A Defibrillator For Your Home Medicine Chest

By Debbe Geiger

Debbe Geiger is a freelance writer.

December 3, 2002

Defibrillators, the machines that jump-start hearts stopped by a deadly electrical malfunction known as cardiac arrest, could one day become as common in the home as fire extinguishers, now that the FDA has approved the sale of the first at-home automatic external defibrillator (AED).

The HeartStart Defibrillator, manufactured by Philips Medical Systems, will be available starting early next year. Philips is marketing its AED to people over the age of 45, especially if they are at risk for heart attack.

According to the American Heart Association, sudden cardiac arrest is one of the leading causes of death in the United States, claiming more than 250,000 lives each year. More than 70 percent of cardiac arrests occur in the home, and the majority are witnessed by someone who could potentially be a lifesaver.

"We know that if someone collapses of cardiac arrest and someone is able to defibrillate them within a minute or so, almost everybody survives," says Dr. W. Douglas Weaver, chief of cardiology at Henry Ford Hospital in Detroit. These devices, he says, "could have a significant impact as long as people recognize when someone has cardiac arrest and takes action."

Questions remain about how people will react in life-threatening situations. A recent New England Journal of Medicine article on defibrillator use at Chicago's O'Hare airport proved that untrained Good Samaritans can and will save people's lives when faced with sudden cardiac arrest. The study suggested "that people will take action, and the amount of training that is required is somewhat less than what was thought in the past," says Weaver. "People can use these devices even though they weren't part of the emergency response team."

Even so, he says, "the experience we have in the home situation is quite limited. Although I think the downside for having these in the home is almost zero, there are some unanswered questions, like will people use them in the moment of urgency?" Will these devices "be used when they should be used, and will people be effective at resuscitating these victims of sudden death? I don't think we know that for sure."

To determine how effective defibrillators will be in the home, the National Institutes of Health is beginning a four-year international study of 7,000 people at risk for heart attack. The randomized trial will put defibrillators in some of the patients' homes and train family members in their use. "In the past, the approach was simply call 911 and do CPR and wait for the paramedics to arrive," said Dr. Marcel Salive, a project officer for the National Heart, Lung and Blood Institute in Bethesda, Md. "This allows the defibrillation to occur earlier. We really don't know how many of these people could be saved. That's the reason for doing the study."

The American Heart Association is hoping for answers to the same questions before it gives the at-home defibrillator its nod of approval. "We believe that early defibrillation saves lives," stressed Dr. Vinay Nadkarni, chairman of the emergency cardiovascular care committee of the American Heart Association in Dallas. "What we don't know is whether putting an automated external defibrillator in the home can actually accomplish the goal of early defibrillation." While the device requires a physician's prescription, special training is not mandated, and that concerns the heart association, Nadkarni says. "We'd like to see the sale of the AED tightly contingent upon training in early recognition of an emergency, CPR and AED use. That is the triumvirate of intervention for cardiac arrest."

According to David Freeman, vice president of cardiology marketing at Philips, a tug on the pull handle activates a clear voice that calmly directs the user through each step of the defibrillation process. It also prompts him or her to call for emergency help and provides CPR coaching. Freeman says the device is so sophisticated that it can sense the user's actions and automatically adjust the pace of its verbal instructions. When not in use, the defibrillator does daily checks on all its systems, including the batteries and pads' readiness. It chirps like a smoke detector in need of batteries to alert family members when a part needs attention.

"I think it's great," says Dr. Todd Cohen, director of electrophysiology at Winthrop-University Hospital in Mineola. "They're idiot-proof. I'm a big believer in getting these things closer to patients because they can save lives."

Cohen says CPR can keep the circulation going, but it cannot correct the abnormal heart rhythm called ventricular fibrillation, which is most often associated with cardiac arrest. Prompt defibrillation is recognized as the definitive treatment. For every minute that goes by without defibrillation, a victim's chance of survival decreases by about 10 percent. After 10 minutes without defibrillation, few attempts at resuscitation are successful. The average response time for emergency medical services in a typical community is nine minutes.

