When popular Monta Vista High School teacher and coach Ron Freeman collapsed and died of a heart attack at a school basketball game in 2011, the school community was galvanized into action.
Less than two years later, the Cupertino high school -- as well as each of the other four campuses in the Fremont Union High School District -- has at least seven automated external defibrillators (AEDs) on hand around campus, including units that are carried by school athletic trainers to practices and games.
During a sudden cardiac arrest, defibrillators deliver an electric shock to the heart to restore normal rhythm. After the shock is delivered, the typical AED will prompt the operator to perform CPR while the device continues to analyze the victim.
As the machines have become user-friendly and portable since the 1990s they have proliferated in offices, campuses, police cars, airports, golf courses and houses of worship.
Palo Alto resident Stephanie Martinson, a speech therapist and the mother of daughters at Palo Alto High and Ohlone Elementary schools, is on a mission to bring AEDs to schools and elsewhere.
"We are so far behind other states and other places in the adoption of these machines," Martinson said.
"Defibrillators are easy to use -- they talk the responder through and determine if the person needs a shock or not.
"We do a phenomenal job with asthma -- we have EpiPens everywhere and they're mandated in our schools -- but we also need the same standard of care for sudden cardiac arrest."
Martinson partners with organizers of local running events to lend the portable defibrillators in case a runner collapses -- and to promote awareness of their life-saving potential. She shows up on race days with friends and volunteers from Racing Hearts, a nonprofit she founded last year.
"I think what Stephanie is doing is really compelling," said John Carrington, a Menlo Park executive and survivor of sudden cardiac arrest.
Carrington, now CEO of the thin-film solar company MiaSole, credits his survival after a 2006 heart attack to an alert colleague and an AED.
"The more people that can become aware of this, the better," he said.
Martinson has secured AED endorsements from Olympic athletes, doctors, politicians, opinion leaders and survivors like Carrington.
She has research AED litigation records in an effort to talk people out of their fear of lawsuits.
She asks participants in running events to donate an extra $3 above the race fee to fund the spread of the defibrillators and training on their use.
There's just a 5 percent survival rate among the more than 300,000 Americans stricken with sudden cardiac arrest every year, Martinson said.
"People don't realize this could happen to anyone. Every three days it's a young athlete who dies.
"But we have a simple solution to improve the survival rate -- AEDs everywhere."
Martinson is not a heart-attack survivor herself. But her medical condition, hypertrophic cardiomyopathy, puts her at heightened risk.
For several years she lived with an internal defibrillator implanted in her chest, but it caused her "nothing but trouble."
The internal device was removed after it malfunctioned in 2007, mistakenly delivering 26 shocks to her heart.
"People say it's like being kicked by a horse but I say, 'No, it was like a 777 jet crashing in on me,'" she said of the experience. "All the electrical circuits were just exploding.
"I had to heal myself. There were so many parts of my brain I had to rework and study to try to heal myself.
"People who have gone through cancer or sudden cardiac arrest say, 'There's just a new me.'
"We all have a story, and this is my story, and I'm finally willing to share it."
Erik Walukiewicz, a former teacher and coach, used to play poker and golf with Freeman, the Monta Vista coach, who was 52 when he died on Jan. 21, 2011.
"It was at the end of a basketball game and he was out there and he said, 'OK guys, it's time to go home.' And then he collapsed and died right there on the site. It was really sad," Walukiewicz said.
"He was a great teacher and coach of kids."
Though nobody can say for sure whether an AED would have saved Freeman, the shock of his death was a catalyst for Monta Vista and its sister schools -- Homestead, Fremont, Cupertino and Lynbrook -- to get serious about a defibrillator program that already had been on the drawing boards, Walukiewicz said.
By that summer, trustees of the Fremont Union High School District had approved a defibrillator policy and by fall "we rolled out a program," said Walukiewicz, who is now the district's maintenance and operations coordinator and oversees 37 defibrillators in the five high schools.
"Fortunately we haven't had to use them, but the good thing is that if we ever had to, the units are there," Walukiewicz said, adding that the district so far has spent about $80,000 on the program.
"We have them all over the place because you want to be able to get one and be back in one and a half minutes. We typically have one on the pool deck, one in the gym, usually one in the theater, one in the main office -- and the athletic trainers have them to carry to athletic events.
"Anybody could have a sudden cardiac arrest at any time, but sometimes kids get struck by a ball or a blow to the chest, so that's why we place them where there are athletic events going on," he said.
Walukiewicz said he personally checks each unit monthly to make sure it is functional and that the batteries and adhesive electrode pads, which are to be placed on the victim, are up-to-date.
Maintenance and training are critical to sustaining a successful AED program, said Julianne Brawner, a founding partner of Menlo Park-based Health Education Services, a health training company that sells turnkey AED programs.
The Lodi Unified School District paid $400,000 in a 2009 legal settlement after an AED failed to resuscitate a Lodi High School student who collapsed in a physical education class. The student ultimately was resuscitated by paramedics using their own defibrillator and taken to the hospital, where it was determined he suffered a brain injury, according to the Lodi News.
