Like many veteran marathoners, Bob Pohl always had an eye on the clock.
"I used to tell my wife that if I drop in a race to stop my watch because I don't want to go to the hereafter with a bad time," he said. "The joke was funnier before."
The 55-year-old Marriottsville runner did collapse during a race. He was about 200 feet from the finish line of the Baltimore half-marathon on Oct. 15 when a blockage in a main artery stopped his blood from flowing — and his heart from beating.
Now seconds seriously mattered.
The minutes lost in receiving aid typically make it rare for someone to survive sudden cardiac arrest outside a hospital. But close on Pohl's heels this day were a Baltimore police officer, a Columbia chiropractor, some Howard County paramedic trainees, a Union Memorial Hospital doctor and other medical professionals who swiftly provided CPR, a shock to his chest and a trip to the emergency room.
The speed was part planning and part luck, Pohl learned. Though he didn't open his eyes for days, he is now home recuperating and reflecting for the first time publicly on the time he still has.
"He went from dead to alive in a matter of minutes," said Dr. Cynthia Webb, chief of Union Memorial's emergency room who has been coordinating medical care at the Baltimore Running Festival for three years along with the event organizer, Corrigan Sports Enterprises.
She normally sees cases of cramps, blisters and hyperthermia — not heart attacks. A 2009 American College of Cardiology study found there is less than one death from cardiac arrest per 100,000 people, far better odds than dying in a car accident or from some diseases.
But when there is cardiac arrest, fewer than a third of the victims typically get CPR or defibrillation in the first crucial minutes, and only about 8 percent survive. The condition has claimed the lives of two other runners in the festival's marathons and half-marathons since 2001.
"He was really lucky, not that it happened but where it happened," Webb said. "He could have been alone running in his neighborhood or home watching TV. It couldn't have been in a better place."
Even on the 26.2-mile course, where there are six other medical tents and medical personnel riding bikes among the 25,000 competitors and tens of thousands of spectators, there could be a three- to four-mile gap where help is not available.
As Pohl neared the finish line outside Camden Yards around noon, he dropped to his knees and then fell to the ground. Some other runners stopped to help, including Baltimore Police Lt. Col. Ross Buzzuro. One runner checked for a pulse and another held Pohl's head, said Allen Manison, a chiropractor with special training in emergency and sports medicine, who jumped a fence onto the course.
"It was so impressive those runners stopped their race to help," said Manison. He normally tends to the muscles and bones of the elite athletes but immediately recognized Pohl's heart rhythm was irregular. His position, on his back with his arms bent in toward his chest, also was a possible sign of brain damage. Manison called for help.
Howard County paramedic trainees came with a gurney. Within minutes they were inside the tent, with Webb and a team from Union Memorial, Franklin Square and Harbor hospitals and Baltimore City Emergency Medical Services. They took over resuscitation, provided defibrillation and placed a breathing tube down Pohl's throat.
Meanwhile, Webb flipped over the paper that was pinned to Pohl's shirt and displayed his race number, and found his emergency contact. She dialed his wife, Karen, and told her it was serious.
Emergency personnel didn't wait for her to reach the medical tent. Her husband was already in an ambulance en route to the closest hospital with a cardiac specialty, the University of Maryland Medical Center.
Karen Pohl and race officials set out to find her 27-year-old son, Mike, who was also racing and had disappeared into the crowds after running ahead of his father a half-mile from the finish. The father had wanted to keep a slower pace as part of his training for his 15th Marine Corps Marathon.
She found her son pacing beyond the finish line. He'd seen a commotion and thought his father was stuck behind it. A police officer took them to the hospital.
"We weren't promised he'd make it," she said of the agonizing first few minutes at the hospital. "It was amazing circumstances. He had such a swarm of angels over him."
The Maryland doctors suspected a heart attack and moved immediately to cool Pohl's body to delay the chemical reaction that causes injury to organs when the blood supply is cut off. Without therapeutic hyperthermia, "you can get the heart back but the brain never recovers," said Dr. Michael D. Witting, an emergency department physician.