The HeartStart's suggested retail price is $2,295, and it is not covered by most insurance policies. It can be ordered by calling 866-333-4246, by visiting www.heartstarthome. com, or at select CVS stores.

Copyright © 2002, Newsday, Inc.

Device Pays Off Again Defibrillator helps save life of Brightwaters man at ballgame

By Erik Holm

STAFF WRITER

November 18, 2002

When his doctor walked into the emergency room a few hours after John Tierney's heart stopped on Saturday night, he took one look at his patient and pronounced him blessed.

"You're a very lucky man,” the doctor said.

Tierney, who suffered the heart attack in the stands moments before the kickoff of a high school playoff game between Locust Valley and Seaford, was revived by a defibrillator that had been on the sidelines.

The heart-starting device was there, in part, because of the efforts of one Northport couple, who believe a defibrillator could have saved their 14-year-old son, Louis Acompora, who died after being struck on the chest while playing lacrosse in 2000.

Defibrillators will be required at every high school sporting event in New York State beginning Dec. 1, thanks to a new state law the Acomporas had pushed for. But the Locust Valley school district and parents' groups had purchased their district's defibrillators more than two years ago, not long after Louis Acompora's death.

When he heard about Tierney late Saturday night, Louis' father, John Acompora, said he "got goose bumps.”

"It's extremely gratifying. This is exactly the sort of thing we've been telling people,” he said yesterday. "The people who could be saved by this are teachers, janitors, parents, anyone at the event.”

Tierney, 61, an attorney from Brightwaters, was listed in critical but stable condition yesterday. But family members said that he is well on the way to recovery and would likely be moved out of the critical care unit today.

Tierney had lived with an irregular heartbeat for years without incident and had stents put in his heart in the past year as a preventive measure.

Between cracking jokes about his health and his luck yesterday, said his wife, Cecilia Tierney, Tierney was expressing amazement over the trainer, the doctors and the firefighter who happened to be on the sidelines at Hofstra University's stadium, where the playoff game was being held.

He was amazed, too, that there was a defibrillator on hand, thanks to the efforts of Locust Valley school administrators, boosters and the Acomporas.

"Good things come from tragedy sometimes,” Cecilia Tierney said. "He just can't believe there are so many good people in the world . . .”

Tierney is not the first on Long Island to be saved because of the efforts by the Acomporas to make defibrillators more widely available.

Among those who have been helped is Muhammad Shah of Nesconset, 15, a student at Smithtown High School, revived in December with a defibrillator purchased by school officials.

James Hanrahan of St. James was on the third hole at St. George's Golf and County Club in Stony Brook in September 2001 when he had a heart attack. Club officials had heard of the Acomporas' efforts and completed their training on their newly purchased defibrillators just two weeks before. They shocked him three times before restoring a normal heartbeat. Hanrahan said yesterday that he has played roughly 140 rounds of golf since.

About the Acomporas, Hanrahan said: "Without them, I wouldn't be here. They have done an incredible job in a small amount of time. They are wonderful people.”

Copyright © 2002, Newsday, Inc.

Defibrillator at Game Saves LI Man's Life

By Tom Rock and Daphne Sashin

STAFF WRITERS

November 17, 2002

A Bay Shore man's life was saved last night after he had a heart attack in the stands of a high school playoff football game at Hofstra University and was revived with a defibrillator, a team physician and an athletic administrator said.

"Thank God we had the defibrillator here today," said Pat Pizzarelli, Nassau football coordinator. "The response of the doctors and the trainer was exceptional and it saved that gentleman's life."

About 8 p.m. as the players from Locust Valley and Seaford were being introduced, John Tierney, 62, was walking toward the bleachers. Suddenly, his knees buckled and he hit his head on the first row of seats, said Kathy Carusi, the mother of a Locust Valley player, who saw it happen.

Emergency personnel and Hofstra security rushed to him. Artie Sanderstrom, a volunteer firefighter with the Locust Valley Fire Department who was a security supervisor for the game, administered CPR along with Dr. Howard Cohn, Locust Valley team physician.

