SIX hours elapsed before Natasha R. received specialized trauma care.

[pnwmom]

Almost four hours before she was even admitted into the local hospital, before being sent on to the trauma center in Montreal. Why didn't this hospital immediately send her to Montreal in a helicopter? Do they even have that capability?

Something most ski resorts won't tell you -- how far away is REAL help in the event that you do get in trouble?


http://www.theglobeandmail.com/servlet/story/RTGAM.20090319.wrichardsonhours0319/BNStory/National/home

MONTREAL — Nearly four hours elapsed between Natasha Richardson's lethal fall at Mont Tremblant and the actress's admission to a local hospital, a time delay that raises questions about whether more prompt treatment might have saved her life.

SNIP

According to Yves Coderre, a paramedic and ambulance manager who has reviewed the dispatch records, the first 911 call from Mont Tremblant in response to Ms. Richardson's accident came at 12:43 p.m. on Monday.

Mr. Coderre, whose company, Ambulances Radisson, serves Mont Tremblant, says medics arrived at the hill 17 minutes later. At that point, the wounded actress refused medical attention, he said. Ambulance staffers turned and left after spotting a sled taking the still-conscious actress away to the resort's on-site clinic, Mr. Coderre said.

Nearly two hours later, at 3 p.m., a second call was placed to 911 from Ms. Richardson's luxury hotel room, as her condition deteriorated. Ambulance technicians arrived nine minutes later.

“She was conscious and they could talk to her,” Mr. Coderre said. “But she showed instability.”

The medics tended to her for half an hour before transporting her to the Centre Hospitalier Laurentien in Ste. Agathe, a 40-minute drive away.

The hospital stabilized the actress before transferring her less than two hours later, according to a hospital spokesman. Then she was taken by ambulance for an hour-long drive to a specialized trauma centre at Montreal's Sacré-Coeur Hospital.

SNIP

[AZ Criminal JD]

1. Don't blame this on the ski resort

She refused medical treatment and signed a release to that effect.

[pnwmom]

4. After the SECOND call, it took several hours and two hospitals before she

got to a trauma center.

That is the bottom line. People skiing at a resort deserve to know how difficult it will be to obtain specialized trauma care in the event it is needed.

[Horse with no Name]

6. I do not understand the significance

Most Americans do not have local access to a trauma center--they are too expensive to maintain in every locale (that is why they have helicopters)... however, that doesn't mean that she didn't receive initial appropriate and proper triage and treatment. Even little hospitals can do that.

[pnwmom]

9. So why didn't they helicopter her directly out to the trauma center in Montreal?

Since she was already obviously in trouble by 3 pm, why did they drive her to the local hospital instead of flying her to Montreal?

[Horse with no Name]

14. The answer is mundane

but here it is.
It costs thousands of healthcare dollars to put a trauma transport helicopter in the air. Every time the med-evac goes in the air, the people on it risk their lives to save someone else.
Until they knew FOR SURE what was wrong with Mrs. Richardson, it was an inappropriate use of resources to put her in the air for what might have been a simple bump on the head.

[pnwmom]

28. By 3 pm they knew the situation was dire. It was at that point I think they

should have evacuated her by air.

Surely cost couldn't have been an issue for that family.

Friends of mine had their son badly injured at a resort in Oregon. His hit a tree, his face taking the impact, and he could easily have had a serious concussion (along with the broken nose, etc.) The resort wasn't prepared to deal with it at all, and there was no hospital anywhere nearby. The resort finally put this injured college student on a bus to Portland to go to a hospital there!

[EmilyAnne]

39. I'm wondering if, by the time its obvious that the situation is dire, its too late?

I don't know enough about how they assess the situation, but you are right, the hours wasted should be looked at.

That story about your friend's son is terrifying! A bus to Portland? I assume that he is OK, but jeez. Why someone on staff couldn't have at least driven him in a car is beyond me. That is screwed up.

[Horse with no Name]

46. Luckily for the 90% of Americans who do not live in the backyard of a Level 1 Trauma Center

Local hospitals have the capabilities to do CT scans, give medication and other lifesaving treatment, and stabilize patients before they are shipped to these trauma centers.
And yes, sometimes it can take 4-6 hours to get them there. It is a simple fact of geographical logistics. Weather has much to do with it as well. If the weather is bad--the bird aint going in the air. You have to wait for a trauma transport team by ground.
I speak as a healthcare professional who has had to sit on critical patients until help from the big city can arrive.
This OP is painting a picture of incompetence at the receiving hospital level that unless we know differently, wasn't a factor at all.
Sometimes patients hurt themselves so severely that no matter what happens or where they are transported to, they die.

[pnwmom]

55. The OP was NOT painting a picture of incompetence at the receiving hospital.

For all I know, the receiving hospital was perfectly competent at doing what it is MEANT to do -- but that is NOT to serve as a trauma center. They couldn't do the surgery on Richardson till she got to the trauma center. In sending her -- by ambulance -- 40 minutes away to the local hospital, (and two hours later, another hour's drive to the 2nd hospital) instead of immediately putting her on a medivac to the trauma hospital in Montreal, they lost what could turn out to be critical time.

It is far too early to blame anyone, but if there is any blame to be assigned, I think it belongs to ski resorts who underplay the risk to skiers from not having quick access to trauma care, in the event of an emergency.

In the case of my friend's son, when all a ski resort can do is put a college student with facial injuries and possible head trauma into a bus for a 4 hour trip to a major city, no one skiing at that resort should feel safe.

[Horse with no Name]

45. So in your eyes it is about this particular patient and their own personal wealth

and the fact that had they chose to, they could have purchased their way to what you perceive would have been better healthcare treatment.
I see.

[pnwmom]

56. You said that cost would be the reason she wasn't transported by medivac and

that obviously wasn't true.

[Horse with no Name]

64. Cost IS a reason that they don't med-evac every head injury

and yes maam, it is true.

[pnwmom]

68. It isn't the reason they didn't medivac HER. n/t

[Gwendolyn]

72. She lost consciousness on the way to the hospital in Ste Agathe...

Even if they had foreseen the dire circumstances, in order to arrange that kind of unique transportation, outside of normal procedure, would have taken time as well. No guarantees either way.

Still, Monday was a beautiful day, she had fun outdoors in the sunshine and fresh air, spent time with her kid, and succumbed relatively quickly and painlessly. She was young, but could have also languished for months dying of cancer. I'd rather go the way she did.

[pnwmom]

97. What a crock, to romanticize death that way. This woman had two young sons.

I would rather die a prolonged death 10 or 20 years later, if I had to, than subject young children to the sudden loss of their mother.

And she wasn't having fun, according to her mother. Vanessa told someone the day before that she didn't understand why her daughter had gone, because Natasha didn't even like to ski.

I'm afraid she probably went to make her son happy -- poor kid. Can you imagine being a kid and living with that thought? That she only went to please you?

[Gwendolyn]

107. If you're saying she didn't like to ski, that implies she's been before. n/t

[pnwmom]

111. That doesn't mean she likes it. That's the point her mother was making. n/t

[Gwendolyn]

114. I guess my point is, if she's been before, she wasn't a complete newbie.

Doesn't matter if she liked it or not. Your argument is that people don't understand the risks. Everyone knows after their first time on skis, how hard the hill feels as you go down. So if she had skied before, even just once, there was a more informed decision about whether or not to wear a helmet. If she's one of those people who's been skiing sporadically throughout the years, it's possible that she wasn't a total neophyte and semi knew what she was doing. Either way, and in every way, it still was a freak, unfortunate, sad accident... not really anything more.

[pnwmom]

155. I'm not saying that anyone was at fault here because I don't see how that kind

of judgment can be made at this point, with only sketchy facts.

At the same time, I don't understand how anyone can decide -- in the absence of any facts -- that all the fault is hers and that none belongs to the ski resort or whoever made the decision not to send her to the trauma care center that was in Montreal (45 minutes away) instead of to the "local hospital" that was 40 minutes away.

[Gwendolyn]

161. pnwmom, I don't think anyone's saying it was her fault as opposed to theirs.

It's no one's fault. It was a terrible accident. There isn't always a need to lay blame.

People who fall, on a ski slope or elsewhere, often think they're fine when they aren't. Don't go to the doctor with dire consequences. That happens every day and it's always tragic.

