On a busy Saturday morning in the emergency room, Gerald A. Coleman III, DO, got the call that would change his life. Dr. Coleman, who practices at Lehigh Valley Hospital in Hazelton, Pennsylvania, listened as a paramedic outlined the case: A 25-year-old man had been found frozen in a snowbank, where he’d been lying for 10 to 12 hours in subzero temperatures. The man wasn’t breathing and had no heart rate; the coroner was on his way. Could Dr. Coleman pronounce the patient dead?
What happened next would make headlines around the world. Dr. Coleman asked paramedics to bring the patient, Justin Smith, to the emergency room, where he was given CPR before an airlift to the hospital’s flagship branch for further treatment. Incredibly, Justin survived.
The one-year anniversary of Justin’s hospital release in February 2016 attracted widespread media coverage, including articles from CBS, ABC and the Washington Post, as well as an appearance on the TV show The Doctors. Dr. Coleman says his osteopathic training prepared him to handle a case like Justin’s—a case that has changed his career.
How did Justin’s case unfold?
When Justin arrived in the ER, his chest wall was frozen solid. We did CPR on him for two hours and then flew him to another facility so he could be connected to an extracorporeal membrane oxygenation (ECMO) machine, which oxygenates and circulates the blood. As he warmed up, Justin’s heart started beating and then fibrillating. The cardiothoracic surgeon who was treating him shocked his heart three times, and Justin’s heart began beating normally. Surprisingly, an electroencephalogram (EEG) showed that his brain wave patterns were almost normal and a CAT scan showed no signs of brain edema.
Justin spent 39 days in the hospital. He had to have both pinkie fingers and all his toes amputated, but he has made a full recovery, including a complete return to full brain function. As far as we’ve been able to find in the medical literature, Justin had the lowest core body temperature—68 degrees Farenheit—that anyone has ever survived in North America.
How is it possible that anyone could survive what Justin did?
When your core body temperature drops that much, you almost go into suspended animation. Because your metabolic rate also drops, the brain process that leads to cell death is stopped. In fact, physicians sometimes use therapeutic hypothermia to place patients with conditions such as cardiac arrest or severe trauma in that “suspended animation” state because it gives the health care team more time to treat them.
How has your osteopathic training shaped your approach to medicine?
DOs are trained to care for the whole person, mind, body and spirit, and to be empathetic with family members and patients. The day I got the call about Justin was exactly nine years after one of my daughters died. You never really get over burying a child; it’s one of the worst things anyone can go through, and that experience was at the back of my mind when I got the call about Justin.
Each time I sit down with a patient’s family, I know the emotions they’re experiencing and I’m keenly aware that the patient is someone’s son, spouse or brother or friend.
How has this case changed your career?
My colleagues and I are submitting the case to numerous medical journals and I’m also starting to write a book about the experience.
Before this case, I was starting to feel burned out—I was working a lot of hours, and the emergency room is a stressful place. But this case completely grounded me and reminded me why I’m a physician.