Once she fell, Natasha Richardson was doomed (Vanity)

[devere]

It seems that there was no neurosurgeon at the local hospital, and no medical helicopter in the entire province of Quebec, so once she fell poor Natasha was doomed, even if she had asked for immediate medical assistance. It seems almost unbelievable in the 21st century, but that's what socialized medicine brings you. Death.

[EDINVA]

Maybe you should read the original question: what is the difference between the Richardson fall/death in Canada v. the Sonny Bono/Kennedy deaths following ski accidents in the US?

The difference, as has oft been explained on this thread is that SHE fell on a bunny slope, hitting her head, and could have been treated had facilities been available, whereas the other two were on advanced slopes, going very fast, and crashed directly into trees. They never had a chance.

[Polybius]

I question this "7 hours " time frame. She had an afternoon skiing lesson and fell. 911 records show there is 2 hours between the first ambulance refusal and a call for the second. We know she was transported from the hospital at Ste-Agathe to Montreal at 5pm . An early afternoon fall , even as early as 1pm , with a 2 hour wait , doesn't make 7 hours to get her to an hospital .

With further information, it seems it was 6 hours from the time of injury.

Here is a good description of the timeline.

Doctor: Lack of medical helicopter cost Richardson ..... Montreal's top head trauma doctor said Friday that may have played a role in Richardson's death.

Two hours were wasted by the patient's initial refusal of medical care. That is definitely her fault.

Then comes the second 911 call.

When the EMT's arrived, her condition had "deteriorated" and they worked on her for half an hour. Something is obviously very wrong.

In our system, such a situation, (a deteriorating patient after head trauma) would have resulted in the EMT's calling for a helo medevav from the scene of the call directly to the Level One Trauma Center.

That is what happens with bad auto accidents in our county. We, at our local hospital, get the trauma that our surgeons can handle. The patients that we can't handle (needs neurosurgeon, etc.) are flown straight from the accident scene (the helos land on the blocked off highway) and are flown straight to Seattle.

Instead, Natasha Richardson was taken to a local hospital, (with, of course, no neurosurgical capabilities) that was a 40 mile drive away. By the time she arrived at the local hospital, one hour and 10 minutes had elapsed since the EMT's first saw her.

If a helo medevac had been called once the EMT's assessed a deteriorating patient after a head trauma, one hour and 10 minutes later, the helo would have already flown from Montreal and picked up the patient and be just about to land back in Montreal at the helo pad of the Level One Trauma Center.

As it was, a CT may not even have been available at the local hospital and neurosurgery certainly isn't. More time is then wasted deciding, "Yep. She certainly seems to be going down the tubes. Let's drive her to Montreal."

According to the director of trauma services for the McGill University Health Centre driving to Mont Tremblant from the city (Montreal) is a 2 1/2-hour trip.

According to this article's timeline, " She didn't arrive at a specialized hospital in Montreal until about four hours after the second 911 call from her hotel room at the Mont Tremblant resort."

[Polybius]

Maybe you should read the original question: what is the difference between the Richardson fall/death in Canada v. the Sonny Bono/Kennedy deaths following ski accidents in the US? The difference, as has oft been explained on this thread is that SHE fell on a bunny slope, hitting her head, and could have been treated had facilities been available, whereas the other two were on advanced slopes, going very fast, and crashed directly into trees. They never had a chance.

From this old article, it seems that Sonny Bono was already dead when the Ski Patrol found him.

Bono, an avid skier, was reported missing about 4:30 p.m. at Heavenly Ski Resort in South Lake Tahoe, California. .... A ski patrol searched the Nevada side of the mountain and found the body some two hours later.

[fanfan]

link

Danush Rudolph was skiing on Canada’s Mont Tremblant last Monday when a call went out saying the actress needed help.

The athletic blonde dashed to the spot where Ms Richardson, 45, had tumbled during a lesson with another instructor, and tried to persuade her to go to hospital immediately for medical checks.