The ski resort had absolutely nothing to do with it. That she was sent to the closest hospital is protocol. That I can tell you is a fact. Even in Montreal, call an ambulance to your home and they will take you to the closest hospital based on your address, even if you prefer one only ten minutes further away. At that point, I'm assuming no one knew exactly what was wrong with her, and so all the presumptions of where she should have been taken are hindsight. Had it been another sort of injury, perhaps getting her to the closest hospital would've saved her life.

You're a little off on the distances between hospitals as well. Tremblant is about an hour and 10 from Montreal, driving at the speed limit. Ste-Agathe-des -Monts (first hospital) is much closer. Probably under 20 minutes if you race. I posted it down thread for you, but here's a link of a map to show you visually the difference in distance.

http://www.magnificat.ca/directions/Montreal2Mont-Tremblant.htm

On edit: The map says 1 hour 20 minutes from Montreal. It's definitely over an hour driving normally.

[northernlights]

118. then why was she taking a lesson?

And why, if she was doing it only to please someone else, did she not wear a helmet?

She was an adult. If she wanted to please her son, she could have let him ski and stayed at the bottom and watched.

She chose to take a lesson. She chose, as a beginner, to not wear a helmet.

[pnwmom]

154. The majority of people on ski slopes still don't wear helmets and there is the

unfortunate perception that people on bunny slopes aren't at much risk.

I don't understand the point of your questions. Taking a lesson is something beginning skiers often do, even if they've had one before.

Yeah, she's an adult who made her decision. But I think her son, if he had anything to do with her being there, is doubly devastated.

[quiller4]

178. Because helicopters were grounded due to weather per

news reports out of Canada.

[Bandit]

51. How long do you think it takes an Iraqi mother to get help for her and her child when her home is

destroyed by American bombs? Four hours is an incredibly short time and the Canadians should be praised repeatedly. I would bet any amount of money she would not have had better attention anywhere in the USA.

[pnwmom]

58. I'm not comparing Canadian care to U.S. care. I'm pointing out that the

trauma care available to injured people at MANY ski resorts is less than optimal, because of the problem of getting them to well-equipped trauma centers. There was an article about this in the NYTimes several years ago but I haven't been able to find it again.

[northernlights]

74. if she had listened to her ski instructor

and the people attending to her immediately after the fall and taken the first ambulance, she could have ended up at the trauma center far more quickly.

Half the time lost was due to her refusing to go -- between 12:45 or so when the 1st ambulance arrived and 3pm when they called for the 2nd ambulance. 2 1/2 hours lost right there due to her refusal to accept a medical evaluation.

And much of the rest of the lost time was due to having to stabilize her for transport to the trauma center.

[pnwmom]

76. I think asking someone who is possibly brain injured to make a competent decision

is problematical in itself.

[northernlights]

117. well you can't blame the ski resort for that

Nobody can legally force someone into an ambulance. From what I read, they stayed with her the entire time, trying to convince her to go to the hospital.

[pnwmom]

156. The problem is that they turned the medics away without even speaking to her.

I think they should have had the medics come and talk to her. The medics could have asked her questions designed to assess her status, and looked for signs like unevenly dilated pupils. If they saw something of concern, they could have told her -- look, we're worried about X, Y, and Z, so please let us examine you.

But they didn't have a chance to do this because they were turned away without seeing her.

[uppityperson]

168. They tried to get her to allow assessment but she refused.

She refused. Legally they could not force treatment upon her. "They" did not turn the medics away, she did. If they had allowed medics to see her without her permission, it would be assault.

The outcome is very sad, but this is how it is.

[uppityperson]

123. It is, but until a person is obviously incapable, they are.

having been there myself. You can't force an adult to get care, unless they are deemed mentally incapable of it. And by the time someone gets to that point, the care may be too late.

[pnwmom]

158. The thing is, the medics weren't even given a chance to speak to her.

They were turned around without a chance to.

Why did the resort people send them back after they had come all the way out there? A woman with a possible head injury says, no, I"m fine. And on that basis they're not even going to let the medics speak to her?

Suppose they didn't turn the medics away. The medics could have questioned her closely, and watched her reaction while she spoke to them. Perhaps she would have told them, that yes, she was fine -- but then allowed that she did have some little symptom that hadn't seemed important to her. Or maybe the medics might have noticed that she was trembling, or that one of her pupils was bigger than the other. IF they had had this chance to speak to her, they might have noticed something of enough concern that they could have then convinced her to allow them to examine her.

Of course this is all speculation. Maybe she really had no symptoms. Maybe she would have stubbornly continued to resist treatment. But maybe not. I'm glad I'm not one of the resort people who might have to live with this possibility.

[uppityperson]

167. SHE refused to see them.

From your OP link:
"Mr. Coderre, whose company, Ambulances Radisson, serves Mont Tremblant, says medics arrived at the hill 17 minutes later. At that point, the wounded actress refused medical attention, he said."

SHE refused to see them, not the resort people turning them away. SHE had the legal right to refuse treatment. SHE should have let them assess her. The resort people could not force treatment upon her at that point, and they did not block treatment of her.

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=5291485&mesg_id=5296128

[stklurker]

87. ski resorts

Ummm I would kind of expect that given their locations.. I mean there are activities that a person chooses to partake in (Skiing, scuba diving, mountain climbing, etc) where the risks are inherent, and the availability of critical care/trauma centers is a known risk.. I have read several articles and it seems that the resort personnel did everything they could to encourage medical attention... Sometimes, thats the way it is.. you cant account for everything, and sometimes you just take the risk because you just cant live in a protective shell..

[DS1]

88. there's always one

[Fire_Medic_Dave]

187. You would lose that bet.

Here she would have been flown to a level 1 trauma center immediately.

David

[uppityperson]

2. Looks like she refused to go, and it didn't take long to get to er. Lesson is: Don't listen

to people with head injuries as they are not thinking straight. Seriously, having been on both the injured and health care provider sides, you don't think straight. If someone you are with hits their head, use all your powers of persuasion to get seen.

If it happens to you, please get checked out rather than refusing medical attention.

[pnwmom]

5. Even after the 2nd call from the resort, it took several more hours before

she actually arrived at a hospital that was properly equipped for trauma care. (She had to be driven from the first hospital.)

I agree that it doesn't make sense to ask someone with a head injury to make this kind of medical decision. I feel for her poor sons, who were apparently with her.

[uppityperson]

15. More thoughts and bits from that article about feeling fine after head injury...

"he medics tended to her for half an hour before transporting her " this is normal. To take time to assess, and treat as they can before transporting someone.

"the hospital stabilized her" is also routine.

Having helicopter available at a ski resort seems like a good idea but they transport people to nearby hospital for further evaluation before moving them on, in cases like this.

Experts say victims of head trauma frequently feel no immediate symptoms. In a process known as “lucid intervals,” they feel fine despite the fact that blood buildup is forming within the skull lining.

Yet patients can be saved with prompt medical intervention. If the problem is diagnosed quickly, surgeons can relieve the pressure on the brain and stop the bleeding.

“Time matters in these cases. The sooner you get treatment, the better you'll do,” said Dr. Judith Marcoux, a neurosurgeon with the McGill University Health Centre in Montreal. “Initially you may not feel much, but as time goes by, the blood accumulates more and more and the blood clot gets bigger. By the time you feel symptoms, it can go really fast.”

[pnwmom]

30. Here in Seattle, in a trauma case like this they'd take someone directly

to Harborview even if a small hospital was closer.

And in the Richardson case, they drove her to both hospitals. I bet with a helicopter she could have gotten to the Montreal hospital faster than the 40 minutes it took her to be driven to the "local" hospital.

[Horse with no Name]

49. That is protocol ANYWHERE there is a local major trauma center

In Dallas, they go to 1. Baylor 2. Parkland and 3. Methodist. They don't take trauma patients to satellite hospitals in that situation.
That is the receiving order. Of course there are outside factors that change the order up that aren't necessarily important to go into here.
However, you are insisting on comparing apples to oranges. There was NOT a local trauma center--so the closest hospital would be the receiving hospital. EMS picked her up--more than likely, the receiving hospital didn't have their own Med-Evac helicopter and trauma team available--most hospitals don't...so the next best thing is to get the patient to a hospital and have them assessed, treated, and stabilized by a physician while awaiting transport to the trauma center.
Would you prefer they left her on a treacherous mountain for the length of time it took to get the team there instead of taking her to an equipped hospital, then risk THEIR lives landing them in sub-optimal conditions instead of on a helipad at the receiving hospital?
Somehow, I think you would.

