'He just wasn't near an AED'
VALLEY CITY, North Dakota – In 2017, Jerry and Amy Noeske's 11-year-old son, Sam, had a cardiac arrest while camping with family friends. They were about 20 miles from the nearest hospital in Valley City, a town with a population of roughly 6,500.
Although Sam had been born with a congenital heart defect that required open-heart surgery, "he just was like a normal kid. There weren't any signs that he would go into an arrhythmia," Amy said, noting he was big for his age and able to participate in sports. Baseball was his favorite.
Frantic to save Sam's life, his friend's father performed CPR until he collapsed from exhaustion. His 13-year-old daughter continued chest compressions until local first responders arrived. Not equipped with a rescue device known as an automated external defibrillator, they kept Sam alive with CPR until the sheriff showed up and used the AED in his vehicle to restore a normal heart rhythm.
By the time Valley City paramedics arrived, nearly 20 minutes after Sam's cardiac arrest, his heart had gone back into arrhythmia. While they were able to reestablish a normal heart rhythm using an AED, too much time had passed. After five days in a coma, with his parents by his side, Sam died.
When he first collapsed, "he just wasn't near an AED, and that might have changed the course for him," Amy said.
"It changes you. It changes your whole family."
Sam's parents are quick to credit the American Heart Association. They are helping to educate rural communities about the importance of knowing CPR, providing grants to put AEDs in public buildings such as churches and libraries, and encouraging people to "know their numbers."
The first responder unit that initially arrived on the scene for Sam is now equipped with an AED.
"A lot of people said they were going to take CPR classes after Sam died," Amy said. "The American Heart Association is an important voice for heart health and community readiness for cardiac emergencies."
The AHA's Mission: Lifeline® program has been invaluable in those efforts, said Alana McClellan, a close friend of the family and a nurse for more than 30 years. Mission: Lifeline works to build a nationwide network of interactive systems of cardiovascular care.
"The AHA has been instrumental in getting grants and programs running so that we can improve our stroke and heart attack care," said McClellan, director of nursing at the local hospital, CHI Mercy Health Valley City. She also heads the Cardiac Ready Community advisory committee. In 2022, the hospital was recognized by the state as its first Acute Cardiac Ready Hospital.
Mission: Lifeline's 2017-20 rural stroke care initiative in North Dakota — including lectures, conferences, workshops, stroke simulation trainings, online courses and a stroke certification program — has helped to spread awareness of stroke symptoms, improve stroke care driven by national guidelines and promoted speedier access to emergency care. The initiative in North Dakota, and similar efforts in Nebraska, Montana and Iowa, have received support from The Leona M. and Harry B. Helmsley Charitable Trust.
In North Dakota, people who reported knowing the signs and symptoms of stroke increased by more than 20 percentage points over two years after participating in Mission: Lifeline activities, a 2020 survey showed. And more than 70% of those surveyed knew to call 911 at the first sign of stroke symptoms — a jump in two years of more than 6 percentage points.
In addition, nearly 93% of health care professionals surveyed felt strongly that they have a better understanding of the key issues related to working with stroke patients. And nearly 70% strongly agreed that communication between hospital staff and emergency medical services has improved.
"We review each case to see if something went wrong, so we can improve and make our processes better," McClellan said.
That's especially important in rural areas, where people are at a significantly higher risk of dying from stroke than in urban areas.
Research sponsored by the AHA has also yielded significant results. When Marcy Dawson began working as a flight nurse in 1990, very few people she treated in rural areas survived cardiac events. "Everything is evidence-based, and (the guidelines) have changed many times through the years," she said. "We are seeing more people survive because of that research."
Dawson relies on such research in her current role, as an outreach development specialist, training paramedics in, among other things, advanced stroke and cardiac life support techniques.
Jerry and Amy Noeske are ever grateful for the expertise of local emergency personnel.
"If they hadn't known CPR, we wouldn't have been able to say goodbye," Amy said.
To honor Sam, administrators at the local elementary school established Sam's Field, a baseball diamond, complete with an old-time scoreboard and dugouts. People in the tight-knit community donated the materials and their labor.
While Jerry acknowledged that the grief never goes away, "It's not a sad place," he said. "It brings a smile when we get here."