Three passengers had been thrown from the car and lay immobile in the middle of the road, almost impossible to spot in the hours before dawn.

A fourth crash victim was conscious and walking around the battered vehicle, which had come to a stop in the middle of the road from Johannesburg to Carletonville early June 24. But tending to the injured person was a life-threatening proposition in itself, paramedics told newspapers.

Each time the paramedics saw approaching headlights, they had to be on guard — and occasionally sprint into a nearby ditch — lest they be hit by a clubgoer or someone else returning from the South African capital who noticed the rollover crash too late.

“It’s a very, very bad road,” Gerrit Bradnick, operational manager for Distress Alert, the small private ambulance service that responded,told the New York Times. “Very dark. We have many accidents.”

But in time, they whisked the crash victims away. The survivor was taken to a hospital. The three on the road, who had been declared dead and were covered with silver sheets, were taken to a morgue and placed in refrigerators.

It was there that a forensic officer noticed something, according to the Department of Health in Gauteng province:

One of the “dead” people was breathing.

The case of a living person declared dead has shaken South Africa, particularly people in Gauteng, where private contractors operate ambulance services and have the authority to declare people dead.

Authorities have not released the identity of the not-dead woman or given updates on her condition. She and her family have declined interview requests through the Department of Health.

Meanwhile, authorities and the people who work at Distress Alert were trying to figure out how the misdiagnosis happened.

“The crew is absolutely devastated — we’re not in the business of declaring living people dead, we’re in the business of keeping people alive,” Bradnick told the Daily Voice, a South African newspaper. “All the right checks were done — breathing, pulse — so the patient was declared deceased.”

The case is under investigation by the department, which will report its finding to an agency that regulates private paramedic services.

In that province, paramedics and other trained and designated people can certify that someone has died, according to a press release, which specified that the call on the woman's condition was made by a private medical service, not the health department.

As taphophobics (those who fear being buried alive) are well aware, death isn't always an easy-to-detect, binary equation, even for medical professionals with sophisticated equipment.

In some rare cases, presumed-dead people suffer from catalepsy, in which a person's heartbeat and breathing slow to almost imperceptible levels, according to the National Center for Biotechnology Information. And a study in the British Medical Journal highlighted a case in which a child submerged in cold water for 25 minutes survived, as the low temperatures slowed the body's processes.

There have been scattered (but headline-making) cases of people being declared dead when they weren't.

In January, Gonzalo Montoya Jiménez, who had been imprisoned in the Asturias region of northern Spain, was certified dead by three doctors, according to the BBC. He wasn't, and he woke up a few hours before an autopsy was set to be performed, his body already bearing pen marks to help medical examiners make the appropriate incisions.

[Russian ‘cannibal couple’ may have drugged, killed and eaten as many as 30 people, police say]

In November, a baby born premature and later pronounced dead began crying on the way to his funeral, The Washington Post reported. The doctors involved didn't do electrocardiograms tracings that would have detected tiny electrical impulses put out by the baby's heart — and have been fired.

Three years before that, according to The Post's Lindsey Bever, a 91-year-old Polish woman who had been declared dead in the town of Ostrow Lubelski woke up after 11 hours in the morgue and asked for hot tea and pancakes.

In January 2005, Larry Green was hit by a car and declared dead by paramedics on the side of an eastern North Carolina road, the New York Times reported. He was discovered alive after a Highway Patrol trooper investigating the case asked technicians to open the morgue freezer so he could examine the body for his report.

And, perhaps most chilling of all, Maria de Jesus Arroyo didn't survive her trip back to life in 2010.

The 80-year-old grandmother was pronounced dead after a heart attack and placed in the freezer of a hospital's morgue, according to NBC Los Angeles. A few days later, she was found in a half-unzipped body bag, face down, with bruises and a broken nose.

Her family's medical malpractice lawsuit claims Arroyo “struggled unsuccessfully to escape her frozen tomb.”

(The Washington Post)