[pnwmom]

59. I would prefer that ski resorts were more open about the real risks of injury

and the lack of availability of urgent trauma care.

And, in a separate but related issue, I think we went too far in rewriting tort laws to favor the ski resorts when they're sued for negligence that leads to serious injuries.

[stklurker]

89. negligence

OMG... WHAT negligence do see that happened here??... please, you are hitting one of my hot buttons.. WHAT did the resort do wrong in this case....

[pnwmom]

105. I'm leaving open the possibility, not accusing them. But I think they made

a mistake when they sent the ambulance back without letting the medics speak to her (as opposed to treating her, which I know they couldn't do without her consent). If the medics questioned her carefully and saw signs for concern, they might have been able to convince her to allow treatment.

Unfortunately, it will never be known whether this could have saved her.

[northernlights]

120. what part of SHE REFUSED do you not understand?

They called the ambulance immediately. SHE REFUSED to go to the hospital.

They stayed with her the entire time, trying to convince her to go. They called the ambulance a 2nd time AS SOON AS SHE AGREED TO GO.

Legally, they could do no more.

There is no negligance here. And they'd be fools to be lying: about a celebrity, and with so many witnesses, including her sons.

Sheesh :eyes:

[elleng]

11. Sounds like one of those situations

when an ill or injured person needs an advocate, whether s/he knows it or not. No one was with her with the knowledge we all have now, or could have said, Just Take Her.

No 'blame' here, as I see it.

[uppityperson]

12. I agree with you. Posted that for future reference for others.

Head injured people need an advocate, need to be checked out. Having been there myself, we don't think straight, want to just rest and be left alone. I was lucky, she was not.

[elleng]

21. Thanks.

Had situation during this year with family member, no similar injury but abundant confusion. I think its a general rule. How many/who among us is really capable to make all necessary decisions?

[xxqqqzme]

38. I was lucky as well.

I was close to a first rate trauma center. I was in a coma for two days, on life support until my brain swelling started responding to treatment. I have left side paralysis as a result of my brain trauma. I was extremely lucky.

[pnwmom]

43. I'm very glad for you. n/t

[tonysam]

169. Coulda, Woulda, Shoulda.

It doesn't do any good to speculate after the fact. Richardson made a choice not to seek immediate medical help, and she died.

There is nothing medical people or ski resort personnel could have done. She made her choice and she lost her life.

[uppityperson]

189. exactly eom

[Horse with no Name]

3. But it was her choice

She initially refused treatment.
When she sought treatment, she was symptomatic which often times includes seizures and combativeness...and you cannot transport a patient that is not clinically stable IF they are already in a hospital setting...they have to be stabilized first even if that includes placing them on a vent and inducing a coma.
I do not see a problem with the way this was handled.
In fact...after initial refusal of treatment from the medics and two transports, I think they actually did quite well timewise.:shrug:

[pnwmom]

8. The problem was that they couldn't evacuate her directly to a trauma center.

That resort should be capable of a helicopter evacuation to the Montreal trauma center, IMO.

[Horse with no Name]

10. They HAVE to transport to the nearest hospital

They do that here in America too.

[pnwmom]

26. No, they don't. In my county they would transport to the nearest trauma center, which is not

necessarily the closest hospital.

[Xithras]

23. Virtually every ski resort I've been to has an area that can be used for them.

Sometimes it's a staff parking lot that can be cleared in a hurry, sometimes it's a big flat spot at the base of the runs that can be cleared of people when needed, and sometimes it's a dedicated landing area, but virtually every sky resort I've seen has had a spot capable of landing a helicopter on.

The problem here is simply that there was no real sign of trauma. She said she was OK and refused treatment, so there was no reason to dispatch a helicopter.

[pnwmom]

27. They turned the ambulance away without even examining her.

When they finally came back two hours later, she was clearly in trouble. That's when I think it would have made sense for them to helicopter her to the hospital with the trauma center, rather than drive her to the closer hospital without that capability.

[bottomtheweaver]

34. Do we know with certainty who turned away the first ambulance?

If you're thinking something doesn't smell quite right, it doesn't.

[pnwmom]

37. I haven't seen anything about who turned the first ambulance away.

I've been wondering about that myself. It seems strange to not even have the medics look at her.

[Horse with no Name]

47. If a patient refuses treatment

and the EMS proceeds to treat her anyway, it is assault.

[pnwmom]

60. And not questioning such a patient closely may constitute negligence.

In this case, the ambulance turned around the first time without even seeing her.

http://braininjury.blogs.com/braininjury/2009/03/did-natasha-richardson-receive-proper-care-from-the-ski-area-and-the-doctors-and-hospitals-who-treat.html

[northernlights]

79. SHE REFUSED THE FIRST AMBULANCE

Did you read a single article and ignore everything else that has been written?!?!

SHE REFUSED TO GO TO THE HOSPITAL. What part of that do you not understand?

The resort didn't call the ambulance and then tell them they changed their mind, go away. They called the ambulance and tried to convince her to go. SHE REFUSED.

They stayed with her the entire time after the fall, tried to convince her to accept medical help. SHE REFUSED.

It wasn't until she had a pounding headache and felt ill that they finally CONVINCED HER TO GO.

The resort is in no way at fault. The hospital is in no way at fault. And if she hadn't refused, she could have ended up at the trauma center much, much sooner, and in time to save her life.

SHE REFUSED TO GO.

[pnwmom]

101. Refusing to go to the hospital cost her 2 and a half hours of time.

After that, they had the choice of sending her to the "local hospital" which was 40 minutes away, or to the trauma center in Montreal. Montreal was 45 minutes from the ski resort, but let's assume that the trauma center was farther away -- say another half hour. Why was she taken the 40 minutes to the local hospital, only to be put in another ambulance sometime later for an hour's drive to the hospital in Montreal? When she could have just been taken directly to Montreal?

And you're saying that you know for a fact that the correct decision was made? I'm reserving judgment until much more is known.

http://www.examiner.com/x-5289-Celebrity-Sightings-Examiner~y2009m3d19-Ski-Lodge-Where-Natasha-Richardson-Was-Injured

"The resort is located 45 minutes north of Montreal"

[northernlights]

121. until now you've been blaming the resort

Well the resort doesn't pick and choose where a patient goes. They call the ambulance. The ambulance follows whatever protocol they have.

So are you now switching to blaming the hospital protocol?

You're just looking for someone to blame other than the victim, smearing one group (1st the resort, now the local emergency protocol).

Normally, I'm not into blaming victims. Yet the facts are that in this case, the unfortunate victim made a series of bad choices. They are the sorts of choices we all have made at one time or another, and have survived to talk about. Just last week I slipped on ice, fell and hit my head on a fencepost. Nobody was there and I didn't seek medical help. I monitored myself and felt better with time, not worse. I just miss hitting my temple, and have a nice bruise on my upper cheekbone (actually a sinus bone). A little further over, and I could have hit my temporal bone, ruptured by temporal artery and died.

In this case, the same set of poor choices that we all have made at one time or another led to the to worst possible outcome.

Sometimes shit happens and there is nobody to blame.

[pnwmom]

160. I'm not blaming anyone at this point, because the facts aren't out yet.

Unlike you, I'm reserving judgment. We don't know if all the mistakes were hers, as you seem to think. Or if her death could have been averted if either the resort or the medical authorities had made different choices.

And we may never know.

[uppityperson]

170. "They turned the ambulance away" sounds like blame.

An adult can legally refuse treatment. If it is forced on them, that is assault. If the medics had chosen to assault her, perhaps she might be alive. Perhaps not.

Which comes down to the basic fact that an adult can legally refuse treatment. I guess you disagree with that.

[roseBudd]

7. I know I'm glad I live three minutes away from a level one trauma center

[malaise]

13. Had she gone for a check up when the first ambulance arrived

She'd still be alive. Sorry. This was just a tragic freak accident.

Here are some pictures to make you all cry.

http://www.huffingtonpost.com/2009/03/18/natasha-richardson-and-li_n_176670.html

I love this one.

[Horse with no Name]

16. Very tragic.

She was quite beautiful. She was also my age.
I feel badly for her family.
It is just one of those freak accidents.

[pnwmom]

31. Thanks for the photos. They were lovely, and I hadn't seen most of them before.

There is something about this couple that always seemed genuinely loving -- unlike so many others in that field. And she was only 45. What a tragedy.

