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**warning - this article may be difficult for some to read it is very emotional and if you are having a bad day you may wish to read this some other time**
Lisa
To Sarahs Family:
Your daughter was very loved and that is clear to the entire world. She was lucky to have you and you were luck to have had her in your life.
Peace, Lisa
Saying goodbye;
Friends and family show their love for a girl claimed by a heart flaw
BYLINE: LEILA FADEL; Star-Telegram Staff Writer
NORTH RICHLAND HILLS--When Laura Friend's first daughter was
born, a rush of love filled her. She would protect Sarah, always.
She remembers fending off the reaching hands of a relative who
tried to hold her baby. A year later, when Laura left Sarah Friend
with a day care provider, she felt nauseated at the thought of
being without her.
At Sarah's fourth-grade talent show, she remembers tearing up
with pride and embarrassment when her little girl stood on stage,
dressed as Rose from the movie Titanic, and sang My Heart Will Go
On.
But it's the missing memory that consumes her: the details of
what happened July 14, the day 12-year-old Sarah died at the NRH20
water park. Since then, Laura has spent almost every day making
phone calls to people who were with Sarah that day. She has studied
reports to piece together the moment she couldn't protect her
daughter.
When Laura awakens, the first thing on her mind is the image of
her daughter on a stretcher: "Sarah fell at the water park. ... I
wasn't there."
Day is a blur
Sarah woke early that morning for her last day of junior
lifeguard training at NRH2O. She turned on MTV in her mother's
bedroom and sang along with a Hoobastank song as she coaxed her mom
out of bed.
Downstairs, she ate half a peanut butter sandwich. She never ate
cereal; she hated milk. At about 8 a.m. she headed to the water
park with her friend Lexi.
She promised to wear sunscreen.
"What time should I come home?"
"I'll call you," Laura told her.
Inside Sarah's heart lurked an undetected condition,
hypertrophic cardiomyopathy. Her heart was thick, and it beat so
fast when she ran and swam at the park that the blood flow was
fatally disrupted.
At 10:49 a.m. Laura got a call on her cellphone.
"It's Lexi. Something terrible has happened. Sarah collapsed."
Laura grabbed her other daughter, 10-year-old Katherine, and
Katherine's friend, turned on her car's hazard lights and sped to
the park. She called her husband, Luther.
The rest of the day is a blur. Laura doesn't remember talking to
people on her cellphone. She doesn't remember the crowd that
watched as paramedics tried to revive Sarah. She doesn't remember
the IV. She doesn't remember the moans coming from her own mouth or
screaming, "What's happening to her?"
All she saw was Sarah, on the first platform of steps leading to
a seven-story water coaster, her stomach swollen in her black
bikini, her neck limp, her eyes cold and unblinking. All Laura
could think was, "I wasn't there when she fell."
A woman kneeling over Sarah cried.
"Why is she crying?" Laura asked a staff member at NRH2O. But
she knew.
Her daughter wasn't going to make it.
She prayed for a miracle, and she called others to pray with
her. Laura touched Sarah's forehead as she was taken to the
ambulance on a stretcher. She hugged her, oblivious to the tubes
and to the paramedics pounding on Sarah's chest.
She climbed into the front of the ambulance and tried to look
back at her daughter. "Don't look in the back, ma'am," the
paramedics said.
Her husband waited at North Hills Hospital. They yelled
encouragement to Sarah as doctors used defibrillators to try to
revive her. It was a tug of war with God, Laura said.
"Hang in there, Sarah."
"We love you, baby."
The shocks made Sarah's 130-pound body jump off the bed. One,
two, three times.
"Stop, I can't take it anymore," Laura said.
The physicians said there was nothing else they could do. At
12:14 p.m., Sarah was pronounced dead.
Luther and Laura held her and cried.
Rethinking details
Every morning now, Luther and Laura wake up together and cry.
Luther writes his feelings in a notebook, but Laura talks about
Sarah to keep her memory alive.
She pores over every detail of that day and thinks, "What if?"
What if someone had reached Sarah with defibrillators within six
minutes?
What if there had been a line at the Green Extreme water coaster
that day and Sarah hadn't run up the steps so quickly?
What if Laura had been there?
She scans medical Web sites about hypertrophic cardiomyopathy.
Sarah had none of the symptoms -- she never fainted or complained
that her chest hurt.
She asks Sarah's friends whether they are allowed to go to the
water park alone. She wishes she hadn't let Sarah.
She called the manager of emergency services at the hospital to
talk about Sarah's death. Did she regain consciousness? She never
did.