Whittney Smith, the Locust Valley athletic trainer, then called for the school's automatic defibrillator, which was on the sidelines.

As "The Star-Spangled Banner" played, Tierney was moved underneath the stands out of the rain and hooked up to the machine. Smith had never used a defibrillator before, he said, "other than on a mannequin."

After the first shock from the portable device, the man's heart regained its rhythm briefly, then lost it, Smith said. After the second shock, his heartbeat was restored. Tierney was taken to Nassau University Medical Center in East Meadow, where he was admitted to the critical care unit. He was in stable condition last night, spokeswoman Shelley Lotenberg said. Tierney is an uncle of Locust Valley senior receiver Ryan Simensky.

Under a state law that went into effect Sept. 1, a defibrillator is required to be in every school and at every athletic event and school-sponsored event by Dec. 1. A defibrillator is required at all playoff games, Pizzarelli said. Yesterday's game was a Nassau Conference IV semifinal game.

The Locust Valley school district has about 12 machines. For the past three years, it has had one at the sideline of every sporting event, a school official said.

"If that man lives, it is because of [Smith]," Cohn said. "Without the defibrillator, he never comes back."

Copyright © 2002, Newsday, Inc.

Public Access Defibrillator programs make life-saving difference

The NCAA News -- November 11, 2002

Supplement to The NCAA News -- Health and Safety Newsletter

BY ROCHEL RITTGERS

AUGUSTANA COLLEGE (ILLINOIS)

Gerry Bram, an NCAA Division I football referee, is alive today due to the availability of a defibrillation device and the swift actions of the sports-medicine staff from Syracuse University.

University and college athletics programs are in a unique position to raise public awareness of the life-saving capabilities of automatic external defibrillators (AEDs) just by having them available for the people they service.

Sudden cardiac arrest was responsible for about 490,000 deaths in 1999, according to the Center for Disease Control, and only about half of those victims made it to the hospital. Tomorrow, about 1,000 people will suffer a cardiac arrest in our country, and only about 50 will survive. Most of those deaths are unnecessary.

In the collegiate athletics environment, the risks of sudden cardiac arrests are present with our coaches, referees, staff members, bus drivers, fans and even student-athletes. Most cardiac arrests are caused by a disruption in the heart's normal rhythm. This rhythm disruption most often results in a condition called ventricular fibrillation, where the heart maintains an electrical charge, but it is essentially misfiring.

Defibrillation is the technique involving the administration of an electric shock that can restore the heart's normal rhythm. While this procedure historically has been available only from paramedics or in hospital settings, the development of a portable computer that can analyze a person's heart rhythm has enabled lay people, coaches and sports-medicine staff members to be trained to perform this procedure. These portable devices, about the size of a lightweight laptop computer, are increasingly more practical to have available.

Remarkable outcomes

Sudden cardiac death in young athletes is a rare but devastating occurrence. Although attempts are made to identify athletes at risk for cardiovascular disease, many have no symptoms and no physical examination findings. Structural cardiac abnormalities are the most common cause of sudden cardiac death in student-athletes. Because of the difficulty in identifying these underlying anomalies, the accessibility of an AED is important in the event of a life-threatening dysrhythmia.

Truly remarkable outcomes are seen when defibrillators are used on sudden cardiac arrest victims. The success rate of restoring normal heart rhythm through standard CPR techniques is less than 5 percent. Add defibrillation within the first minute after arrest, and it becomes an amazing 95 percent. Communities who have initiated Public Access Defibrillator (PAD) programs that place AEDs in ambulances, police cars, and other public locations are experiencing sudden cardiac arrest survival rates of as high as 43 percent, compared with large cities with no such program where the survival rate drops as low as 1 percent.

Paramedics nationwide will be the first to admit that their life-saving attempts in cases of cardiac arrest are rarely successful. The time it takes for the emergency squad to respond to a 911 call is usually greater than 10 minutes. Those precious minutes are the critical difference between life and death. As mentioned, 90 percent of sudden cardiac arrest victims who are treated with a defibrillator within the first minute of arrest can be saved. However, for every minute that defibrillation is delayed, there is about a 10 percent reduction in the chance for survival.