[malaise]

57. Yep

I can't imagine her family's pain.

[chollybocker]

17. She refused treatment and SIGNED A STATEMENT as such.

Neither the ski hill nor the EMT unit are to blame for her death. The details show that the Mont Tremblant staff and the medical teams handled the situation in exemplary fashion. Her death would be no more unfortunate if there was someone here to blame.

[pnwmom]

32. I'm not casting blame. But I think crucial time was lost when the decision was made

to drive her to a local hospital instead of putting her on a medivac to the trauma center in Montreal. And by that point (two hours after the first ambulance came and went), they knew she was in serious trouble.

[JSK]

18. Her death will probably save lives

Small consolation for her family. Very sad.

[Arugula Latte]

19. Definitely. I'll bet she's already saved a life.

More people will wear helmets while skiing and snow boarding, and more people will seek medical attention for seemingly "minor" head injuries.

[bullwinkle428]

61. I took my girlfriend skiing a few times this past winter,

and told her I'm not letting back on the slopes next year without a helmet!

I've worn one for a few years, and didn't really think she absolutely needed one as she skis at much lower speed, being a beginner, but we saw how tragic that misjudgment can be...

[Berry Cool]

20. People very often minimize their own injuries.

"I'm fine." "Don't make a fuss over me." "I don't want to ruin everybody else's day."

There are a million ways we make light of something that later on turns out to be very serious.

[NashVegas]

22. People Who Live Take Risks

Ms. Richardson understood that; every time she walked out on stage she risked falling flat on her face.

It would have been to her benefit to have chosen to ski at an area closer to Montreal, but she did not. It's a tragedy for her family she did not.

[nadinbrzezinski]

24. Former medic here

wish I could (and can't for privacy reasons) recall the many a times a patient refused care... signed an AMA (against medical advise) and later was transported to local hospital\trauma center

Unfortunately, especially with ahem, VIPs and tourists... yes both groups, this is very common practice... "hey man I'm fine, and leave me the fuck alone..." by the way, that's a direct quote. Add some alcohol and belligerence, and you got it

As a medic, as long as they can play the game of twenty questions, hands are tied, even when you want to take them to the hospital because that pesky gut tells you.. they need help.

Now once they got her to the first hospital, a local center, their job is to evaluate and stabilize and then arrange for that pesky chopper

Problem is that there are many things that can and will at times go wrong

There is also this little pesky thing... we don't know all the details, nor do I want to know all the details, that is between her, the family and if you believe a god... as well as medical providers

I know I have asked myself many a times, what if? And I am sure the medics, the doctors, the nurses, everybody involved is asking the same thing

WHAT IF?

RIP...

That is all I can say

[pnwmom]

33. I remember reading an article in the NYT several years ago talking about this

problem -- that many resorts are not set up to quickly get injured skiiers transported to trauma care, and that most skiiers aren't aware of the additional risk this poses.

This hit home a few years ago, when a friend's son was injured at a ski resort in Oregon -- he hit a tree with his face. There wasn't a hospital nearby, so they put him on a BUS to a hospital in Portland, because that was faster than an ambulance!

[treestar]

67. Recalling the great mountain climbing wars of DU

Skiing may be fun, but there's an underlying risk. People need to know they are literally risking their lives for some fun. That is the case with mountain climing and parachuting. Some will get killed doing it. If you want to take that chance, fine, and most of the time it won't end in death or injury. But the possibility is there. So when it happens, it's not right to blame others.

[pnwmom]

69. Your argument is sound as long as ski resorts are open about the risks.

The article I read said they are not, and that the lack of availability of urgent trauma care is also something they are less than open about.

[northernlights]

82. the minute you sign the waiver

you are acknowledging that you understand that what you are doing may result in your death or serious injury, and you choose to take on the liability of that risk.

They recommend helmets, and you choose to reduce your risks by wearing one, or you accept the risk and liability for not wearing one.

I'm sorry your friend's son had such a terrible experience. There is no guarantee in life to anyone that a trauma center is waiting nearby, unless you are participating in an extremely high risk event where they plan for medivac.

Now when I white-water rafted the Grand Canyon, we WERE advised before we got on the rafts that there would be no help nearby. But in that case, they literally meant no help nearby. The only way out is down the river to a place where an airlift is possible. And helicopters won't airlift after dark, so if you have an accident in the afternoon, you are on your own. You either don't survive until dawn or you do. In which case, you have a long ride to the nearest hospital.

So a couple hours, especially given that she refused the first ambulance, sounds pretty reasonable to me.

[pnwmom]

84. Don't you think that if the waiver included the information that urgent

trauma care would be unavailable, fewer people might sign it? And wouldn't fewer parents bring their children skiing if they knew they might not be able to get them trauma care in time?

[northernlights]

116. no, I don't

People sign waivers because they don't expect disastrous accidents to happen to them, not because they expect that if they have a disastrous accident a trauma hospital will be there to save them.

Just before embarking, long after we'd signed the waivers, they advised us of lack of *any* immediate medical care beyond their own 1st aid kits, because even with an immediate cell call, help could be 12+ hours away.

But they didn't advise this on the waiver. Just listed some of the ways you might die. And there were many, many ways to die. Not just from a bad spill out of a raft, but dehydration, too much water, too little electrolytes, getting lost on a hike, rattlesnakes, poisonous spiders, and mountain lions to name 8 off the top of my head.

[Xithras]

145. I think that most skiers understand this anyway.

Ski resorts are usually located in remote mountain areas far from cities that are only accessible by driving narrow mountain roads. You know you're in the middle of nowhere when you go skiing (excepting a few urban ski areas like those at Tahoe), and it's generally obvious that there aren't any hospitals hiding between the trees. Hospitals only exist in towns.

This really isn't a "ski" issue anyway. Last summer I went hiking in the Yosemite backcountry (as I do every summer) and I came across a similar scene one morning. A family had been doing a hike in the backcountry and their 14 year old daughter had fallen and broken her leg. A passing good samaritan hiker dropped all of his gear at the site of her fall (other than water) and power-hiked for five hours to reach the nearest ranger station. The rangers jumped on their horses and rode back out to the site with their medical gear. By the time they reached her, the sun was setting and the trails were WAY too steep to hike in on foot (they were in the granite country in north Yosemite). The rangers pitched a tent, sedated her, and they spent the night in the forest. The following morning, when I came across the scene, they were just packing her up for the ride out. They were looking at a 10 hour ride to reach Tuolumne Meadows and put her on an ambulance...it was thunderhead weather so flying a helicopter in wasn't a possibility.

The fact that help can be many hours, or even days, away is simply a reality of most forest sports and activities, and everyone who participates in them should be aware of that. I've met very few people who weren't.

[Fire_Medic_Dave]

186. What the hell did the medics do in her hotel room for 30 minutes before transporting her?

[Butch350]

25. it's a MOOT point now.

[pnwmom]

35. It is for Richardson, but not for anyone else who still skis. n/t

[Lost in CT]

29. The ambulance got there in nine minutes on the second call.

They stabilized her then transfered her to a trauma center... sounds like they did everything they could.

[pnwmom]

36. No, they didn't take her directly to a trauma center.

They stabilized her at the resort, then drove her to a local hospital, then stabilized her again before driving her to a trauma center hospital in Montreal.

They probably could have put her on a medivac and gotten her to the trauma center in less time than it took to drive her to the local hospital (which was 40 minutes away.)

[AngryAmish]

53. You don't send every head injury to trauma center

Standard of care is to send to local ER where they can do the CT which will tell you very fast if there is a bleed. Then to trauma for neurosurgery (unless they can get a neurosurgeon there or even just a trauma surgeon. The actual surgery to relieve the pressure is very simple (all you need is a drill and stop when blood shoots out at you - you can do it with a local anesthetic).

[pnwmom]

62. Is there any reason they couldn't have the means to do a CT scan at the

ski resort itself?

[AngryAmish]

70. Yes. I would prefer to have my CTs read by someone who knows how to do them

CTs are big machines. I doubt they have them at a ski resort. Plus you need a radiologist, neurologist, neurosurgeon or trauma surgeon to read the films. These guys don't just hang around a ski resort.