In the guest book at Sarah's funeral, someone wrote, "I was
there with you that morning at the park. I held your hand and saw
an angel."
She called the woman, Colleen Carri.
Carri told her that she had held Sarah's hand after she fell.
She said she felt peace in it, as if Sarah were watching from
above. Carri and Laura talked for more than an hour.
Laura asked her about the crying woman. Carri didn't know her
name. The woman was an off-duty nurse, standing in line for the
ride.
She called the park's emergency medical technician who worked on
Sarah that day at NRH2O, but the park wouldn't let the technician
talk about the events of that day, Laura said. They spoke only
briefly; Laura wanted to ask about the nurse, the woman who cried
for her daughter when she couldn't be there.
"If Sarah ever needed me, it was then," Laura said.
She asked Lexi if Sarah felt sick when they climbed the steps to
the water coaster for a second time. She was having fun, Lexi said.
The two girls talked about Sarah's upcoming birthday party.
Balloons and wishes
Laura and Sarah had already started to plan the party. Unopened
invitations are still in the downstairs closet, and a list Sarah
wrote on a ragged piece of notebook paper has the names of 32
potential guests with a reminder written on top, "might not be able
to invite everybody."
Laura had the party on Aug. 10 to celebrate the day that her
daughter would have become a teen-ager. There were pink balloons,
vanilla cake and chocolate ice cream. Thirteen-year-old girls
giggled, told secrets and chased boys.
The cake said "Happy birthday, Sarah. We love you!" in pink
frosting but had no candles. There was no one to blow them out.
At the cemetery, Sarah's grave was covered with balloons, pink
roses, carnations and white lilies.
"You are my hero," Luther wrote on a balloon, tears streaming
down his face. "RIP, We miss you Sarah," Lexi wrote on another.
Then 24 balloons, covered with messages, were released.
"Happy birthday, Sarah," the guests said as they watched the
balloons disappear. "We miss you."
The group left the cemetery together for cake at the house, and
Laura watched the girls whisper to each other.
Sarah's friends said goodbye that day. But Laura keeps her
daughter alive. For Laura, every day is July 14, and Sarah is lying
on the platform at the water park, waiting for her mother.
"I don't know what else to do," Laura said. "I just have a hole
in my heart."
* Sarah may have been saved if an automated external
defibrillator was used four to six minutes after her collapse
NORTH RICHLAND HILLS--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."
The second study, conducted in Canada, shows that trained
bystanders could increase survival rates after cardiac arrest with
CPR and early defibrillation because paramedics often arrive too
late.
AEDs are now common in public places and businesses. Dallas/Fort
Worth Airport has one at every checkpoint. American Airlines
carries the devices on planes and trains flight attendants to use
them. Some cities, including North Richland Hills, stock AEDs in
all public buildings. The HeartStart Home Defibrillator is
available with a prescription.
Most states, including Texas, have "Good Samaritan" laws that
protect the average person from liability if they come to the
rescue of a person in distress with an AED.
The NRH2O water park, unlike a passer-by, has a responsibility
to care for anyone hurt on site, said Ellen Pryor, a tort expert
and law professor at Southern Methodist University's Dedman Law
School in Dallas.
By adding AEDs to its inventory, the park has a responsibility
to use the equipment appropriately, she said.
"The water park is not an average person," she said. "If someone
is drowning or hurting in your pool or on your property, you have a
duty of care. ... The more tools you have when you're under a duty
of care, the more you've got know about what to do with them."
At NRH2O, the 200 members of the water park's staff are trained
to operate AEDs and to conduct CPR, said Paulette Hartman, North
Richland Hills city spokeswoman.
About 50 employees, including lifeguards, and one emergency
medical technician are at the park at all times, said NRH2O
Operations Coordinator Frank Perez.
The park's two AEDs are checked daily. Workers get training
updates monthly on either AEDs, CPR or administering oxygen.
Updates for lifeguards include aquatic training, he said.
"We're going above and beyond by having two AEDs," he said.
The park had tried in the past to store one of the AEDs at the
Green Extreme tower for easier access, Perez said. But the machines
got too hot and malfunctioned.
Instead, one is kept in the first aid office and the other in
the park's administration office, both at the front of the park
near the entrance.
Sarah's death was the first cardiac arrest in the park's 10-year
history. The AEDs have never been used, Hartman said.
"The staff at the water park and the paramedics did everything
they could to save this little girl," she said.
Odds against her
The odds may have been against Sarah. She was on the second
story of a seven-story water coaster. The AEDs were 180 yards away.
And no one expected a 12-year-old girl's heart to stop.