AED availability

The value of having these devices appears obvious. However, liability concerns, quick availability of emergency personnel, training requirements, cardiac risk of the population and the cost and maintenance of the machines are among valid concerns that have arisen regarding the need for having AEDs at athletics venues.

The liability risk of using an AED was addressed when in 2000 President Clinton initiated a bill that grants legal immunity to good Samaritans who use AEDs. Since then, most states have rewritten their own good Samaritan laws to include language about the use of AEDs.

From another angle, a plaintiff in a fitness facility received a $2.5 million award after a lawsuit charging the facility for not meeting a member's emergency-response needs when the plaintiff had a heart attack and there was no AED available (Chai versus Sports Fitness Clubs of America, Circuit Court, 17th Judicial District, Broward County, Florida). This suit may represent a shift toward requiring fitness-related facilities to have AEDs available.

All instructors of CPR through the American Heart Association and the American Red Cross are now trained in the use of AEDs. The NCAA currently recommends annual training of athletics personnel in CPR. The inclusion of AED education within that training would be practical and time efficient.

Although the cost of AEDs is dropping, most still range between $2,000 and $4,000, a hefty sum for many athletics departments. For state institutions, the U.S. Senate passed the Community Access to Emergency Defibrillation Act in 2001, which budgeted $55 million a year for five years for communities to install AEDs in public places, to train first responders, to encourage private companies to purchase AEDs, and to promote public access to defibrillation in schools. Grant applications can be sent to the Secretary of Health and Human Services. More information on the details of this act is available at www.senate.com.

Public access to AEDs is critical for successful intervention. The statistics speak for themselves and the cost of saving one life certainly justifies the purchase price of a unit.

Douglas P. Zipes, former president of the American College of Cardiology, said in a recent New York Times article, "I have a cure for sudden death: it's getting a defibrillator to the patient. The problem is getting it to them in an appropriate time interval. How can I make that happen?"

The initiation of PAD programs by colleges and universities has created results that travel like waves from campus communities all the way to state legislation. Those who have recognized the need are spreading the awareness and making a difference.

Athletic trainers promote AED use

There are countless stories of university and college medical teams using AEDs to save lives. As a result, many have impacted the awareness and availability of AEDs on their campus and also in their surrounding communities.

Stephanie Brandt, athletic trainer at Concordia College, Moorhead, was glad the school purchased its AED when it did. Less than one month afterward, a retired professor had a massive heart attack after playing a lunch-hour basketball game in the athletics building. "He is alive today, two years later, because of the training I obtained and expedient use of the AED by myself and others," Brandt said.

The medical staff at Syracuse University, including athletic trainer Tim Neal and team physician Irving Raphael, joined forces with athletic trainers from East Carolina University to save the life of a football referee during the teams' game in September.

At a University of Iowa wrestling match, the device was used after the collapse of a spectator in the bleachers. Iowa athletic trainer Dan Foster said, "The results were dramatic. The immediate success has resulted in a continued high quality of life for the patient. That one incident has resulted in an increase in AED purchases in the community, general public awareness, and changes in the AED regulations in the state."

Athletic trainers nationwide are spearheading Public Access Defibrillator programs on their campuses and in their communities. These programs market the development of phases to initiate the availability of AEDs in public places. Initially, they are made accessible on all ambulances, followed by police cars and campus security, and then in public buildings. Communities that recognize PAD as a priority are using ingenuity to make it happen.

Rochel Rittgers is the director of athletic training services at Augustana College (Illinois). She chairs the drug-education and drug-testing subcommittee of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports.

© The National Collegiate Athletic Association

A Lifesaving Procedure Districts on deadline for defibrillators

By Jason Molinet

STAFF WRITER

September 1, 2002

Automated external defibrillators save lives. But a number of school administrators still are working to comply with the new state law mandating that the machines be present at all public schools and athletic events for grades 4-12.

Although Education Law section 917 goes into effect today, several districts across Long Island are scrambling to purchase AEDs, train staff and ensure the devices are strategically placed for quick access. The law allows a three-month extension, giving Long Island's 102 school districts as well as the rest of the state until Dec. 1 to comply, and several administrators have said the extra time is necessary.

