fadeaway jump shot—“A shot that I don’t usually make,” he says—Matlaga raced to him. Unable to feel a pulse, the physician started CPR. He also told the other players that the school probably had an automated external defibrillator—better known as an AED—and sent them to find it.

A few minutes later, with the help of a school janitor and congregation members gathered for Sunday services at a nearby church, the AED pads were on Belkin’s chest, and the machine shocked him once. Within seconds, he woke up.

More than eight years later, Belkin continues to play softball and tennis regularly, but his wife won’t let him play basketball. He also serves on the board of the Sudden Cardiac Arrest Foundation, a Pittsburgh-based nonprofit organization dedicated to improving survival rates through public outreach and education. “You do kind of live your life thinking about how precious life is—because you never know,” says Belkin, who still doesn’t know what caused his cardiac arrest. He celebrates what he calls his “second birthday” every year on the anniversary of the incident.

THERE WERE NO DOCTORS around at College Gardens Park. Liu’s guardian angel was Von Kurtze—if she and Alexandra had decided to skip the park that afternoon, Liu may not have survived.

“There’s a gentleman who was jogging with a baby. He came over and collapsed just a few seconds ago,” Von Kurtze told Jeff Purcell, the 911 dispatcher at the Montgomery County Emergency Communications Center. Purcell stayed on the line with her for the next five minutes, asking questions and providing instructions.

Von Kurtze told Purcell that Liu was lying on his stomach with his eyes open, but he was not responding. Purcell asked her to roll him onto his back to see if he was breathing. “I don’t feel breaths coming from him,” Von Kurtze said. “His lips are blue.”

“Heather, you need to start doing CPR right now,” Purcell said.

Von Kurtze, a voice-over artist, had taken a CPR class nearly a decade earlier. But she had never performed chest compressions on a real person, and had never faced a situation like the one she confronted that day not far from her King Farm home.

“Put the heel of your palm in the center of his chest right between his nipples,” Purcell said. His tone was reassuring and assertive. “Put the other hand on top of that hand. Pump the chest hard and fast at least twice per second. You need to let the chest come all the way up in between pumps. You need to count out loud.”

He began counting with her. “One, two, three, four,” she said, short of breath. “One and two and three and four.”

Finally, after what seemed to Von Kurtze like an eternity but was actually only a few minutes, paramedics arrived. Von Kurtze and her daughter stepped back and let them work. They entertained Nathan, who sat calmly in the stroller while his father lay on the ground nearby. After several minutes, firefighters placed Liu in an ambulance and left the scene. Von Kurtze and her daughter went home, wondering for weeks whether Liu had survived.

AS A PARAMEDIC, I like to think that I help people, sometimes even saving patients who were on the brink of death. But while paramedics often get the chance to make a difference in someone’s life, it’s rare that we have patients literally seconds from death who go on to have long and productive lives because of our treatment. Sudden cardiac arrest can be one of those cases, but even then, the interventions performed by EMS and hospital staff often only work thanks to the actions of bystanders.

For many years, CPR was regarded as solely the realm of lifeguards, paramedics and nurses. Although others received training—often in school or baby-sitting classes—few people who suffered cardiac arrest received CPR before first responders arrived. Paramedics, once on the scene, performed chest compressions and defibrillated, but we also quickly inserted breathing tubes, started IVs, and administered medications. The body of research on cardiac arrest was limited, and medical treatments often were based on scientific theory rather than scientific evidence.

Cardiac arrest survival rates throughout most of the nation have been stagnant, hovering at around 10 percent for half a century, research shows. But in the last decade, a shift has occurred as medical researchers have found new ways to study cardiac arrest, and some communities are demonstrating improved survival rates.

The interventions most associated with survival were found to be early defibrillation and early and continuous chest compressions, while the effectiveness of some of the more advanced procedures—intravenous medications, breathing tubes—hasn’t yet been demonstrated. The AHA and other groups began advocating “hands-only CPR” instruction for the public for two reasons: people feared contracting infectious diseases and didn’t want to perform mouth-to-mouth breathing, and the chest compressions seemed to be more critical to survival. When people who were walking and talking suddenly collapsed in cardiac arrest, they had oxygen in their bodies that could last several minutes, much like when you hold your breath underwater. They just needed that oxygen-filled blood to be circulated throughout their bodies; chest compressions could perform that role. And anyone could be taught to do chest compressions.