"When you hear of a 12-year-old going down, you don't think of
cardiac arrest," Yamada said. "You think of heat exhaustion, you
think of falling. You never think she's going to have a cardiac
arrest."
Sarah was one of about 450,000 people who die of sudden cardiac
arrest in the United States each year. Forty-seven percent of the
deaths occur outside a hospital, according to another study in the
New England Journal of Medicine. Only about 5 percent of people who
experience cardiac arrest outside a hospital survive.
But Lever contends that defibrillation within minutes of a
collapse could mean a normal life for a person with hypertrophic
cardiomyopathy.
"This is one of those cases that makes you feel really bad," he
said.
When seconds count
Sarah Friend, a 12-year-old from North Richland Hills, collapsed
at NRH2O and died July 14. Doctors attributed her death to a
previously undetected heart condition.
Some medical experts say that she may have been saved if the
staff had used automated external defibrillators, stored at the
park, within four to six minutes of her collapse.
About 10:45 a.m. A lifeguard at the Green Extreme at NRH2O
learns that a girl has collapsed.
10:48 a.m. Dispatchers notify the Fire Department.
10:49 a.m. Laura Friend gets a call saying that her daughter has
collapsed.
10:51 a.m. Paramedics arrive at the scene.
10:54 a.m. Paramedics make contact with the girl.
10:56 a.m. Paramedics start to monitor her heart.
11:06 a.m. Defibrillator is used, but paramedics cannot revive
her.
12:14 p.m. Sarah is pronounced dead at North Hills Hospital.
SOURCES: NRH2O incident report, North Richland Hills public
safety reports, Friend family
Hypertrophic cardiomyopathy
* The disease causes the heart to thicken and can fatally
disrupt the flow of blood.
* The most common genetic heart disease, hypertrophic
cardiomyopathy is underdiagnosed. It occurs in about one in 500
people and is more common than cystic fibrosis and muscular
dystrophy. For some people, sudden death is the first sign.
* Symptoms include palpitations, shortness of breath, dizziness,
passing out and chest pains. The disease is diagnosed with an
echocardiogram, an ultrasound scan of the heart.
ONLINE: www.4hcm.org
clevelandclinic.org
SOURCES: Hypertrophic Cardiomyopathy Association, Cleveland
Clinic Heart Center in Ohio
Lisa
To Sarahs Family:
Your daughter was very loved and that is clear to the entire world. She was lucky to have you and you were luck to have had her in your life.
Peace, Lisa
Saying goodbye;
Friends and family show their love for a girl claimed by a heart flaw
BYLINE: LEILA FADEL; Star-Telegram Staff Writer
NORTH RICHLAND HILLS--When Laura Friend's first daughter was
born, a rush of love filled her. She would protect Sarah, always.
She remembers fending off the reaching hands of a relative who
tried to hold her baby. A year later, when Laura left Sarah Friend
with a day care provider, she felt nauseated at the thought of
being without her.
At Sarah's fourth-grade talent show, she remembers tearing up
with pride and embarrassment when her little girl stood on stage,
dressed as Rose from the movie Titanic, and sang My Heart Will Go
On.
But it's the missing memory that consumes her: the details of
what happened July 14, the day 12-year-old Sarah died at the NRH20
water park. Since then, Laura has spent almost every day making
phone calls to people who were with Sarah that day. She has studied
reports to piece together the moment she couldn't protect her
daughter.
When Laura awakens, the first thing on her mind is the image of
her daughter on a stretcher: "Sarah fell at the water park. ... I
wasn't there."
Day is a blur
Sarah woke early that morning for her last day of junior
lifeguard training at NRH2O. She turned on MTV in her mother's
bedroom and sang along with a Hoobastank song as she coaxed her mom
out of bed.
Downstairs, she ate half a peanut butter sandwich. She never ate
cereal; she hated milk. At about 8 a.m. she headed to the water
park with her friend Lexi.
She promised to wear sunscreen.
"What time should I come home?"
"I'll call you," Laura told her.
Inside Sarah's heart lurked an undetected condition,
hypertrophic cardiomyopathy. Her heart was thick, and it beat so
fast when she ran and swam at the park that the blood flow was
fatally disrupted.
At 10:49 a.m. Laura got a call on her cellphone.
"It's Lexi. Something terrible has happened. Sarah collapsed."
Laura grabbed her other daughter, 10-year-old Katherine, and
Katherine's friend, turned on her car's hazard lights and sped to
the park. She called her husband, Luther.
