Heroes in our midst

“The odds of this happening are very, very small”

More than three months have passed since 21-month-old Gore Otteson nearly drowned in an irrigation ditch north of Gunnison on July 6, 2010. Gore spent an estimated 45 to 50 minutes without a heartbeat, and 20-plus minutes underwater. And somehow he survived, thanks to the efforts of his family and local rescuers and hospital staff in Gunnison and Denver. In particular, local heroes Dr. Roger Sherman, paramedics Erik Forsythe, John Wysong and Matt Messner, and ER nurse Chris Evans are lauded for their extraordinary efforts.

Gore’s miraculous, full recovery defies all odds and has received national media coverage, and even made the “Today Show.” Though local efforts were largely glazed over by the mass media, the EMS crew that was first on the scene, and the ER staff at Gunnison Valley Hospital played a heroic role in saving this child’s life.
As in most cases, even if Gore survived he likely would have remained in a persistent vegetative state due to the extended amount of time he was without a heartbeat. But that’s not how it happened. And the end result frankly has a lot of people taking a hard look at some deep philosophical and medical questions.
According to Gore’s mother, Amy Otteson, time and commitment made all the difference. “Honestly, I just feel like those EMTs… that was such a critical 10 minutes and I just can’t say enough of what they did. I think about them all the time; it was critical what they did. They didn’t give up on him and it had been a long time at that point.”
“They were on scene for 47 seconds. My dad and cousins, they describe [paramedic Erik Forsythe] as ‘jumping out of the ambulance,’ then he ran, grabbed Gore, took him and was back in the ambulance and driving away in less than one minute,” explained Amy.
Medical experts are also attributing a phenomenon known as “mammalian dive reflex” for aiding Gore’s survival and full recovery. According to Dr. Roger Sherman, who treated Gore when he arrived at Gunnison Valley Hospital, the mammalian dive reflex is also employed by dolphins and whales. “It slows the heart rate down, and decreases the metabolic requirements of the brain and vital organs. The colder the water, the more likely this reflex is to occur.”
The News spoke with Amy Otteson last week at her Lakewood, Colo. home, the same day Gore received his two-year check up. He’s a perfectly healthy, happy kid. “It’s an overwhelming feeling,” Amy Otteson says, especially when she thinks of the children who weren’t as fortunate as Gore. “Everyday I feel like we should just be sitting in the hospital.
“Since this has all happened, I have heard so many bad stories,” she continued. “The thing that’s the most unbelievable and I will never understand, they never sound as bad as Gore’s situation, but the outcome is so much worse. I still cry almost every single day. I’m broken-hearted for the people whose outcome isn’t like ours.”

Erik Forsythe was working for Gunnison Valley Health EMS as a paramedic and was one of the first responders on scene, along with fellow EMS crewmembers John Wysong and Matt Messner. He spoke to the emotional challenges associated with responding to a dire situation involving a small child.
“As a paramedic, I often bear witness to the tragedies of people’s lives,” explained Forsythe. “When this happens to adults, especially those later in life, death can be viewed as a part of the natural cycle of life. When tragedy strikes at a young age, there is nothing natural about it. It’s difficult to deal with, no matter how seasoned the professional.”
ER Nurse Chris Evans agreed. “You feel your emotions after the fact, at least from my perspective. After the child left our hospital, a number of nurses broke down. Up until then it’s up to you to do your job, and work as a team. That’s key in a really intense emotional situation like that. We all did our thing, did what we were taught to do. We worked together as a team, and in this case we got good results. It just… it gives you the drive to continue on.”

These seasoned professionals made some potentially life-saving decisions that defied convention, but paid major dividends. According to Forsythe, “One of the ways that I feel the EMS crew contributed to the successful outcome of this call was in our decision to transport the patient immediately upon our arrival. For most calls like this, the general thought is to begin work on the patient on scene. This is because the minutes that it can take to load a patient into the ambulance can be wasted, in that they delay the commencement of potentially lifesaving interventions.
“In this case,” said Forsythe, “we decided to break with convention, in that we prepared the ambulance by laying out all of the necessary tools for the call on the way to the scene, and then moved the patient immediately to the ambulance rather than take the time to begin treatment on scene. This was only possible because of the small size and easy portability of the patient.”
Throughout it all, paramedics, doctors, and nurses had to keep their emotions in check. “On a call like this one, I often wait to process the emotions until learning the disposition of the patient,” Forsythe explained. “In this case, as the family used the Internet to update interested parties, I was checking the site every couple of days. When the helicopter left the Gunnison Valley Hospital, the best that I thought anyone could hope for was some sort of meaningful recovery likely with significant brain damage. When I learned that Gore had recovered ‘100%,’ it was an exhilarating feeling of relief.”
Dr. Sherman agreed. “What was so dramatic about this is that we managed to get the heart rate back and we shipped him up to Children’s Hospital, and 24 hours later we check in and they had done an EEG [assessing brain activity], and it was a flat-line EEG,” he said. “We thought that we rescued the heart, but the brain was gone. About 48 to 72 hours after that he came out of his coma and he made a full recovery. The odds of this happening are very, very small.
“There’s an adage we have,” said Dr. Sherman. “‘You’re not dead until you’re warm and dead.’ The hypothermia had something to do with it as well. At Children’s they kept him in a relative hypothermic state for a couple days.”
For Dr. Sherman, and the medical community as a whole, this case raises profound ethical questions about when to resuscitate, and when not to.
“Certainly Children’s [hospital in Denver] asked us, ‘Why did we bother to resuscitate him because of that prolonged submersion?’ Normally you would just get someone back that was in a vegetative state,” Dr. Sherman said. “The ethical questions are who and when do you resuscitate, and when do you withhold resuscitation.
“You can’t say, who is the one who is going to survive and who is not,” Dr. Sherman continued. “In this case, if we were just thinking about that, we would not have resuscitated him, and we would have lost a child. How do you know who to put your resources toward? How do you know when to save someone and when to let them go? It’s a very profound and looming question.” In the case of Gore Otteson, that question has been answered.
Amy Otteson said, “At any point any one of them could have said, ‘That’s too long,’ and given up. Every one of them—it wasn’t in them to quit. That’s amazing to me. You just tell them, we think about them every day,” she said. “Tell them, ‘Thank you.’ That’s not enough, but we don’t know what else to say.”
As she left the Gunnison Hospital, Amy Otteson’s parting words to Dr. Sherman were, “I’ll bring him back when he’s well. That’s the last thing I said. And we did.”