Before his cardiac arrest, Ryan Chian was having a pretty normal day. The 15-year-old had run a mile in PE at school. Minutes into basketball tryouts at the local community center, he sank to the floor.
He was unresponsive for almost 10 minutes.
Luckily, a pair of nearby lifeguards initiated lifesaving CPR. An ambulance was called and paramedics used an automated external defibrillator, or AED, to deliver shocks to Ryan's heart.
Linda Chian, Ryan's mother, remembers getting a call from a teammate's mom. Ryan had fallen, and she needed to get to the gym immediately.
She rushed to tryouts, but the ambulance had whisked Ryan away to a local hospital already. She said she remembers seeing Ryan in a pediatric cardiac intensive care unit for the first time.
"He was intubated. He was unconscious. He had wires from head to toe. It was just very scary to see your kid like that," Chian told ABC News.
While Ryan made a close-to-miraculous recovery, not all victims of cardiac arrest are that lucky. According to the CDC, approximately 90% of cardiac arrest victims do not survive an out-of-hospital arrest. The American Heart Association states that only 40% of cardiac arrest victims get appropriate help from a bystander right away.
As athletes, parents and coaches all flood back into school arenas and fields at the start of the new academic year, many advocates say they want schools to prioritize CPR training for staff and maintain visible AEDs.
"There's plenty of data out there to show that high quality CPR and early defibrillation have a huge impact on outcomes both in terms of mortality and neurologic outcome," said Laura Presnell, a pediatric cardiac nurse practitioner for over 20 years.
Ryan said that the AED at the community center was not available, and he received shocks only after the paramedics arrived.
At work, Presnell said she is comfortable performing CPR in stressful situations. However, she said she did not expect to be working at her daughter's basketball game, when an adult coach suffered a cardiac arrest.
The coach had just called a timeout, and "all of a sudden he just drops on the ground," Presnell recalled. The scene turned chaotic with the "screaming kids all running for the doors." The assistant coach and referee hovered while Presnell checked for a pulse, she said.
As soon as Presnell turned around to call for an AED and start CPR, she saw the gym had emptied. One referee trained in CPR remained, and Presnell said she instructed him to start compressions.
The referee performed high-quality, lifesaving CPR, but was incredibly overwhelmed and "was crying during the entire time," Presnell said.
The coach made it to a hospital soon after and had a bypass surgery a week later, Presnell said.
While the incident was a success story, Presnell said she was wary of how many people were comfortable performing CPR at the event. "I think CPR is scary for a lot of people. I think that people are afraid to do it," she said.
Since both incidents, Presnell's kids and the Chian family have all become trained to administer CPR, they said. The Chians said they also advocated for clear AED placement and for all athletes at Ryan's high school to receive cardiac screening with electrocardiograms, or ECG.
Experts debate the merit of screening all athletes with ECGs. The AHA released a policy statement in 2014 recommending that all school athletes be screened with a standardized questionnaire about cardiac history and symptoms. This questionnaire has been updated since the pandemic, but the AHA still does not recommend universal ECG screening for athletes.
Currently, athletes are recommended to complete an annual sports physical exam. At this visit, a medical provider should review the athlete's questionnaire, history, and physical exam and decide if further screening is necessary.
All agree that CPR training for the general public is important.
For his part, Ryan said "CPR is a really great skill for everyone to learn, because you never know what might happen."
Sejal Parekh, M.D., is a practicing pediatrician and a member of the ABC News Medical Unit.
Editor's note: This story was updated to note Ryan Chian experienced a cardiac arrest at his local community center.