A source close to the Canadian police said: ‘Danush is a professional. Natasha had no visible injuries, but any time you take a bad tumble there is a remote possibility that you can tear a blood vessel in the brain.

‘The protocol when you are a ski instructor is better safe than sorry.’

An ambulance arrived at the hill just 20 minutes after the fall but Ms Richardson refused even to be seen by paramedics.

Instead the mother of two insisted on returning to her £300-a-night hotel suite.

‘It was over two hours later when she finally agreed that she needed help and a second ambulance was called,’ said the source.

‘By then she was disoriented, confused and vomiting.

‘If she had listened to Danush, who grew up in the Quebec mountains and has been a ski pro for 14 years, she would have been at the local hospital, which has a CT scanner, within 30 minutes.

‘But it was nearly four hours before she got there and they discovered her brain injury.

‘They immediately sent her on to Montreal, but that’s an hour away and by the time she got there it was too late.’

At the Sacre Coeur hospital in Montreal, trauma surgeon Ronald Denis and an expert team battled in vain to save the actress.

Ms Richardson’s instructor had urged her to wear a safety helmet during the tuition.
A member of the resort staff claimed: ‘Natasha refused. We can’t force people to use helmets.’

[Snowyman]

According to the director of trauma services for the McGill University Health Centre driving to Mont Tremblant from the city (Montreal) is a 2 1/2-hour trip.

Google it or use Mapquest. If it takes 2 1/2 hour to go 76 miles, gotta be one hell of a blizzard going on or the good doctor needs to get off his bicycle and drive a car.

Highway #117 goes from Mont Tremblant to Montreal Sacre Coeur Hospital . The Centre Hostopial Luarentien where she was first taken is in Ste-Agathe-Des-Monts on #117

Mont Tremblant to Montreal Sacre Coeur Hospital .Total estimated distance, 76.3 miles

[Polybius]

According to the director of trauma services for the McGill University Health Centre driving to Mont Tremblant from the city (Montreal) is a 2 1/2-hour trip.

Google it or use Mapquest. If it takes 2 1/2 hour to go 76 miles, gotta be one hell of a blizzard going on .... Mont Tremblant to Montreal Sacre Coeur Hospital .Total estimated distance, 76.3 miles

Well, in the winter around here, some roads are in such a state that, literally, "You can't get there from here." But, I will defer to your local knowledge and stipulate that it was not a 2 1/2 hour drive.

The bottom line, however, is that the documentation shows that two hours elapsed between the injury and the second 911 call and that four hours elapsed between the second 911 call and the time she arrived at Sacre Coeur Hospital.

If those four hours were not wasted driving to Montreal, then they were wasted driving to a local hospital that had no neurosurgeon and may not have even had a CT Scanner.

If driving does not account for the four hour delay between the second 911 call and the arrival at Sacre Coeur Hospital, then the delay must be attributed to driving her to Centre Hospitalier Laurentien where all they could do was mumble:

"Yep. She certainly seems to be going down the tubes. Yep. Down the tubes, alright."

It turns out that the autopsy in New York demonstrated the cause of death to be an epidural hematoma.

That is a "no-brainer" diagnosis on CT that even the cleaning lady emptying your waste basket can see, "Hey, Doc, what's that big white thing on that picture?"

With immediate CT diagnosis and immediate transfer to a neurosurgical facility, the epidural hematoma can be evacuated.

With a delay, the epidural hematoma literally squeezes your brain to death inside the closed cavity of your skull. On the CT image, note how the hematoma on the left hand side of the image is squeezing the brain structures to the right hand side of the image.

If that incident had happened at a ski area in our county, with exactly the same geography, this would have been the radio message traffic between the EMT's and our ER.

EMT's: "We have a 45 year old female that sustained closed head trauma and is progressively deteriorating. Our ETA to your facility is 40 minutes."

ER Doc: "Okay. That is NOT good. Most likely a traumatic intracranial bleed. Hurry up. We'll cal Airlift Northwest. With 30 minutes flying time and ten minutes to scramble and unload, the Airlift Northwest flight crew should be walking through our doors at the same time you do. We'll see how she's doing and then get her on her way to Seattle ASAP."

