It was a beautiful summer day in July. John Horan and his wife, Andrea, had spent the weekend with friends at their family’s ranch in Heeney, between Kremmling and Silverthorne, Colorado.

That Sunday morning, they were driving to Denver. Andrea turned onto Colorado Highway 9 and suddenly slumped over the steering wheel.

Unresponsive behind the wheel

With Andrea unresponsive, John took hold of the steering wheel and put the vehicle in neutral. He steered them to the shoulder of the road, coasted to a stop and put the vehicle in park. John screamed at Andrea. But there was no response.

John unbuckled himself, ran around the vehicle, and opened up the driver’s side door. He couldn’t feel Andrea’s carotid pulse. He put his ear next to her nose and mouth. He couldn’t hear any respiration.

With the door ajar, John frantically waved his hand, hoping someone would stop to help. Vehicles kept flying by at 50 mph.

John unbuckled Andrea, and as he pulled her out of the car, the first good Samaritan stopped to help. It was Christina Rand with her 6-year-old son Atlas.

John told her: “She’s not breathing, and there’s no pulse – stay with me. I need your help.”

They were at least 40 miles from the nearest hospital and 30 miles from the nearest fire station and emergency medical services. Being in a remote area, they were on their own until help arrived. To give Andrea the best odds of survival, they needed to take immediate action.

Recently certified in cardiopulmonary resuscitation (CPR) for rescue scuba diving, John knows that you might as well not do CPR if you don’t do it aggressively.

With Andrea on the gravel shoulder, John directed Christina to do chest compressions. John told Christina, “I’m her husband, and I want you to break her ribs.”

CPR can save the life of someone who’s in cardiac arrest. Chest compressions keep blood flowing to vital organs until a regular heartbeat returns. Rescue breaths bring more oxygen into the person. While Christina was giving chest compressions, John was providing rescue breaths.

Five minutes after Andrea’s cardiac arrest, another good Samaritan arrived on the scene. Aida Marquez announced she’s trained in CPR and took over chest compressions.

Knowing CPR saves lives

Meanwhile, Erika Musante, a UCHealth emergency medical technician (EMT), and her husband, Zeth Ramsay, were leaving their campsite at Green Mountain Reservoir, 30 minutes north of Silverthorne, Colorado.

They were heading south on Highway 9 to meet up with family to go fishing when Erika saw a commotion on the side of the road. She felt compelled to help.

“We should turn around and go back,” Erika said to her husband.

When they arrived at the scene, Andrea was on the gravel roadside, receiving CPR from John and Aida.

Erika took command of the scene. She announced she was medically trained and quickly took over chest compressions as John continued rescue breathing.

“And she was doing chest compressions the textbook way that chest compressions are taught. I mean fast, aggressive chest compressions.” John said of Erika.

Erika’s husband, Zeth, a police officer with Arvada Police Department, directed traffic, giving Erika much-needed space on the shoulder of the road.

With several people helping, including an off-duty medic, a nurse and civilians, Erika gave clear and direct instructions on how they could help while she continued chest compressions.

“She was kind but direct. This woman knows what she’s doing,” said John of Erika. “Making it very clear that this is what we need to do to save Andrea’s life.”

Erika offered words of encouragement to John. She ensured they were performing CPR at the right pace by getting everyone to count out loud.

Thirty minutes into their roadside CPR, officer Mark Pitney and Sgt. Abigail Hosier from the Silverthorne Police Department arrived with an automated external defibrillator (AED). They drove outside of their jurisdiction to help.

Erika continued to direct others on the correct location for locating Andrea’s pulse and proper placement of the AED.

John pleaded with Andrea, saying, “Honey, you can’t go. We depend on you. You have to stay. Don’t go.”

The AED finally restored some rhythm to Andrea’s heart. But it wasn’t much. Her heart was still pumping faintly.

For 45 minutes, Erika and John maintained their seemingly endless loop of 30 chest compressions and two rescue breaths.

EMS from the Summit County Sherriff’s Office arrived. A paramedic took over rescue breathing with a resuscitation bag, a medical tool that forces air into a patient’s lungs.

The thrumming of the helicopter was heard in the distance. A medical helicopter, with paramedic TJ Holloway and flight nurse Maureen Maledon, landed on Highway 9 to fly Andrea out of the canyon to St. Anthony’s, the closest hospital.

Due to capacity constraints, John was not able to ride along with Andrea. He was eager to be with Andrea, but Erika offered her last piece of advice to John: Don’t drive.

Zeth, with advanced driving skills as a police officer, drove John in Andrea’s vehicle 80 miles to the hospital. Erika followed at a distance in their truck.