The bill was signed into law by Gov. George Pataki with much fanfare during Northport High School's graduation ceremony June 27, the culmination of a grassroots push by the Louis J. Acompora Memorial Foundation.

The portable devices, which cost $1,800 to $3,000, are designed to restore a regular heartbeat via an electrical shock to the heart after cardiac arrest. An AED could have saved the life of Northport freshman lacrosse goalie Louis Acompora, who died in March 2000 after being struck in the chest with a ball.

"In a sad way, it's bittersweet to see it come into law," said John Acompora, Louis' father. "Quite honestly, I never thought this would happen two years ago. Two years ago, no one ever heard of a defibrillator."

Schools already had begun to embrace the device before the state made it mandatory. According to an April survey compiled by Section XI, Suffolk's athletic association, 27 of the county's 57 school districts had at least one AED. Eighteen more districts indicated they planned to acquire defibrillators by the new school year. Section VIII, Nassau's athletic association, did not have statistics available. Northport spearheaded the push with 36 of the life-saving machines mounted on walls at 10 buildings districtwide, including 11 AEDs reserved for athletics.

"Long Island was ahead of the game because of the unfortunate death of the Northport student," said Nina Van Erk, executive director of the state Public High School Athletic Association. "That raised awareness. But districts would have benefited from having more time. The timing was very tight."

Freeport athletic director Bob Zifchock said he was one of several administrators convinced of the need for AEDs after attending a Nassau safety seminar featuring the Acomporas in April 2001. Freeport now has 17 AEDs.

The law, however, does not apply to private schools, which are not members of NYSPHSAA. Bro. Kenneth Hoagland, chairman of the Nassau-Suffolk CHSAA, said it will be left to each school to address the issue. "Certainly our schools will look into it," Hoagland said. "Each school has to make that decision."

Long Island Lutheran, a small independent school in Brookville, has one defibrillator on campus. Athletic director Gary Proce said, "I think it's foolish if you don't comply."

Island Trees was one of many districts to file for a waiver until December. Athletic director Steve Connell said he needs time to enact an emergency action plan and train staff while the district cobbles together the funds to purchase 10 AEDs. Because school budgets are submitted as early as December for the following year, many districts didn't set aside funds to start a defibrillator program.

"Where is the money coming from?" Connell said. "That's the real question."

Resources and tips on setting up a defibrillator program are available at the Acompora Foundation Internet site: www.la12.org. And financial relief is on the way to some Suffolk schools. State Sen. Kenneth LaValle (R-Port Jefferson) will help underwrite the cost of defibrillators and training with $3,500 grants to each of the 39 school districts in the First Senate District, which serves the Town of Brookhaven and the entire East End.

"The Senate is always reluctant to pass an unfunded mandate," said Margaret Rothwell, LaValle's executive assistant. "But the health and safety issues here are so strong."

Another problem administrators are grappling with is the language of the law, which calls for strategic placement of the devices, and for full coverage of all athletic practices and games. Other factors, such as the size of the school and whether to purchase pediatric defibrillators, cloud the issue.

"There's real science that shows the faster you get the unit applied to a victim, the more effective they are," said Stuart Cherney, the team physician at Stony Brook University and a member of a Section XI committee examining how the new law should be applied. "So in an ideal world, they're on every sideline."

Westhampton added four defibrillators, and athletic director Rich Schaub, a CPR instructor, supervised the certification of coaches and security personnel. While Schaub believes Westhampton is following the spirit of the legislation, he's not sure if the school fully complies with the letter of the law.

"I don't know if you can put a definitive number on how many you need because there are so many variables," Schaub said. "But four is better than none."

"I'm sure the law will only help," said Hempstead athletic director James McClellan, whose district purchased 15 AEDs. "The idea is to be in compliance. And everyone wants to be on the safe side. No one wants to see that tragedy happen again."