The student's lawyer alleged that an expired battery had caused the school's machine to malfunction.
But if organizations observe state guidelines requiring that machines be maintained and that some staff be trained, even untrained users of AEDs are protected under California's Good Samaritan law, which offers legal protection to people who give reasonable assistance in an emergency, Brawner said.
AEDs "are very simple and intuitive to use," she said. "They've done studies where sixth-graders score just as well as paramedics. I haven't heard about the outcome, but I believe they were even testing third-graders to see how well they could follow the prompts."
It's estimated that 40,000 or 50,000 of the 330,000 who die after sudden cardiac arrest each year could be saved if AEDs were nearby, she said.
Brawner cited casinos in Las Vegas and Reno as "wonderful learning labs for the science of resuscitation because they have every inch of their properties under surveillance.
"When someone goes down, all their security forces are trained to do CPR and apply defibrillators, so the typical time from the time of collapse to defibrillation is one to three minutes, which is ideal.
"They report a 60 percent to 70 percent save rate, so we know that this works," Brawner said.
A victim's chances for surviving sudden cardiac arrest are "close to 90 percent" if defibrillation occurs within the first minute of collapse, according to the Sudden Cardiac Arrest Association.
"For every minute that defibrillation is delayed, survival decreases by 7 percent to 10 percent. If it is delayed by more than 10 minutes, the chance of survival in adults is less than 5 percent," the association says.
Brawner said organized AED programs are in place at schools in Menlo Park, Foothill and De Anza colleges, the San Mateo County Community College District, the University of California at Berkeley, Alameda County and Los Angeles.
"They're popping up all over," she said. "It's our mission to have defibrillators as available as fire extinguishers. The deterrent is cost, and in schools that is a huge issue."
Price of AEDs vary by make and model, but most cost between $1,500 and $2,000, according to the American Heart Association. Machines then must be monitored and maintained, with regular replacement of batteries and adhesive electrode pads.
The American Heart Association supports school-based AED programs as long as they are supported by"effective and efficient communication throughout the school campus; coordinated and practiced response plan; risk reduction; training and equipment for first aid and CPR and implementation of a lay rescuer AED program in schools with an established need."
"While getting AEDs placed is important, we want to assure it is done strategically and is supported by appropriate training and planning," Kate Lino, the heart association's communications manager for CPR & First Aid said.
At Stanford University, Assistant Fire Marshal Alison Pena oversees a database that tracks nearly 160 AEDs spread all around campus.
"This landed in my lap in 2003 and at that time we had just 15 units, but we knew this was going to take off," Pena said.
Stanford leaves it up to individual departments to purchase and manage their AEDs, but Pena tracks the machines and sends monthly maintenance reminders to every site coordinator, who must check their units and report on their condition. Pena also sends reminders, 60 days in advance, for scheduled replacements of batteries and pads.
"We've had a couple of uses -- three to be exact," Pena said. "They were all over in the athletic facilities."
Of the three victims, just one -- a Senior Games participant who was stricken while swimming at Avery Aquatic Center -- survived after use of an AED, Pena said.
The other two -- an athletic staff member in 2012 and a baseball spectator at the Sunken Diamond in 2004 -- succumbed, she said. She declined to disclose any additional information about the circumstances or victims.
"These machines are so easy to use -- really anyone can use them -- but they're used under very stressful situations," she said.
"We need to start getting comfortable with seeing these units and using them. Of course, we always encourage people to be trained in CPR and AEDs. I really believe in another decade AEDs are going to be as common as fire extinguishers -- and people should know how to use fire extinguishers as well."
Armed with a two-for-the-price-of-one coupon for AEDs, Stephanie Martinson in the fall of 2011 approached friends and the Palo Alto Council of PTAs for purchase of defibrillators for Palo Alto schools.
The PTA Council purchased the machines last June, with a plan to have three at Paly and three at Gunn, she said.
The machines currently sit in school district offices, but will be deployed on the campuses -- probably in February -- after athletic and office staff members on both campuses complete training, according to Associate Superintendent Charles Young.
"Stephanie is quite an amazing woman," Brawner said.
"It's a small community of people who have this same passion and mission, and she's coming up with some very innovative ways to fund the defibrillators.
"Her creativity is just unique. She's taken it upon herself to do outreach to these organizations to get funding, so my hat is off to her."
Martinson works days as a speech pathologist at the VA Palo Alto Health Care System, seeing many patients in the critical care unit.
After her own six surgeries between 2002 and 2008, and ultimate removal of her internal defibrillator, it took her some time to recover. It was only last August that she obtained nonprofit status for Racing Hearts from the Internal Revenue Service.
"People can overcome their life's difficulties," she said.
"I always knew I would advocate for AEDs in the schools; I just didn't start it until last fall," she said.
"I finally felt healed enough that I knew I could do it."