[pnwmom]

75. At many smaller hospitals, these scans are read long distance anyway. n/t

[amborin]

40. the Daily Mail said the first hospital operated

on her to remove the clot....they said it was due to a break in her temporal artery...and that after they operated to remove the clot, she suffered a massive stroke

<http://www.dailymail.co.uk/tvshowbiz/article-1163074/As-family-switch-life-support--Natasha-Richardson-saved.html>

[pnwmom]

42. No, they said it was at the second hospital in Montreal that she had the surgery.

That's the hospital that I'm thinking she should have been taken to in the first place, rather than the closer hospital without a trauma center.

"She lost consciousness as she was taken to the Centre Hospitalier Laurentien where her condition deteriorated rapidly.

"Medical sources said that CT scans of her brain revealed a tear in the temporal artery in the left side of the brain and she was immediately transferred to Montreal's Sacre Coeur Hospital.

"She was given steroids to reduce the bleeding, but scans showed that her level of brain activity was minimal.

"Doctors operated to remove the blood clot but shortly afterwards she suffered a devastating stroke when the tear to the artery widened."

[amborin]

93. ok, second

but the point is it said they did operate

however they removed that article and there is no other mention of any medical treatment

also, neurosurgeons will tell you that just b/c brain activity is minimal does not mean the brain will not recover over time....it has happened....keep the patient in coma like sedation and wait and see

[northernlights]

136. and the article *also* says she missed the "golden hour"

when she refused examination immediately after the fall.

It is a freak accident, or we'd all die young. We laugh off "minor" falls all the time. You have only a short time after a blow to the head for surgery to prevent or minimize brain damage, or death, in the extremely rare event that you've ruptured an artery.

It's all to easy to try to assign blame to the resort for not trying harder to make her get an exam. They did everything they could, and have witnesses, logs and signed statements to support that.

Or to try to assign blame to whomever for not taking her directly to the trauma center, once symptoms appeared.

But it is the *rareness* of this kind of injury that likely is behind the protocol. The vast majority of bumps to the head are just that -- bumps to the head that result in a minor ache and a bruise. And the symptoms, once they appear, are like a concussion which is a far more common occurrance.

If they airlifted everybody who every took a spill and possibly bumped their heads and therefore may have ruptured an artery, the cost would be astronomical.

And there may be other, medical, reasons that we don't know of behind the protocol, for not airlifting someone with that type of brain injury. Possibly the change in air pressure could cause or increase swelling and therefore intercranial pressure.

So this thread is past being a ridiculous attempt to assign some blame to somebody. It was a freak accident. They do happen, even to celebrities.

[K8-EEE]

41. I'm think if she would have worn a helmet she'd most likely still be here

Which is not to say it's her FAULT or anybody's FAULT == Hey it was an accident....sometimes the damage is not so obvious to the injured person and those surrounding them, and she was in a remote location. It's a tragic accident -- but does there always have to be finger-pointing?

[pnwmom]

44. I'm not seeing this as finger pointing, but as something many of us can learn from.

If a loved one has a head injury, we may well have to advocate for immediate care -- even if that person thinks s/he is fine.

[Dorian Gray]

48. On the news

I heard that she had turned away the ambulance that was called for her because she was walking and talking.

Tragic, but also indicative that help was there for her quite quickly and promptly.

[Horse with no Name]

50. I'm not really sure what the OP is trying to indict

The trauma system (that works well for many) or the Canadian Health System--which in this particular case, followed the same protocol as hospitals here in the US.:shrug:

[pnwmom]

63. I'm not trying to "indict" either one. I'm asking questions, but mostly

I'm concerned about the fact that most skiers don't understand the risk they're taking in a situation where urgent trauma care is often not available. This isn't a U.S. vs. Canadian problem. It's a ski resort problem (and snow boarders happen to be at the highest risk).

[Gwendolyn]

83. It's also a problem for campers, mountain climbers, people who vacation on remote islands...

Anytime you find yourself away from civilization in any way, even if it's just a family cottage out in the boonies somewhere, you run the greater risk of dying from some ailment or accident. Tis life. :)

[pnwmom]

85. I doubt that people in ski resorts -- which can feel like small cities -- realize

how unprepared many of these places are to get a seriously injured person to urgent trauma care.

People camping individually, or climbing remote mountains, are more apt to realize that they are unlikely to get urgent trauma care if they need it.

[Gwendolyn]

91. I don't know if you ski...

...but I would disagree. Most resorts require some travel time from true civilization to the elevated ski resort area, often along winding, rural roads. I've been skiing all my life, learned on the very ski run Ms. Richardson died on, and would say that people are aware of the risks. Anyone who's been skiing for a long time has stories of the near disaster.

There are comparatively few injuries such as the one Ms. Richardson sustained, and to keep expensive, state-of-the art equipment and procedures available just isn't practical. Most injuries are of the broken limb variety and even then... people know that if you go off piste and end up with your legs broken on the top of some expert trail, it'll take awhile before they get to you. It was a freak accident. And real life isn't a television show. Not every one ends up with "House" saving their life.

[pnwmom]

You have more confidence in people's knowledge of these risks than I do. n/t

[Gwendolyn]

102. But then, what can you say, except people should inform themselves?

You can rent out a sailboat with friends tomorrow, but if you don't know how to sail you're a fool if you don't take lessons first, starting with theory classes. Horseback riding, the same. In fact, it's the same for all sports. If you don't want to wear the gear that's prescribed for newbies, chances are also greater that you risk injury to yourself. What right-minded person doesn't know that? It's common sense. But even then, thousands and thousands of middle-aged people take beginner ski lessons and end up with little more than bruises on their asses. Aside from telling people they "can't" go try some new sport because there's a one in a million chance they'll die, there's no alternative other than to rely on peoples' own judgement calls. As far as skiing goes, most people get to the mountain by car, and you only have to look out the window along the way there, to know where you are and how isolated from civilization you might be.

[TwilightGardener]

52. Had she agreed to go to the hospital right after her fall, she probably

would have survived, although maybe not with the same brain function (that's hard to say)--a tragic moment of bad judgment on her part. It's not like she couldn't afford it, or was very busy doing something very important. Her family must be wrestling with all sorts of "if only" regrets right now. But unless someone can prove that the medical community didn't follow normal protocol in this case, then it's just hindsight judgment. I will say that I've taken care of head-trauma patients, and it's pretty hard to know what's going on with them sometimes. I took care of a teenage girl in Florida who was thrown out of a moving car by her boyfriend, she passed thru ER and into my ICU unit, and seemed not too bad off at a casual glance--she seemed alert and oriented, and responded appropriately to my questions and actions--but when I did my initial assessment, I realized her pupils were of uneven size--bad finding--called the doc right away. It could be that Ms. Richardson's signs and symptoms were subtle until she downright crumped.

[LisaL]

54. We have no idea if she would have survived if she agreed

to go to the hospital right away. But if she felt fine at first she didn't think anything was wrong.

[treestar]

65. After the fact Monday Morning Quarterbacking

Are there trial lawyers in Canada?

There is always something else that could have and "should" have been done when you are looking at the completed story, not in the middle of it.

[pnwmom]

71. As I asked in the OP, in the event you sustain a serious injury while skiing,

and every minute counts, how long will it take you to get to trauma care?

Many people don't think of this when they bring themselves and their children to isolated ski resorts. If they did, they might think twice.

Friends of ours learned this the hard way when their college age son (skiing with friends) hit a tree and sustained facial injuries. The resort's best solution? To put him on a BUS for a four hour trip to the closest major city.

[WI_DEM]

66. There wasn't much the paramedics could do if she refused to go to the hospital

and gave the appearance of being okay that first time they came out. It was her call, and unfortunately it was a bad one.

[pnwmom]

73. My question is about what happened after they made the second trip.

Even at the point, there was another 4 hour delay before she got to the trauma center.

[Maru Kitteh]

77. And people have already answered your question. You just don't like the answer.

It's very tragic, but this young lady likely sealed her own fate when she refused treatment.

[bottomtheweaver]

78. It's tragic, but there are a string of unanswered questions

beginning with what hit her in the head. I hope her family gets the answers because there may something sinister afoot.

[northernlights]

81. oh honestly, nothing hit her on the head

She fell and hit her head when she fell. She was out in public. According to witnesses, the snow was soft and wet.

Either one or both of her sons was there was a witness. There is nothing sinister afoot. :eyes:

[bottomtheweaver]

94. 'The bleeding that led to the clot was caused by "blunt impact to the head,"

according to the official report.' No one wants to believe that there are sinister forces covertly manipulating events, but then again it's been public knowledge for at least the last 62 years that there are.