Then there are the complexities of training. Who should be certified, and are they willing participants? "The simple part is getting AEDs in the building," Northport athletic director Bob Christenson said. "The more complicated part is getting the staff trained to use them. Because the tragedy happened here, we've had well over 200 staff get the training, from the superintendent to the coaches. And well over 140 students have been certified."

Copyright © 2002, Newsday, Inc.

Oyster Bay Parks Get 18 Defibrillators

By Pat Burson

STAFF WRITER

August 25, 2002

William Zang hovered over the lifeless figure lying near the 50-meter pool, attached two monitors to the upper right chest and lower left side and waited for a signal to administer a life-saving electric shock.

Thankfully, the victim was only test dummy "Resuscitation Annie," and Zang, Oyster Bay Town's director of aquatics and lifeguard operations, was only demonstrating the workings of an automatic external defibrillator for elected officials and a half-dozen lifeguards yesterday at Marjorie Post Community Park in Massapequa.

Town officials recently purchased 18 defibrillators with a $45,000 grant secured by state Sens. Charles Fuschillo (R-Merrick) and Kemp Hannon (R-Garden City), who attended the demonstration.

Oyster Bay joins a growing list of municipalities adding defibrillators to their arsenals of safety equipment at public recreational facilities.

"This all came about because residents approached elected officials to ask if we could have this in our parks," Oyster Bay Supervisor John Venditto said.

"Without AED units," he said, "town lifeguards, parks personnel and bay constables would have to perform CPR on sudden cardiac arrest victims while they wait for the local fire department or ambulance to arrive ... With these AED units now available at town recreational facilities, [they] will be able to defibrillate victims quickly and effectively, dramatically improving chances of survival."

The equipment will be used year round, Venditto said. "With football, soccer and ice hockey leagues starting shortly after Labor Day, we feel that adding the extra defibrillators to the ice rinks and parks will enhance the safety of our residents," he said. "While I'm happy to have them, I'll be a lot happier if we never had to use them."

Copyright © 2002, Newsday, Inc.

Nurse Saves Life of Football Fan

PUBLICATION: The Observer, Northport, NY

February 14, 2002 - Elizabeth "Liz" Devine, a nurse in the Weiss Center for Pain Management at John T. Mather Memorial Hospital in Port Jefferson, received an American Heartsaver Award from the American Heart Association "Operation Heartbeat Task Force" February 5 at St. George's Golf & Country Club in Stony Brook. Ms. Devine used an AED device (Automatic External Defibrillation) to save the life of Robert Fitzpatrick of Massapequa who collapsed during a Chaminade football game at St. John's University in Queens, where her son Daniel plays. Mr. Fitzpatrick's twin grandsons also are on the team.

Ms. Devine was a spectator in the crowd when she heard a request for a doctor over the PA system. she responded and found Mr. Fitzpatrick on the ground with no pulse. She called out for someone to call 911, asked if there was an AED unit on campus and began CPR.

While Devine administered mouth-to-mouth, someone else started chest compressions. After about two minutes, an AED arrived - a physician attending the game had it in the trunk of her car. They shocked Mr. Fitzpatrick and immediately got a pulse. The ambulance arrived, administered oxygen, and took Fitzpatrick to the hospital where, Ms. Devine was later informed, he was awake and alert.

Ms. Devine resides in Port Jefferson with her husband, Michael. They have six children - Patricia, 26, Michael, 24, Meaghan, 18, Daniel, 17, Joseph, 15, and Kaitlyn, 12.

© Copyright 2002, The Observer, Northport, NY

This Time a Boy Survives Efforts of Northport couple who lost son help to save a life

PUBLICATION: Newsday

BY: Samuel Bruchey. STAFF WRITER

January 13, 2002 - They were two boys from Northport and Smithtown, teenage strangers bound by a single tragic strand.

Louis Acompora, 14, was outgoing, a starting goalie and co- captain of the Northport High School freshman lacrosse team. Muhammad Shah, 15, was more spectator than star. The Smithtown High School sophomore cheered the 49ers for their return to the playoffs, and fretted when Knicks coach Jeff Van Gundy resigned.