The rest of the day is a blur. Laura doesn't remember talking to
people on her cellphone. She doesn't remember the crowd that
watched as paramedics tried to revive Sarah. She doesn't remember
the IV. She doesn't remember the moans coming from her own mouth or
screaming, "What's happening to her?"
All she saw was Sarah, on the first platform of steps leading to
a seven-story water coaster, her stomach swollen in her black
bikini, her neck limp, her eyes cold and unblinking. All Laura
could think was, "I wasn't there when she fell."
A woman kneeling over Sarah cried.
"Why is she crying?" Laura asked a staff member at NRH2O. But
she knew.
Her daughter wasn't going to make it.
She prayed for a miracle, and she called others to pray with
her. Laura touched Sarah's forehead as she was taken to the
ambulance on a stretcher. She hugged her, oblivious to the tubes
and to the paramedics pounding on Sarah's chest.
She climbed into the front of the ambulance and tried to look
back at her daughter. "Don't look in the back, ma'am," the
paramedics said.
Her husband waited at North Hills Hospital. They yelled
encouragement to Sarah as doctors used defibrillators to try to
revive her. It was a tug of war with God, Laura said.
"Hang in there, Sarah."
"We love you, baby."
The shocks made Sarah's 130-pound body jump off the bed. One,
two, three times.
"Stop, I can't take it anymore," Laura said.
The physicians said there was nothing else they could do. At
12:14 p.m., Sarah was pronounced dead.
Luther and Laura held her and cried.
Rethinking details
Every morning now, Luther and Laura wake up together and cry.
Luther writes his feelings in a notebook, but Laura talks about
Sarah to keep her memory alive.
She pores over every detail of that day and thinks, "What if?"
What if someone had reached Sarah with defibrillators within six
minutes?
What if there had been a line at the Green Extreme water coaster
that day and Sarah hadn't run up the steps so quickly?
What if Laura had been there?
She scans medical Web sites about hypertrophic cardiomyopathy.
Sarah had none of the symptoms -- she never fainted or complained
that her chest hurt.
She asks Sarah's friends whether they are allowed to go to the
water park alone. She wishes she hadn't let Sarah.
She called the manager of emergency services at the hospital to
talk about Sarah's death. Did she regain consciousness? She never
did.
In the guest book at Sarah's funeral, someone wrote, "I was
there with you that morning at the park. I held your hand and saw
an angel."
She called the woman, Colleen Carri.
Carri told her that she had held Sarah's hand after she fell.
She said she felt peace in it, as if Sarah were watching from
above. Carri and Laura talked for more than an hour.
Laura asked her about the crying woman. Carri didn't know her
name. The woman was an off-duty nurse, standing in line for the
ride.
She called the park's emergency medical technician who worked on
Sarah that day at NRH2O, but the park wouldn't let the technician
talk about the events of that day, Laura said. They spoke only
briefly; Laura wanted to ask about the nurse, the woman who cried
for her daughter when she couldn't be there.
"If Sarah ever needed me, it was then," Laura said.
She asked Lexi if Sarah felt sick when they climbed the steps to
the water coaster for a second time. She was having fun, Lexi said.
The two girls talked about Sarah's upcoming birthday party.
Balloons and wishes
Laura and Sarah had already started to plan the party. Unopened
invitations are still in the downstairs closet, and a list Sarah
wrote on a ragged piece of notebook paper has the names of 32
potential guests with a reminder written on top, "might not be able
to invite everybody."
Laura had the party on Aug. 10 to celebrate the day that her
daughter would have become a teen-ager. There were pink balloons,
vanilla cake and chocolate ice cream. Thirteen-year-old girls
giggled, told secrets and chased boys.
The cake said "Happy birthday, Sarah. We love you!" in pink
frosting but had no candles. There was no one to blow them out.
At the cemetery, Sarah's grave was covered with balloons, pink
roses, carnations and white lilies.
"You are my hero," Luther wrote on a balloon, tears streaming
down his face. "RIP, We miss you Sarah," Lexi wrote on another.
Then 24 balloons, covered with messages, were released.
"Happy birthday, Sarah," the guests said as they watched the
balloons disappear. "We miss you."
The group left the cemetery together for cake at the house, and
Laura watched the girls whisper to each other.
Sarah's friends said goodbye that day. But Laura keeps her
daughter alive. For Laura, every day is July 14, and Sarah is lying
on the platform at the water park, waiting for her mother.
"I don't know what else to do," Laura said. "I just have a hole
in my heart."
* Sarah may have been saved if an automated external
defibrillator was used four to six minutes after her collapse
NORTH RICHLAND HILLS--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."
