standing there outside the fire station. He wouldn’t have a newly implanted defibrillator, and he wouldn’t be looking forward
to getting back on the golf course. Just six weeks after he died, the only lingering effect is a set of sore ribs.
Mertz probably owes his life to a handful of physicians who were willing to challenge the rules, if not quite break them.
And when the doctors say there was nothing to lose, they have a point. Basic artificial respiration has been around since
the 1700s, and the modern technique has been in use for half a century. But a dirty little secret remains: most of the time,
it doesn’t work. In most cities, “survival to good outcome” for cardiac arrest outside the hospital is still around 2 percent,
and in some places, it’s even worse. In Detroit during a six-month period in 2002, paramedics responded to more than four
hundred cardiac arrest cases and emerged with just a single success story—one patient who survived long enough to make it
out of the hospital. 23
Yet other places seem to have cracked the code. Arizona tripled the survival rate of cardiac arrests. Seattle, with its high
percentage of trained bystanders and tradition of innovation in emergency medicine, reports a survival rate of close to 20
percent—and nearly 40 percent in cases where paramedics find a patient whose heart is in ventricular fibrillation, the most
“survivable” rhythm. 24 Like Arizona, Seattle now uses a resuscitation method that emphasizes chest compressions. Seattle does something else that’s
interesting; officials take care not to hire too
many
EMTs. They’ve found that when they hired too many people, each EMT got less practice and survival rates dropped. 25
None of this is rocket science or brain surgery. The closer you look, the more you see that it doesn’t always require a fancy
breakthrough to save tens of thousands of lives. When it comes to cheating death, it sometimes happens that simple measures
are more important than the hoops and frills of high-tech medicine. Sometimes a sea change in the world of medicine can be
accomplished by lucky accident and the efforts of a few individuals who refuse to accept the conventional wisdom.
CHAPTER THREE
Suspend Disbelief
When does death really take place? I would argue that we don’t really know the answer.
—Dr. Lance Becker
A SOLDIER FALLS IN a gully, off a long mountain pass near Khost, Afghanistan, after being hit by sniper fire. His comrades scatter for cover,
scanning the hillsides for the sniper. Seeing no target, they let loose with a heavy machine gun to provide cover while a
medic tries to reach the fallen man. There’s no panic, but there is urgency. The medic tears through his pack, fingers pulling
apart the edges of a small syringe. With heavy breaths, he counts off, “One, two, three…” then races across the open ground
while his friends lay a withering burst of fire in the general direction of the sniper’s position.
When the corporal reaches the fallen man, he feels for a pulse, but the one he finds is so weak that he knows it won’t last
more than a few minutes. The platoon is dozens of miles from help, and even a helicopter couldn’t arrive in time to save the
injured soldier. Gritting his teeth, the medic saws open the unconscious man’s field jacket and cuts away his trousers. There’s
the sound of more gunfire not far off. It looks like the soldiers might be stuck here for a while.
With a grunt, the medic jabs his syringe into the thigh of his fallen comrade. The effect is immediate. The soldier’s skin,
already pale, turns gray and then white within seconds. His skin grows cold and dry. Breathing goes silent, and the pulse
goes still. But the medic isn’t alarmed. He knows his friend will probably be fine. He isn’t dead; he’s merely preserved in
a safe cocoon. Call it suspended animation, slow motion, a pause button—whatever. As long as the patrol
to getting back on the golf course. Just six weeks after he died, the only lingering effect is a set of sore ribs.
Mertz probably owes his life to a handful of physicians who were willing to challenge the rules, if not quite break them.
And when the doctors say there was nothing to lose, they have a point. Basic artificial respiration has been around since
the 1700s, and the modern technique has been in use for half a century. But a dirty little secret remains: most of the time,
it doesn’t work. In most cities, “survival to good outcome” for cardiac arrest outside the hospital is still around 2 percent,
and in some places, it’s even worse. In Detroit during a six-month period in 2002, paramedics responded to more than four
hundred cardiac arrest cases and emerged with just a single success story—one patient who survived long enough to make it
out of the hospital. 23
Yet other places seem to have cracked the code. Arizona tripled the survival rate of cardiac arrests. Seattle, with its high
percentage of trained bystanders and tradition of innovation in emergency medicine, reports a survival rate of close to 20
percent—and nearly 40 percent in cases where paramedics find a patient whose heart is in ventricular fibrillation, the most
“survivable” rhythm. 24 Like Arizona, Seattle now uses a resuscitation method that emphasizes chest compressions. Seattle does something else that’s
interesting; officials take care not to hire too
many
EMTs. They’ve found that when they hired too many people, each EMT got less practice and survival rates dropped. 25
None of this is rocket science or brain surgery. The closer you look, the more you see that it doesn’t always require a fancy
breakthrough to save tens of thousands of lives. When it comes to cheating death, it sometimes happens that simple measures
are more important than the hoops and frills of high-tech medicine. Sometimes a sea change in the world of medicine can be
accomplished by lucky accident and the efforts of a few individuals who refuse to accept the conventional wisdom.
CHAPTER THREE
Suspend Disbelief
When does death really take place? I would argue that we don’t really know the answer.
—Dr. Lance Becker
A SOLDIER FALLS IN a gully, off a long mountain pass near Khost, Afghanistan, after being hit by sniper fire. His comrades scatter for cover,
scanning the hillsides for the sniper. Seeing no target, they let loose with a heavy machine gun to provide cover while a
medic tries to reach the fallen man. There’s no panic, but there is urgency. The medic tears through his pack, fingers pulling
apart the edges of a small syringe. With heavy breaths, he counts off, “One, two, three…” then races across the open ground
while his friends lay a withering burst of fire in the general direction of the sniper’s position.
When the corporal reaches the fallen man, he feels for a pulse, but the one he finds is so weak that he knows it won’t last
more than a few minutes. The platoon is dozens of miles from help, and even a helicopter couldn’t arrive in time to save the
injured soldier. Gritting his teeth, the medic saws open the unconscious man’s field jacket and cuts away his trousers. There’s
the sound of more gunfire not far off. It looks like the soldiers might be stuck here for a while.
With a grunt, the medic jabs his syringe into the thigh of his fallen comrade. The effect is immediate. The soldier’s skin,
already pale, turns gray and then white within seconds. His skin grows cold and dry. Breathing goes silent, and the pulse
goes still. But the medic isn’t alarmed. He knows his friend will probably be fine. He isn’t dead; he’s merely preserved in
a safe cocoon. Call it suspended animation, slow motion, a pause button—whatever. As long as the patrol