In a health crisis, the difference between life and death can depend on where catastrophe strikes -- but there is one Minnesota town that leads the nation when it comes to saving people from sudden cardiac arrest.
Wayne Demydowich is a veteran distance runner, and the 13-mile run on a damp morning with a teeth-chattering chill would span a punishing 3 hours that would put tremendous stress on his heart.
"It's pretty important for me that I'm still out here doing it," Demydowich explained. "It's a lot better to be out here running today in the cold than it is to have to learn to retie my shoes."
Just 5 months ago, Demydowich was seconds away from suffering severe, irreversible brain damage all because his heart was quivering. He'd suddenly stopped breathing and had no pulse. His car came to a stop in the middle of traffic, and he couldn't respond to the passerby who stopped to call 911.
"I'm knocking on the window," Chuck Miedtke told the 911 dispatcher. "He won't respond."
Demydowich was dead, but Miedtke's quick call kept him out of a casket.
The doors were locked, keeping Miedtke from making contact with Demydowich -- but help arrived quickly. First responders smashed out the window to get to Demydowich and determine what was wrong.
"We showed up having absolutely no idea what issues might have been," firefighter Brett Knapp recalled.
Once Demydowich was pulled from the car, first responders realized he was experiencing sudden cardiac arrest.
"The heart is in a state of mechanical and electrical chaos," explained Dr. Roger White, of Mayo Clinic.
That meant no blood was pumping through his veins, no oxygen was going to his brain, and Demydowich would needed an electrical shock to get his heart started again.
When cardiac arrest occurs outside a hospital, odds of survival vary greatly depending on location. In Detroit, the odds are close to zero; in Chicago, just a 3 percent chance. In Minneapolis, there's an estimated 20 percent chance of survival.
Demydowich suffered his cardiac arrest in Rochester, Minn. -- which boasts the highest chance of survival in the nation at 58 percent.
"He had essentially no brain damage at all," White said.
White works closely with the city's EMS crews, and automated defibrillators are carried in city squad cars and fire trucks. Each device has a voice and data recorder in it, and White reviews each recorded case to see what worked, what didn't, and then shares his findings with the first responders.
"You restored heart rhythm in a second shock," White explained. "That tells me that you had to have been doing really good CPR."
Good CPR can be difficult to watch. When done properly, it's forceful, and it's fast.
"We want people to press at least at the rate of 100 per minute, and we want the compressions to be at least 2 inches in depth," White said.
It took about 26 minutes to get Demydowich to the point where he was breathing without help, but he still wasn't out of the woods.
"After pulses come back, the brain continues to be at high risk of continuing injury," White continued.
That's part of the reason why the ambulance crew bypassed the ER and took Demydowich straight to the Coronary Care Unit at St. Mary's Hospital. He was put in a medically-induced coma and his body temperature was lowered to about 91 degrees for 24 hours in an attempt to minimize any damage to his brain.
There was at least one side effect for Demydowich. He has no memory of the day his heart stopped or of any of the people who saved his life -- but that changed at a reunion in Rochester. He got to meet Miedtke, White and the first responders to thank them for keeping him going.
Demydowich is dedicated to distance running, adding that it helped him lose 100 pounds. Now, he has a defibrillator implanted in his chest to protect him from another arrest -- and although he's had faster races in the past, none have been sweeter than the half-marathon he finished after his health crisis.
"To come out and run a half marathon after a cardiac arrest is just phenomenal," he said.
It is important to note that sudden cardiac arrest is not a heart attack. It's a condition where the heart muscle quivers out of control, and it strikes more than 350,000 Americans annually. A sudden blow to the chest can cause it, and so can disorders that affect heart rhythm or valves.