Report: Defibrillator Used Too Late in Texas Teen Girl's Death in July

Time was the key to survival for Sarah Friend.

The 12-year-old collapsed on the steps of a water coaster at NRH2O on July 14. She was declared dead more than an hour later. But she might have lived if she had been shocked with defibrillators within four to six minutes of her collapse, experts and studies say.

The water park has two of the devices, which send an electric shock through the heart. They were stored at the opposite end of the 7 1/2-acre park in the first aid office and the administration office. Paramedics used their own defibrillators some 20 minutes after Sarah collapsed -- far too late to save her.

"If there was any chance to bring her back, it would have been with defibrillation," said Dr. Harry Lever of the Cleveland Clinic Heart Center in Ohio. He is a leading expert in hypertrophic cardiomyopathy, the condition that led to Sarah's death.

For each minute that passed after her collapse without defibrillation, Sarah lost 10 percent of her chance to survive, Lever said.

An incident report obtained from the park states that a lifeguard at the Green Extreme was notified of Sarah's fall at about 10:45 a.m. She announced a medical emergency over the radio and cleared Sarah's airway.

The report does not state what time the park's emergency medical technician, Jennifer Kettner, got to Sarah. When she arrived, Kettner, of North Richland Hills, asked for an oxygen tank. An off-duty nurse who was helping told Kettner that she could not find a pulse.

Kettner asked for an automated external defibrillator. The report does not specify what time she asked for it, only that the device, which was 180 yards away, got to the scene at 10:51 a.m., the same time that the paramedics arrived.

Kettner could not be reached to comment.

"The reality is, there has to be an assessment done," said Richard Torres, an assistant city manager who oversees NRH2O along with the city parks and recreation division. "She's up on a tower, and there are lines of people everywhere. This is a large park with thousands of people and one EMT. For all we know the EMT didn't even get to her for several minutes."

Although paramedics got to the park three minutes after the 911 call, they didn't make contact with Sarah for another three minutes, according to reports.

Sarah had already been down for at least six minutes, and paramedics did not use defibrillation right away, said Dr. Roy Yamada, medical director of emergency medical services with the North Richland Hills Fire Department. They used cardiopulmonary resuscitation first to get her blood flowing, but her heart had completely stopped. Quivering or fibrillation of the heart must be present for the device to work.

Medics gave her an IV and epinephrine to make the heart quiver, he said.

The paramedics could not have known Sarah had hypertrophic cardiomyopathy. Epinephrine can make it worse, Lever said.

About 21 minutes had passed before medics administered the first shock, according to reports from both NRH2O and paramedics.

"If she was down next to the first aid center where they had the AEDs, it may have been different," Yamada said. "But in a tower like that where they're on the second floor and they don't have the equipment up there ... and then with the heart being enlarged.

"It's unfortunate, but they tried. They worked their hearts out for her."

Park staff is trained

The off-duty nurse and water park staff administered CPR, but chest compressions and assisted breaths alone are not as effective as CPR with an AED, according to two studies published in the New England Journal of Medicine in August.

One study found that 14 percent of people with cardiac arrest survive with only CPR by trained volunteers. But about 23 percent survive with early defibrillation and CPR combined.

"It was the only chance she had," said Lisa Salberg, president of the Hypertrophic Cardiomyopathy Association, a nonprofit support and advocacy group based in New Jersey. "In all likelihood, they would have resuscitated her."