The second study, conducted in Canada, shows that trained
bystanders could increase survival rates after cardiac arrest with
CPR and early defibrillation because paramedics often arrive too
late.
AEDs are now common in public places and businesses. Dallas/Fort
Worth Airport has one at every checkpoint. American Airlines
carries the devices on planes and trains flight attendants to use
them. Some cities, including North Richland Hills, stock AEDs in
all public buildings. The HeartStart Home Defibrillator is
available with a prescription.
Most states, including Texas, have "Good Samaritan" laws that
protect the average person from liability if they come to the
rescue of a person in distress with an AED.
The NRH2O water park, unlike a passer-by, has a responsibility
to care for anyone hurt on site, said Ellen Pryor, a tort expert
and law professor at Southern Methodist University's Dedman Law
School in Dallas.
By adding AEDs to its inventory, the park has a responsibility
to use the equipment appropriately, she said.
"The water park is not an average person," she said. "If someone
is drowning or hurting in your pool or on your property, you have a
duty of care. ... The more tools you have when you're under a duty
of care, the more you've got know about what to do with them."
At NRH2O, the 200 members of the water park's staff are trained
to operate AEDs and to conduct CPR, said Paulette Hartman, North
Richland Hills city spokeswoman.
About 50 employees, including lifeguards, and one emergency
medical technician are at the park at all times, said NRH2O
Operations Coordinator Frank Perez.
The park's two AEDs are checked daily. Workers get training
updates monthly on either AEDs, CPR or administering oxygen.
Updates for lifeguards include aquatic training, he said.
"We're going above and beyond by having two AEDs," he said.
The park had tried in the past to store one of the AEDs at the
Green Extreme tower for easier access, Perez said. But the machines
got too hot and malfunctioned.
Instead, one is kept in the first aid office and the other in
the park's administration office, both at the front of the park
near the entrance.
Sarah's death was the first cardiac arrest in the park's 10-year
history. The AEDs have never been used, Hartman said.
"The staff at the water park and the paramedics did everything
they could to save this little girl," she said.
Odds against her
The odds may have been against Sarah. She was on the second
story of a seven-story water coaster. The AEDs were 180 yards away.
And no one expected a 12-year-old girl's heart to stop.
"When you hear of a 12-year-old going down, you don't think of
cardiac arrest," Yamada said. "You think of heat exhaustion, you
think of falling. You never think she's going to have a cardiac
arrest."
Sarah was one of about 450,000 people who die of sudden cardiac
arrest in the United States each year. Forty-seven percent of the
deaths occur outside a hospital, according to another study in the
New England Journal of Medicine. Only about 5 percent of people who
experience cardiac arrest outside a hospital survive.
But Lever contends that defibrillation within minutes of a
collapse could mean a normal life for a person with hypertrophic
cardiomyopathy.
"This is one of those cases that makes you feel really bad," he
said.
When seconds count
Sarah Friend, a 12-year-old from North Richland Hills, collapsed
at NRH2O and died July 14. Doctors attributed her death to a
previously undetected heart condition.
Some medical experts say that she may have been saved if the
staff had used automated external defibrillators, stored at the
park, within four to six minutes of her collapse.
About 10:45 a.m. A lifeguard at the Green Extreme at NRH2O
learns that a girl has collapsed.
10:48 a.m. Dispatchers notify the Fire Department.
10:49 a.m. Laura Friend gets a call saying that her daughter has
collapsed.
10:51 a.m. Paramedics arrive at the scene.
10:54 a.m. Paramedics make contact with the girl.
10:56 a.m. Paramedics start to monitor her heart.
11:06 a.m. Defibrillator is used, but paramedics cannot revive
her.
12:14 p.m. Sarah is pronounced dead at North Hills Hospital.
SOURCES: NRH2O incident report, North Richland Hills public
safety reports, Friend family
Hypertrophic cardiomyopathy
* The disease causes the heart to thicken and can fatally
disrupt the flow of blood.
* The most common genetic heart disease, hypertrophic
cardiomyopathy is underdiagnosed. It occurs in about one in 500
people and is more common than cystic fibrosis and muscular
dystrophy. For some people, sudden death is the first sign.
* Symptoms include palpitations, shortness of breath, dizziness,
passing out and chest pains. The disease is diagnosed with an
echocardiogram, an ultrasound scan of the heart.
ONLINE: www.4hcm.org
clevelandclinic.org
SOURCES: Hypertrophic Cardiomyopathy Association, Cleveland
Clinic Heart Center in Ohio
This is a hard, hard way to learn that things need to be changed. 
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