On a cold and raw December Monday at Smithtown High School, the day Shah's heart accelerated wildly then abruptly stopped, their fates overlapped, and then diverged.

A year before, Acompora 's heart had stopped just as abruptly during his team's first lacrosse game of the season. But whereas Acompora died, surrounded by paramedics, coaches and his parents who were unable to restart his heart, Shah survived.

His pulse was coaxed back with a portable defibrillator, equipment the school bought in September, a year after learning of Acompora 's death, and used for the first time that day.

"Every school should have one," Shah's mother, Shahina Shah, said. "He [Louis Acompora ] was not a cardiac patient. Accidents do happen. They happen to everyone."

Shah's accident was not without premonition. A dark-eyed boy with a sweet and toothy smile, Shah was born with a vein missing between his heart and lungs. He had a pacemaker implanted when he was 8, his mother said.

Seconds before his collapse, Shah's pacemaker recorded that his heart-rate shot from 93 to 400 beats-per-minute.

He had just left first-period English. It was 8 a.m., and Shah was walking along an outdoor corridor, on his way to his next class, Fundamentals of Flying. As he climbed five steps leading to the school's separate freshman campus, he buckled, then dropped.

Another student rolled him over onto the grass and ran for help. Nurses and security guards converged. They cut off his black New Jersey Devils shirt and began cardiopulmonary resuscitation.

His body was convulsing and his face turned blue.

At 8:20 a.m., a guidance counselor called Shah's mother.

When she picked up the phone, Shahina Shah said her mind scrambled madly back to earlier that morning. She saw Muhammad gulping down his milk, riding quietly beside her in the car, telling her he felt fine, then trudging off, his green back-pack low and heavy with eight classes worth of books.

"I thought maybe she was calling about his studies," she said. "When I found out, Oh God, I just kept asking 'Is he breathing? Is he breathing?'"

"She said, 'We don't know.'"

Two defibrillator pads were placed on both sides of Shah's heart, and between heart compressions he was shocked. By the third shock, a faint pulse returned.

"It did everything it was supposed to do," Liz Chitkara, a school nurse, said.

Shah was taken to St. Catherine's Hospital in Smithtown, then transferred later that morning to his cardiologist at Stony Brook University Hospital.

By the time he arrived, Shah, who weighs 70 pounds, had developed pneumonia. His body temperature was 75 degrees. After more than one week on a respirator, his pacemaker was replaced on Dec. 26 with a device that functions as both pacemaker and defibrillator.

The day after the procedure, Shah went home.

Recuperating earlier this week, Shah hid his eyes under the lowered lid of his 49ers cap, and burrowed his hands into an oversized yellow sweatshirt when asked how he felt.

He said he was back eating his favorite food - a meat and rice dish called biryani - playing computer games, mostly Age of Empire, and riding a stationary bicycle for physical therapy three times a week.

Soon, his mother added, he will begin home tutoring, and may return to school by Easter.

His recovery has been heartening for Louis Acompora 's parents, John and Karen.

After Louis died, they began pressing schools to buy the $3,000 defibrillators. At the time, Karen Acompora said, few in Suffolk County had one. Now, about 25 do, she said.

"We mandate things in New York State for testing so all fourth- graders can read," said Nick Schroeder, Smithtown's athletic director, who joined a county task force with the Acomporas . "Schools are areas of community congregation. The state should be able to say [the students'] lives are important."

Schroeder convinced a Booster Club in Smithtown to purchase a defibrillator last year. In August, the school district bought another six, and has ordered three more.

Defibrillation was the only thing that was not done when Louis stopped breathing, John Acompora said. He stood on the sideline that day with his wife, he said, when Louis blocked a shot on goal with his chest and then dropped. He thought Louis had the wind knocked out of him and didn't want to embarrass his son by running out onto the field, he said.

But after several minutes, Karen was beside herself. He walked slowly toward a crowd hovered over his son. He opened his chin strap, took out his mouthpiece. "Lou, answer me, Lou! Answer me, Lou!" someone was yelling.

"In the very near future, defibrillators will be a household word," John Acompora said. "I wish they had been then."

© Copyright 2002, Newsday Inc.