While in transit, after John made phone calls to family, the two men talked and formed a strong bond.

Zeth learned that John is one of the founders of the Colorado Fallen Heroes Association, an organization that cares for Colorado families when a law enforcement officer is killed in the line of duty. John is also a funeral director and directly handled the recent deaths of two of Zeth’s Arvada Police Department colleagues, Gordon Beesley and Dillon Vakoff.

“One of my roles is to ensure that we not only observe the law enforcement protocols in a line of duty death but we also remember this person for who this person was, not just as a law enforcement officer but as a spouse, as a family member, as a friend, and the aspect of that person’s life that also defined that individual,” said John. “It’s hard work when we do it, but it’s gratifying when we see the effect that it has on people who are struggling with the most difficult and painful times of their lives.”

“When we found that out, it was kind of like full circle that everything happened the way it did. It was meant to be that we were supposed to make this connection,” Erika said.

In hindsight, Erika believes it was Gordon and Dillon tugging on her to turn around when she initially noticed the commotion on the side of the road that Sunday in July.

They are grateful for the roles they have played in each other’s lives. Erika’s role in helping Andrea and John, and John for his role in helping Zeth and Erika and their entire police family with the loss of the officers.

What is takotsubo cardiomyopathy?

Andrea experienced amnesia from most of that weekend and pain from her broken ribs due to the lengthy and aggressive CPR that saved her life. After two weeks in the hospital, Andrea was on the verge of a full recovery.

“I feel great,” Andrea said at the time. “Now I have a defibrillator. So it’s like having Erika with me all the time.”

Following a complete battery of tests and a clean bill of health in March, Andrea said her cardiac arrest was “incomprehensible.”

“The nature of Andrea’s cardiac arrest was really not a heart attack,” said John. “It was Takotsubo.”

Takotsubo cardiomyopathy is a temporary heart condition that develops in response to an intense emotional or physical experience. Also known as stress cardiomyopathy or broken heart syndrome, the heart’s main pumping chamber changes shape, affecting the heart’s ability to pump blood effectively.

Following her cardiac arrest, Andrea is compos mentis, of sound mind.

“Some say this is a miracle,” said John. “I agree, but I also know the miracle, in part, was Erika’s willingness to stop and assist.”

Approximately 10% of people who suffer an out-of-hospital cardiac arrest and are treated by paramedics survive and leave the hospital after several days.

“You have a lot of heroes in your midst, and Erika Musante is among them,” said John.

Importance of CPR training

“The moral of these events is everyone should keep up their CPR certification,” urged Erika. “It’s a miracle the Horans and myself were able to work with such an experienced care team and very kind civilians.”

“Andrea is living proof that applying CPR early and aggressively not only saves someone’s life but enables that person to live life fully and completely every bit as much as that person would live life without having had a cardiac event,” said John.

Erika credits the commitment and effort of those who stopped to help Andrea’s successful outcome.

“The big picture was no one ever gave up,” Erika said. “We never knew when help was coming, and we continued [CPR] for the full 45 minutes until EMS arrived.”

John said it was extraordinary that Erika and Zeth gave up their weekend plans to care for Andrea.

Andrea and John have been married for 42 years. They have four children together. As Colorado natives, they enjoy the outdoors, skiing and playing tennis. They enjoy watching the football of their alma mater, the University of Colorado Boulder (CU). They also love to travel.

Life-long connections

Erika, Zeth, John and Andrea have built a forever bond following Andrea’s cardiac arrest. To show their gratitude, John and Andrea invited Erika and Zeth to their vacation home at Black Lake for a long weekend. They fished, rode 4-wheelers, watched CU football and enjoyed each other’s company.

John and Andrea have also built connections with the other good Samaritans who stopped and helped save Andrea’s life, extending the same weekend invitations to their vacation home.

“Erika and Zeth were never looking for any recognition,” John said. “And yet, there’s not enough recognition for people who do these things.”

“It was meant to be that we were supposed to make this connection,” said Erika.

Erika has worked for UCHealth for almost seven years. Her goal is to be as prepared as possible for any situation. That July morning, she felt confident in her ability to perform chest compressions and breaths for 45 minutes until EMS arrived.

Native Coloradans Erika and Zeth met while attending college at Colorado Mesa University. Erika played basketball, while Zeth played football for the university. They’ve been together for 8 years and married in 2020. They enjoy fishing and camping with their three dogs.

“Thank heavens there are people like Erika and Zeth who see something, even on their day off, they see someone who needs help, and they stop. And they help,” John said.