[LisaL]

99. Blunt impact to the head can be caused by a fall. Hello?

[bottomtheweaver]

100. No kidding.

:hi:

[northernlights]

124. are you suggesting

The hill picked itself up and smacked her on the head?

There were many witnesses, including her own son. She didn't hit a tree. She didn't hit another skier. Nobody picked up a board and clobbered her.

She fell and hit her head on the hill. Not the other way around. :eyes:

[nxylas]

131. Here's a fact you won't read in the liberal media

The hill was JEWISH!

[bottomtheweaver]

179. I'm suggesting that there are good reasons to ask questions

about this particular "freak accident," because like so many tragic deaths in recent years, some widely publicized, some not, it serves the interests of the permanent war economy aka military industrial complex by punishing and/or silencing an inconvenient truth teller and peace advocate, in this case her mother.

[pnwmom]

80. If whoever was initially examining her just took her word for it -- didn't question

her closely for signs of a head injury -- then negligence MAY be involved.

It is much too early for people to judge this either way.

[Horse with no Name]

90. You CANNOT examine a patient who refuses treatment

You simply cannot. She signed the waiver. She made a terrible, tragic mistake in refusing medical care...but in this case, as it should be, NO MEANS NO!
You cannot examine a patient that tells you NO. It is ASSAULT.
There is not a field head injury test--as long as she was rational, knew her name (obviously she did, she signed it), where she was, and the time (these documents require them to be signed and dated)...then there was absolutely nothing anyone else could do while she was conscious.
Now, if she said no, signed the waiver, and THEN went unconscious, that is considered implied consent and they could have treated her.
I'll tell you right now...if I say I am fine, and someone proceeds to examine me and touch me...there are going to problems.
You don't cross that line. Never ever ever.
Healthcare professionals that do not hold medical licenses also do not diagnose. They give their assessed findings to a physician and he makes the call. It doesn't matter if we "think" we know what is going on, but in the interest of public health and in the scope of practice of those healthcare workers in the field--what you suggest just isn't done.

[pnwmom]

92. The question is not whether they touched her. The question is whether

they asked enough of the right questions. All we know at this point is that the medics in the ambulance were turned away without even speaking to her. Surely there is no Canadian law that prohibits medics from looking at and speaking to a person with a possible head injury -- as opposed to touching her and providing medical care.

What if they had been given the chance to speak to her, and in questioning her, noticed she had some signs of a serious injury that the resort people hadn't noticed? They could have told Ms. Richardson -- look, we're concerned because of X,Y, and Z, and so please let us examine you. But someone -- we don't know yet who -- decided to send them back without seeing her. I think that was a serious mistake, no matter what she had said at that point. No one would have charged them with anything if they had gone to her and asked her some questions. And, based on what they noticed, they might have been able to convince her to accept treatment.

Did you read the blog article at the other link by the malpractice attorney? I'm curious what your response is to that.

[Horse with no Name]

95. Malpractice attorney?

I'm sorry. You are reaching. I'm not interested in reading an ambulance chasers blog. Knock yourself out on that one.
The STANDARD OF CARE (and that is what the court will hold the EMT's to) is that she is oriented to person, place, and time. By signing and dating the refusal of care waiver, she legally satisfied 2 of these 3 requirements. The third wouldn't be hard to prove.

[pnwmom]

103. So you're saying that if they noticed, for example, that one pupil was visibly larger

than the other one, they wouldn't have told her?

Because there are only 3 items that matter?

(And even a relatively small discrepancy in pupil size can be recognized by someone without any special examination. I know this because a relative unfortunately has had this condition since childhood, and I was the first to notice.)

[Horse with no Name]

106. Do you know for certain she didn't have sunglasses on?

Goggles? Do you advocate them physically removing them from her body?
Have you ever been skiing?

[pnwmom]

109. I don't see why she would have been wearing her sunglasses indoors, do you?

That's really a stretch.

But suppose you are right. Would it have been assault and battery for the medics to ask her to remove her sunglasses?

[Horse with no Name]

113. The point is

You have no proof that she had anisocoria. None whatsoever. Most likely, at that point, she did not.
But I guess you want to take this opportunity to bash healthcare workers and hospitals.
I honestly don't know any EMT's that would walk away and overlook symptoms like that--they are adrenaline junkies and that is what they thrive on. I honestly don't believe that if they pointed the fact that her pupils were different sizes that she wouldn't have sought treatment. She wasn't stupid. She was just asymptomatic--totally without symptoms therefore assuming she was okay.
And if she was alert and oriented x3, and had the anisocoria, the medics STILL couldn't touch her without her permission considering that it can also be a normal finding in certain people.
My guess is that it is as they say--she was asymptomatic. Meaning pupils were fine, too.
She was an adult.
She just made a tragic choice that day.

[rucky]

86. Maybe they didn't see the need right away?

A conscious patient refusing treatment would not point to a need for immediate trauma care. So after the first hospital examined her, they found that she did indeed need it, and transferred her.

[northernlights]

96. maybe who didn't see the need?

The resort called the ambulance at 12:43. It arrived at 1:00.
She refused treatment, so the ambulance left.
Resort staff stayed with her until she agreed to go to the hosptial.

At 3:00 they called for a 2nd ambulance. It arrived in 9 minutes. The medics found her now unstable, so spent 30 minutes stabilizing her for transport. That is necessary.

So the delay between 12:43 and 3:39 -- 2 hours and 56 minutes -- was 100% due to her refusal to take the 1st ambulance.

The drive to the 1st hospital was 40 minutes. There they treated her for 2 hours to stabilize her, before sending her to the trauma hospital.

The drive to the 2nd hospital was 1 hour.

So 1 hour and 40 minutes were lost to transport.

2 1/2 hours were lost to stabilizing her, which would not have been necessary had she gone to the hospital to begin with.

And 2 hours and 26 minutes were lost directly to her refusal of the 1st amubulance.

In other words, of the 6 hours and 40 minutes between her fall and her arrival at the trauma hospital, 5 hours were directly due to her refusing treatment to begin with.

One of the reasons was probably the nature of her injury. With obvious trauma, you can call in a medivac. But with epidural hematoma, you look fine and feel fine for one or two hours. Then when you do go down, you go down fast.

[pnwmom]

108. No, the delay because of her refusal was between 12:43 -- when they called

the first ambulance -- and 3:09 -- when the second ambulance arrived. The half hour spent in transporting her would have been spent either way. So the delay caused by her refusal was about 2.5 hours.

But that doesn't answer the question of why, when Montreal was only 45 minutes from the ski resort, they put her in an ambulance to a local hospital without a trauma center that was 40 minutes away.

[supernova]

119. It could be a cultural difference between american/british and french

EMT systems

I remember there was a similar outrage about how Diana's EMTs handled her and her companions.

They didn't take her to the ER right away. They stabilized her at that scene for over an hour (IIRC), then moved her to the nearest hospital. That is the French standard of care in emergency situations. Quebec, being of French origin, seems to have the same system.

I don't know, but it's a possibility

[northernlights]

125. She would not have needed to be stabilized

if she'd gone to the hospital with the 1st ambulance.

You are so looking for someone to blame -- 1st the resort, then the medics for taking her to the local hospital as is their protocol and all they're able to do, and now the medics who SHE REFUSED TO SEE.

She made poor choices. We all make similar choices. Most of the time we do ok. 1 in a zillion run out of luck. Just like 1 in a zillion win the lottery (which she did by accident of birth) and the rest of us just plug along.

[pnwmom]

159. I think the resort made a poor choice when they turned back the ambulance

that had come all the way there to see her.

We'll never know what the medics might have observed about her IF they had been allowed to at least speak to her. And if they spoke to her, they might have been able to convince her to allow them to examine her.

[uppityperson]

171. Prove the resort turned away the ambulance and it wasn't her refusal to be assesed.

Prove that or stop saying that. Is SHE had allowed them to assess her, they would have. Prove that the resort turned them away or stop.

[Gwendolyn]

134. Sorry to intrude again, I'll leave your thread alone after this...

But Montreal is more like an hour away, by ambulance. It's about 85 miles distance, so that's a little over an hour by regular vehicle. The first hospital she went to in Ste Agathe is about 25 minutes from the hill. Probably less by ambulance.


This might give you a better visual idea.

http://www.magnificat.ca/directions/Montreal2Mont-Tremblant.htm

[rucky]

110. I was responding to criticism about the hospital

But a related question from what you explained:

Is there a site test for epidural hematoma? kind of like a stroke test or something that could've helped the first-responders?

