I wanted to sort of finish the medical discussion, and leave a brief (lol!) discussion of suffocation, versus trauma-induced cardiac arrest. I'd like to illustrate why I think it is so very unlikely Max was "suffocated and thrown over the railing." Thanks in advance for humoring me! (Please feel free to roll and scroll if this isn't interesting to you!)
The healthy heart undergoes a fairly predictable deterioration thru a variety of rhythms when a person is dying of acute hypoxia/ anoxia. The final "rhythm" is asystole. Asystole (from any cause) is not so much a rhythm to be "treated" as it is usually a confirmation of death. The survival rate (to discharge) from any period of out-of-hospital asystole is abysmal. Only when there is a clearly identifiable cause that is imminently "fixable", is there usually any possibility of reversing asystole. CPR alone virtually never will convert asystole to any rhythm . Docs and nurses learn these few fixable causes in ACLS as the "6 H's and 6T's" (hypoxia, hypovolemia, tension pneumothorax, and so on).
People sometimes ask, "why you don't just "shock" a heart in flatline?" Electricity is not the treatment for aystole, and incorrectly applied, will inappropriately depolarize the heart, making further resuscitation attempts impossible. So the only chance to "fix" asystole is to identify the source, and rapidly intervene, IF POSSIBLE. However, it is not possible for anyone without a cardiac monitor, using absence of a palpable pulse as criteria, to determine which patients are in aysytole, and which are in pulseless rhythms that still have the possibility to be converted. This is an important distinction when we contrast suffocation with trauma induced asystole.
All of the previous sources I've linked on this thread and others highlight the statistical futility of "fixing" the cause of out of hospital asystole in blunt trauma. You may eventually bring a heart back to a rhythm, but virtually never will the person live to discharge-- and even in the rare situation when they do, they are not "neurologically intact". Meaning, they are in a neurologically devastated state permanently. (Most times in a vegetative state.)
When someone is dying from acute hypoxia, the heart initially goes thru a series of various tachyarrythmias (fast rhythms) as the person's endogenous catecholamines are released. BP can soar. ("Fight or flight response".) As they pass thru this phase, rhythms will deteriorate into bradyarrhythmias (slow rhythms), which can include forms of heart block, and junctional and ventricular escape rhythms. Finally, the heart moves into an agonal pattern, with volleys of what we sometimes call "help me" pings of electricity generated, but without any coordinated muscular contractions. There can also be something that looks like a rhythm, but produces no coordinated contractions of the muscle, which is called PEA, or "pulseless electrical activity". These "help me" bits of random electricity become slower and further apart as time goes on (the person is dying), and sometimes a healthy heart can kick out these electrical signals for 15 or more minutes as they complete the dying process, and move into a very quiet flatline asystole. At this point (asystole) the heart is very refractory to any resuscitative efforts (epi, atropine, etc).
To give an example of a hypoxic arrest many are familiar with, Michael Jackson died what most medical professionals believe to be a prolonged (and very negligent) unattended respiratory arrest from inappropriately administered IV propofol (an IV anesthetic). This was followed by an irreversible cardiac arrest. MJ was in complete asystole when paramedics arrived. MJ was initially pronounced dead at the scene, and then when his "doctor" Conrad Murray objected to pronouncing him dead, they took MJ to the nearest hospital. Whereupon, they attempted for another hour or so to try every possible measure (including the extra- extraordinary measure of an intra-aortic balloon pump in a patient with asystole) to resuscitate him, and were unsuccessful. He was pronounced dead a second time.
The fact that Max was resuscitated from asystole to a sinus rhythm after "only" 3 rounds of epinephrine, to me, argues very strongly that he experienced a traumatic cardiac arrest, and that 911 WAS contacted promptly when he was discovered, as reported by RZ and XZ. Paramedics noted no "help me" agonal beats, or other rhythms, only aystole in their documentation. Both on initial assessment, and ongoing as they transported Max to Sharp Coronado.
At least one poster has commented here that she believes Rebecca "waited" to call 911 until Max was in cardiac arrest. This is unlikely (and completely absurd, imo). If Max had been "suffocated", the absence of a palpable pulse soon after would not guarantee that he was in asystole without other forms of electrical activity being discharged. If Max was suffocated and she "waited too long" to call 911, Max's heart never would have responded to epi after such a prolonged arrest. If she had suffocated him and called "too soon", there likely would have been electrical activity still going on in his healthy 6 year old heart when paramedics arrived. This is what you could call a very "narrow" window, and I sincerely doubt even a talented medical professional could call it that closely without a cardiac monitor-- let alone a lay person with no critical care experience.
Max was perilously close to being a DOA at Coronado, but finally responded to the 3 rounds of epi with a sinus rhythm. (Circulation time is very slow with CPR.) I believe that this argues very strongly that Max had a traumatic arrest from the fall onto his head, just as promptly reported to 911 by Rebecca and her sister.