School nurse Allison Duffy used to grumble when her CPR recertification came due every two years. In 15 years of nursing, even while working in a hospital, she’d never had to use the lifesaving skill.
That changed Nov. 2 of last year.
Alisha Byerly, a teacher at the elementary school where Duffy works in The Colony, Texas, had a sudden cardiac arrest in the classroom.
Byerly was working with a small group of fifth-graders when she collapsed. The alarmed students ran next door to Jennifer English’s classroom for help.
English found Byerly, then 44, lying on her back, making a gasping sound. Thinking she’d fainted or had a seizure, English called her principal Rita Bacque for help.
Bacque shouted for her secretary to call 911 while Duffy and assistant principal Holly Shelton ran to Byerly’s classroom, followed by Bacque and PE coach Jenny Terry. The women comprise four out of five members of Morningside Elementary School’s first responder team trained to do CPR and deploy an AED, short for automated external defibrillator, in emergencies.
Entering the classroom, the Morningside team heard Byerly gasping. “Then I saw she had a grayish look and her lips were blue, and I realized it was agonal [gasping],” Duffy said, referring to the labored sound victims of cardiac arrest sometimes make.
Duffy immediately began chest compressions while Shelton provided mouth-to-mouth breathing. They hooked up the AED, and after deploying the advised shock, resumed CPR.
Two minutes later, the AED was recharged and gave a reading that a shock was not advised, so Terry took over compressions while Shelton continued to provide breaths. They continued with CPR until Byerly began to waken.
At the hospital, doctors placed an implantable cardioverter defibrillator, or ICD, in Byerly’s chest to shock her heart back into a normal rhythm if it detects a chaotic or dangerously fast heart rate.
Byerly was unaware of any risk factors for heart disease prior to the event, although she has since been diagnosed with long QT syndrome, an often inherited condition that affects the heart’s electrical activity. She may also have a family history of the arrhythmia; several of her maternal grandmother’s siblings died suddenly in their 40s, though the cause was never identified.
“There’s nothing to be sad about,” Byerly said. “God left me here, so you’ve just got to enjoy everything you can.”
The emotional events from that November morning — the adrenaline-filled 15 minutes from Byerly’s collapse to resuscitation to the paramedics’ arrival — have left the team of Morningside first responders grateful for how things turned out.
Training was remarkably fresh for the team. Terry had undergone a refresher course with Duffy the night before, and the group had completed its twice-yearly emergency drill only a half hour before the incident.
“I had just hung up the AED bag and said, ‘I hope we never have to use this thing,’” Shelton said.
Each year in the United States, more than 350,000 cardiac arrests occur outside a hospital, and nearly 90 percent of those people die. CPR, especially if performed immediately, can double or triple a cardiac arrest victim’s chance of survival, but less than half of those victims — about 46 percent — get CPR from a bystander.
The team of educators has since refined its emergency response process, including urging witnesses to first call 911. They also emphasize the recognition of agonal gasping during training, Bacque said.
“Had it not been for our nurse and another teammate who had just had the new training, we may not have realized she wasn’t actually breathing,” she said.
Duffy said she now looks for an AED when walking into a building and pays closer attention to people around her to be ready if something were to happen.
For Shelton, the experience bolstered her confidence and spurred her to be more of an advocate for CPR and AED training.
“You always wonder if you could really do it,” Shelton said. “I’d do it again in a heartbeat.”
The incident inspired others at the school to undergo CPR training. As of February, nearly half of the school’s staff, including one substitute teacher, had received training.
“We’ve always taken training seriously,” Bacque said, “but the gravity of having gone through a real-life situation really showed us how important it is to do CPR right.”