[northernlights]

129. no site test

because they are asymptomatic early on. They are leaking blood under the skull, but initially there is room for the blood. When you run out of room, then pressure builds and you get the initial symptoms.

Only a cat scan or mri can show you what's going on inside. Can't carry those around with you, and they require highly trained experts to operate and interpret.

Had she gone with the 1st ambulance, they likely would have held her at the hospital for observation and she would have gotten treatment from the onset of symptoms. As someone else mentioned, the symptoms are similar to concussion. But with a concussion, you have symptoms from the time of the blow, whereas with a hematoma the symptoms are delayed until the pressure starts building. So presumably they would have recognized that it wasn't a concussion and correct treatment would have been started from the get-go.

[RB TexLa]

98. How fast do people expect that type of care?

I know I wouldn't expect people to just drop everything for me.

[serrano2008]

112. With Universal Health Care she would have been airlifted to the

best doctors in the country within seconds of falling, where a team of hundreds would work on her exclusively for a minimum of 3 months, 24 hours a day.

[leftstreet]

115. LOL I wondered how long it would take n/t

[supernova]

104. They were 20 minutes from a community hosp and 1 hour fro trauma center

so I'd say Mt Tremblant is not that out in the boonies.

There are more remote ski areas to choose from. Banff comes to mind.

The initial mistake, and the tragic one, was not agreeing to go to the hosp with the first ambulance.

As to what she hit her head on? Could have been anything, a rock, a block of compacted snow that turned to ice, All of that could have been covered up by the snow. There's just no way to know.

I think the lesson here is that if you are doing something risky, and have an accident, it's better to be safe and go to the ER for no reason than to miscalculate and wind up in a bad way later. ER staff really don't mind if you come in and it turns out there's nothing wrong with you.

[backscatter712]

122. It's very hard to even know a person has this kind of injury.

99% of the time, when someone bangs his or her head, they get a lump on their head, they take an aspirin, and they're fine. Maybe they'll feel more symptoms, which is when they go in to get looked at, get diagnosed with a concussion, take it easy for a few days, and they're fine.

After Natasha hit her head, she got back up, was walking and talking, and her only symptom was a headache. How are you supposed to diagnose an epidural hematoma when the only symptom is a headache?

By the time other symptoms, like nausea, dizziness, etc. started appearing, most people would still think it's just a concussion, and you'll get better just resting and taking it easy.

And given the cost of the tools required to diagnose a subdural hematoma correctly - CT scanners and MRI machines, nobody's going to agree to scan every person that bumps their head, and slam them with thousands of dollars of hospital bills.

I'm not sure how you win this one. Natasha didn't.

[LisaL]

127. Yes it's not like every head injury leads to that kind of an outcome.

She didn't know there was anything wrong until it was too late. Frankly many people in her situation would probably refuse to see a doctor, especially if the fall wasn't too bad, and there were no symptoms initially.

[tomreedtoon]

126. Why does any idiot go skiing in the first place?

You want to slide down a dangerous slope filled with trees and rocks? Anyone who wants to ski INTENDS to die. I say let them.

[LisaL]

130. I say we should ban driving first.

[backscatter712]

138. Let's strap boards to our feet and jump off a cliff!

or...

Let's jump into 2,000 pounds of steel and glass propelled by exploding chemicals and careen around at insane speeds, hoping we don't crash into something and die in a flaming pile of twisted steel!

People do dangerous things all the time. Sometimes they do dangerous things because they're fun!

[tomreedtoon]

142. Driving gets useful stuff done. Sliding down ice does not.

The only time skiing was useful was during World War II, when Nazi troops invaded countries on skis. Ever since then it's been a way for rich people to kill themselves, and nothing else.

I would rather keep trucks that can bring food to hungry people, and get rid of the rich bastards and their ski lifts and their broken legs and their funerals.

[uppityperson]

172. Recreation isn't getting "useful stuff done"?

good grief

[tomreedtoon]

183. "Recreation" is screaming in terror before you die?

You have a pretty odd idea of recreation. You ever hear of Disney World? Lying on a nice, flat, NON-SNOW-COVERED beach and listening to the surf? Instead of the sound of the screaming cold wind and your death oncoming at 40 miles an hour?

God, you rich people who ski are so screwed up. No wonder you decided to wreck the economy before you die on a frozen hill somewhere.

[uppityperson]

185. "God, you rich people who ski are so screwed up." bwahahahahahahaha

bunch of serious assumptions you make there. FWIW I've only downhill skied once in my life, ran into a St Bernard dog and it was all too scary for me.

Now, let's talk about skydiving, or better yet, how about bicycling? No, I haven't screamed skydiving, but have sworn while bicycling. I've found skydiving much more relaxing than bicycling.

People who ski wreck the economy while those who pay for Disney World (total barf) or fly to "nice, flat, NON-SNOW-COVERED beach and listening to the surf" are....saving the economy? They are...Getting stuff done?

OMG, I almost took you seriously.

[tomreedtoon]

190. No, Disney and surf people are NOT SUICIDING.

Skiers are suicidal. You seem to have trouble accepting that basic truth of the universe. Why are you justifying suicide as a "sport" or "recreation"?

[uppityperson]

191. You keep changing the goal posts. "get things done" to "wreck the economy" to "suicidal"

funny

[tomreedtoon]

192. There is one constant factor. SKIING IS SUICIDE.

And anyone who wants to ski is suicidal. Anyone who does dangerous crap, unless they're trying to save someone's life or build something for social gain in an inaccessible place, is suicidal. Skiing, surfing, deep sea diving, hunting...they're nothing more than ways to end one's life.

Which is why, although this actress's death is tragic, I can't summon any sympathies. She wanted to die. She went skiing. Poor people step in front of oncoming trains. The rich go skiing.

Does that boil it down enough for you, Bunky?

[uppityperson]

193. bwahahahahahahaha.

so many assumptions

[tomreedtoon]

194. It's called "wisdom," Charlene.

It's something gained from a lifetime of NOT skiing, hunting, or shooting up. In other words, a life of survival, not suicide.

[uppityperson]

195. Yet I haven't died yet. It's called "experience" Velma.

It's something that is gained from a lifetime of doing things and surviving.

So many of us who ski, or sky dive, or ride bicycles here on this thread. And NONE of us have died yet, or committed suicide. Why do you think that is?

[cali]

135. most moronic post of the thread. and that's saying something.

first of all, it's obvious you know jackshit about the sport. it's not about sliding down a slope. as a skiier for over 40 years, with not a single accident, I can tell you it's a lot safer than bicycling or swimming.

idotic.

[tomreedtoon]

140. And here's the apologist for sliding down a slope.

You do not slide down mountains! You don't go up mountains in the first place, idiot, unless you're going to do something useful like put a TV transmitter or an astronomical observatory on top of the damn thing.

If you wish to risk your life doing something as stupid as skiing, your life insurance and medical coverage should be voided, and given to an intelligent member of the human race who keeps his feet on solid, un-elevated ground.

[cali]

141. on noooes. I'm an apologist for "sliding down a slope"

I pity the likes of you.

[SidDithers]

151. seconded...

as a former ski-patroller, I can say with some authority that that poster is talking out his/her ass.

Sid

[merh]

128. I think it is up to us, the ones who travel to destinations and participate

in sports, to make sure we know what hospitals are around should something happen.

I used to scuba. I would never go to any destination that didn't have a decompression chamber within a reasonable distance from the dive. I wouldn't dive with any master or dive crew that wasn't informed about what hospital emergency facilities were available, that didn't have some emergency plan.

Others have posted that this incident may be a wake up call for others, that head injuries, even if we consider them insignificant, should not be taken lightly. I agree. Also, chances are ski resorts will reevaluate their procedures and will try to implement policies that the guests cannot ignore an examination to be sure that the injuries are insignificant.

My heart goes out to her sons, her husband and family. I also feel for the ski instructor and all those at the resort who tried to help her. An untimely and tragic death - maybe good will come from it even if that good is just our own awareness.

FYI - you can sign her guest book if you like.
http://www.legacy.com/obituaries/jsonline/obituary.aspx?n=natasha-richardson&pid=125245425

[LisaL]

132. You can not force an adult to be examined against their will.

[merh]

133. You can refuse them accomadations unless they do get the

examination, you can tell them they will have to leave the resort.

