Saving a shark attack victim

It's 8pm. The sun is setting over a quiet beach on the Gulf Islands National Seashore, a beautiful, white-sanded national park in north-west Florida. Eight-year-old Jesse Arbogast of Ocean Springs, Mississippi is wading knee deep in the azure water, after a day at the beach with his uncle and aunt. It's an idyllic scene. Straight out of a movie.

When it happens, Jesse's aunt and uncle don't get any warning. From the surf, a seven-foot bull shark lunges at their nephew, savaging his arm from elbow to shoulder. His uncle leaps into the surf, seizes the boy and carries him to the shore. He's bleeding profusely, unconscious, not breathing. The whole of his right arm is missing. While the aunt performs cardiopulmonary resuscitation, the authorities are alerted. Within minutes, park rangers are at the scene. They take over the CPR, along with an off-duty lifeguard. The nearest hospital dispatches a chopper. Jesse should be at the hospital within 20 minutes. He could survive.

But the shark is still out there and it has the boy's arm. The medical team arrive and suddenly Jesse's uncle, Vance Flosenzier, is back in the water.

Unbelievably, he finds the animal, wrestles it, and flings it on to the shore. ("He's a big guy," explains district ranger supervisor, John Bandurski. "He got hold of [the shark] and tossed it ashore.") On the sand, another ranger shoots the shark four times in the head with a 9mm pistol. The shark is still not dead, but the bullets have caused its jaw to relax enough that an almost equally fearless volunteer firefighter can pry the jaws open with a police baton, reach down the shark's gullet and, with a pair of medical tongs, pull Jesse's arm out. The emergency workers get the limb on ice and the chopper airlifts the boy and his arm to nearby Baptist Hospital, Pensacola.

It takes Irish-born plastic surgeon Dr Ian Rogers and his team 11 hours to sew Jesse's arm back on. But they manage it.

Reattaching limbs is, says Dr Rogers "nothing new". The method is "well-established". But Jesse's case was unique because, as you can imagine, it's extremely unusual to retrieve a limb that has actually been ingested.

"It's pretty unusual to even catch the shark," Dr Rogers says, "let alone retrieve the limb intact and get it to the hospital quickly enough." Jesse's arm had been in the creature's stomach for about 15 minutes. This may be the country that spawned Herman Melville, but if you were the surgeon, would you be optimistic?

"When I was called in," Rogers confesses, "I was anticipating a limb that had been torn apart." But he soon learned that "sharks are tearers. They tear off a bit of meat and swallow it, rather than chew it up." So Uncle Vance and the brave firefighter with his baton did exactly the right thing and the arm was, says Rogers "relatively intact".

The operation to sew it back on is like a series of minute repairs. First of all, Rogers evaluated the area and marked out the "vital structure" (basically, this means identifying the nerves, arteries, veins and bones).

Next the surgeon had to prepare the bone - usually this means shortening it, because of "soft tissue retraction" which happens when a limb is severed (Jesse's arm is now several inches shorter). He then inserted a metal plate and screws into the bone to make a "stable fracture site".

"We then methodically go about repairing things, in order," Rogers explains. That is, he sewed Jesse's muscles, nerves and vessels back up again. A limb usually has one major artery and multiple veins. Jesse's arm had two major veins. First the surgeon had to establish how much distance there was between the ends of the artery, because you can't just stretch it to join it up again. In Jesse's case, the gap had to be filled by taking a vein graft from his leg and putting it between the two ends of the artery. The veins in the boy's arm were repaired and the nerve ends sewn together.

Basically, a nerve is a tube through which axons run. When you cut this tube, the axons die. When you sew it up again, Rogers says, "the axons squirt out of the nerve again on the brain side of the repair". This is why nerves can grow back when cut. "Nerve fibres tend to be smart," heexplains, "they tend to seek out other nerve fibres". So if a limb (or hand, or finger, or toe) is sewn back on again skillfully and quickly enough then all being well you can expect it to - eventually - regain some, if not all, sensation.

Once Rogers had repaired Jesse's muscles, artery, veins and nerves, it was time for the moment of truth. Clamps were removed to allow blood to flow through the artery and into the limb again. There was an initial spasm in the artery - a normal reaction for which a local anaesthetic is given as a relaxant. Then the arm began to warm up (it had, after all, been kept in ice for 12 hours by this time). The team watched as Jesse's fingers pinked up. The operation was a success.

It will take six months to a year for the nerve fibres to grow down the boy's arm again, and there's always a chance that scar tissue will intervene and block their growth. But in salvaging the arm and getting it on ice so rapidly, Jesse's rescuers may have changed the course of the boy's life.

The thing to remember, should you find yourself in a similar position, is that is crucial to keep the limb/finger/toe cold. Rogers claims that a severed limb can last up to 12 hours if kept this way. If it isn't cold it can still last up to four hours. Fingers are better still. "A finger can be off for 24-36 hours," he says. "The world record for fingers is about 90 hours," he adds. So, in Jesse's case there's every reason to be optimistic about the arm. "With intensive physical therapy, Jesse could have the use of his arm again within one to two years," he says.

Jesse was still in a critical state last night, six days after the attack. Yesterday there was more distressing news for his family. Dr Tim Livingston, a pediatric neurologist, said Jesse was "in a light coma and [had] suffered some brain injury". He added: "We do have evidence that his brain is not functioning correctly." Follwing the shark attack his body went into shock, which can damage internal organs. The shark also savaged his right leg leaving a huge tear for which he might need skin grafts.

It is, though, a miracle that he not only survived this far, but has regained an arm which has spent quarter of an hour inside a shark.

You have to wonder how crowded Florida's beaches are going to be for the next few days. But don't rush out and cancel your holiday. Though they may be part of our collective psyche thanks to That Film, shark attacks are still a rarity.

JR Tomasovic, chief park ranger at Gulf Islands National Seashore, insists that if you follow safety advice, you really don't need to let it ruin your week in the sun. "Shark attacks," he states, "are uncommon." Though the last one was in 1999 (a woman survived after she was bitten on the leg) he claims that "you could go 10 years without seeing another". The sensible approach, then, is to "be aware of your surroundings and swim in lifeguarded beaches". The beach that Jesse was on was not covered by a lifeguard. And Jesse was in the water at prime shark-feeding time (they feed at dawn and dusk).

The whole of America is astonished by the bravery of Uncle Vance. When asked to describe how he managed single-handedly to hurl out of the ocean a 200lb animal with a taste for human flesh, he replied: "I was mad." For Americans this, of course, means not insane, but angry. And, as Uncle Vance puts it: "You do some strange things when you're mad."

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