[LisaL]

137. Well, most adults are assumed to be able to

make decisions for themselves.

[merh]

139. how obvious

and it is obvious that making decisions for one's self does not always equal wise decisions or even informed decisions.

This tragic death proves that, now doesn't it.

[LisaL]

143. I don't think the solution is to assume no adult can make

a wise decision for themselves.

[merh]

147. If the adult falls on the slopes and the staff is concerned about the

adult's well being, to choose to not get medical attention, to choose to not be examined is an unwise choice as this incident reflects.

It was not only unwise for the guest, but it proved to be unwise for all that loved the guest.

[LisaL]

150. Why not go further and forbid skiing altogether?

Safety first.

[merh]

152. that is silly

hundreds of folks ski without falling - for those who do fall, not all strike their head and some even wear helments.

It is possible that the blow to the head interferes with the capacity to make wise decisions, that being a novice does not afford informed decisions.

[uppityperson]

173. It is obvious that making decisions for one's self does not always equal wise decisions.

That is very tru.

[pnwmom]

162. But we're talking about an adult with a possible head injury. n/t

[northernlights]

144. how long before that puts them out of business

Given the number of spills one might expect, the number of refusals to go to the hospital, the number of people subsequently ejected with their suitcases.

Great PR, that!

[LisaL]

146. Yea exactly.

Demanding everyone sees a doctor for every fall or evicting them from a hotel isn't going to be great for business.

[pnwmom]

164. They knew this wasn't just a little spill, because they had someone accompany

her back to her hotel room who sat with her for the next couple hours. That is not normal ski resort procedure for what is perceived as a minor bump.

But they turned away the ambulance with medics before it even got there. It doesn't make sense.

[uppityperson]

174. "they turned away the ambulance with medics before it even got there."

Who is "they" and where is the proof that "they" were responsible for denying her care?

[merh]

148. What great PR it would be

To be known as the resort that puts the well being and health of their guests as top priority.

[LisaL]

149. Kicking them out doesn't sound like putting their well being and

health as top priority. Sorry.

[merh]

153. I disagree.

I think most guests will find it comforting to know that the lodge takes their safety as a priority over the dollar that would be made.

[LisaL]

180. Yep. And while the hotel is at it, they should pad all their rooms.

What if someone falls in a hallway? People don't want the hotel to be their nanny.

[merh]

181. How boring, you are like a broken record, a silly broken record

I've responded to your nonsense - here, I hate to repeat myself
http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=5291485&mesg_id=5296879

[merh]

157. I think that a mandatory helmet law for their area would be

more harmful to their tourism and ski industry than the hotels implementing a policy that the guests agree to medical evaluations if they suffer a fall that concerns the ski staff.

[pnwmom]

163. Exactly. The resorts are concerned about the PR more than the risk to the

skier.

That was the point of the article in the NYT I read years ago, about the lack of availability of good trauma care at many ski resorts -- that the ski resorts actively work to minimize the appearance of any risk, but the skiers who are injured often have problems in getting good care.

[northernlights]

165. bullshit

You are twisting my meaning and you know it.

Hotels are not in the business of dictating to their clients when they must go to a hospital, nor should they be. Nor could they make such a call legally -- that would be practicing medicine without a license. Therefore, they cannot possibly order conscious guests to go to a hospital for any reason.

If they tried evicting guests that refused to follow their medical directions, they would lose their guests pronto.
The fast majority of spills do not result in any injury at all. And resorts are neither licensed nor qualified to make medical decisions to determine which fall is likely to need further attention. They would essentially be reaching into the wallets of their guests and forcing large expenses on them. As a result, they would lose customers and be out of business in no time.

Even were resorts to hire their own medical staff, they still could not legally make that call for adults, although they can question it when children are involved.

The staff at the resort clearly did everything they were allowed to do legally, and everything they could do morally to help her. The called the ambulance as soon as she fell.

The paramedics could not legally force Natasha to submit to examination. They could not even force her to talk to them -- they had absolutely no legal standing to do so.She refused their help, as she had every legal right to do, whether you approve of it or not.

Your pathetic attempts at assigning blame to somebody, anybody, other than the victim who made the choices, are totally ludicrous.

And your pathetic attempts to turn adults into children who must be ordered around by other adults who somehow know more than they do because...why, you say so?... are equally ludicrous.

[Garbo 2004]

166. "...unlike most provinces, Quebec has no emergency helicopter system."

Quebec re-evaluates air ambulances in wake of Richardson's death
The Gazette March 20, 2009 6:02 PM

The death of actress Natasha Richardson, following a ski accident in Quebec, is raising questions about the province’s emergency medical system. The actress had to be driven in an ambulance from a hospital in Sainte-Agathe to a Montreal trauma centre because unlike most provinces, Quebec has no emergency helicopter system. The trip took about an hour while a helicopter ride would allowed her to be in Montreal in 15 minutes. Paramedics and trauma experts have been warning of the problem for years, saying it could lead to unnecessary deaths. “This is like not having a fire department in a community,� said Dr. Tarek Razek, head of the trauma team at the Montreal General Hospital.

Quebec’s chief coordinator of air-ambulance services says the provincial government wants to put in place a new helicopter service to provide quicker transport of trauma patients to hospitals in Montreal and Quebec City.

André Lizotte, air medical officer for the ministry of health, acknowledged in a telephone interview this afternoon that Quebec has no helicopter service feeding trauma centres in hospitals.

<snip>

Lizotte said Quebec is currently served by two airplane ambulance services a government-run service in eastern Quebec, and a private-contract service in the western half of the province. But these airplanes need airport landing strips and can't land right beside hospitals, like helicopters can.

In addition to ambulances, Lizotte said the government has also operated a mobile airplane hospital since 1988, in the form of a customized Challenger 601 jet. He said budgets were approved last year for two new airplanes for ambulance service, and attention is focusing now on helicopters. http://www.montrealgazette.com/Health/Quebec+reviews+ambulances+after+Richardson+death/1411161/story.html

[pnwmom]

176. That explains a lot, thanks. Maybe this well-publicized death will benefit

a lot of ordinary Quebecans, then.

[Mike 03]

175. I don't think you can force someone who does not want medical care to receive it.

Unless a policeman takes you to a psych ward under a 5150 code.

What were they supposed to do?

This was a horrendous tragedy and loss of a beautiful artist. But I don't want some fucking new laws telling me that I have to submit to doctors or go wherever they want me to go in spite of me telling them I don't want to go.

[pnwmom]

177. What were they supposed to do? I think they at least could have let

the medics who had driven all the way out there speak to her. Instead, they could only see her from a distance, sitting down on a guerney.

I think the medics shouldn't have been turned away at that point, but allowed to speak to her and ask her questions. That isn't medical care and wouldn't have been against the law. Through careful questioning, they MIGHT have been able to determine if she had any "little" symptoms she didn't think important to mention, or they MIGHT have noticed some physical sign (a dilated pupil, trembling, etc.) Then they MIGHT have been able to talk her into submitting to an exam after all.

None of this happened, of course, so we'll never know what MIGHT have happened differently.

(If this were your wife or daughter and she had refused medical attention, wouldn't you have wanted the medics who were already there to at least speak to her?)

[uppityperson]

188. Who turned them away? And yes, asking her questions is part of the assessment process of care.

Asking questions is part of the assessment process of medical care. She refused to talk with them. That was her choice at that point.

The first thing you do is look and listen. You observe, you ask questions. THEN you touch the person (unless they are actively bleeding or some such, in which case you combine observing, questioning and touching). Asking questions is part of getting care.

She refused to be assessed, physically or verbally. It was her right at that point. Going against that would be assault or harassment.

[pdxmike]

182. a doc's perspective

As someone who has some experience in this, I'd like to add my two cents.

She had an epidural hematoma. These are rarer and more dangerous than subdural hematomas. And can kill much more quickly as the cause is an arterial bleed rather than a venous bleed. They often present in exactly this manner. Often the trauma seems relatively minor. The patient is lucid and refuses care. The medical people on the slopes probably see dozens of people like her a day. Someone bangs their noggin, seem OK, and refuse care. No big deal. 99.9% of the time the skier has a slight concussion (at worst).
Natasha Richardson was just very unlucky. Why do we always look for culpability?

[pnwmom]

184. Here's the perspective of the top trauma doc in Montreal.

He says the trauma system in Montreal isn't as good as in other Canadian cities.

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=5300238&mesg_id=5300238