ER Doc: "Nurse, call Airlift Northwest. I'll call the Neurosurgeon on call at Harborview.

[Dr. Luv]

As someone who has actually worked in both Canada and here at home, I don’t believe the actual medical care she would have received in the U.S. would have made an iota of difference. What they lacked in that area is a medivac helicopter - something many areas in our country also lack.

The biggest factor was to deny immediate treatment and the poor decision to not wear a helmet.

[Polybius]

The link at Post 162, quoting Montreal medical sources, documents a different time line.

Injury. First 911 call. Natasha Richardson refuses treatment.

Time from injury to second 911 call: Two hours.

Time from second 911 call to arrival at Montreal Sacre Coeur Hospital: Four hours.

[Polybius]

As someone who has actually worked in both Canada and here at home, I don’t believe the actual medical care she would have received in the U.S. would have made an iota of difference.

True.

The difference is availablity of care. A CT performed in Canada is as of high a quality as a CT performed in the U.S. The difference is that you do not wait four months to get it in the U.S. A friend of mine with a Canadian mother asked me if she could have her CT at our U.S. hospital because the CT for her mother's unexplained abdominal pain was scheduled for four months into the future.

A lot of bad things can happen in four months.

What they lacked in that area is a medivac helicopter - something many areas in our country also lack.

True. Many areas in our country, in Middle of Friggin' Nowhere County, lack a medivac helicopter system integrated into their medical care system.

But NOWHERE in the U.S. does that situation occur in areas that are located 75 miles from a U.S. major metropolitan area that is rich enough to have a MLB team but where they claim that they cannot afford a medivac helicopter system.

[fanfan]

I've been looking at many of the times lines being presented by the press, and many of them don't make sense.

The first ambulance arrived within 20 mins, so we can assume that the second one arrived within 20 mins. as well.

She is reported to have refused treatment for over two hours, which gives us about 2 hours, 40 mins. after the accident, (ATA).

The Paramedics spent about a half hour examining her, and loading her for transport, which leaves us at 3 h, and 10 m ATA.

The local hospital, which does have a CT scanner is about 30 mins away, which gets her there at about 3h 40 m ATA.

She probably spent a good half hour there before being forwarded to the Montreal Trauma center, so 4 h and 10 m have passed since ATA.

A one hour trip to Montreal gets her there around 5h and 10 m ATA.

If we go back to three hour point, ATA, and a helicopter had been summoned, she would have arrived at the Trauma Center in Montreal about 1 h and 10 m ATA. That gets her there around 4 and 10 m ATA.

Obviously, a medivac helicopter should be available, and would have gotten her to the Trama Center sooner, but it still would have been over 4 hours since her accident.

It took me about 2 mins to find the for profit medivac ambulance service available on the internet, and some one should have thought of that, but I still don't think it would have saved her.

[Polybius]

The first ambulance arrived within 20 mins, so we can assume that the second one arrived within 20 mins. as well. She is reported to have refused treatment for over two hours, which gives us about 2 hours, 40 mins. after the accident, (ATA).

The times reported by the Montreal medical sources were based on times "from the 911 call".

Time from first 911 call to second 911 call: Two hours. (Definitely Natasha Richardson's fault. She refused intial service.)

Time from second 911 call to arrival at Montreal: Four hours. (Definitely the responsibility of the Province of Quebec.)

Whatever happened in between, dictated by the fact that there was no Politically Correct helicopter medevac service (See Mrs. AV's prior post regarding the hostilty towards to private service .... EMT's are forbidden to call it even if they beieve it is needed) is therefore an interesting, but fruitless specualtive excersise.

A helicopter medevac called out at the time of the second 911 call would have flown from Montreal, to the scene, and then back in about one hour an 15 minutes, round trip, at the most.

Closed head trauma .... Deteriorating ..... Get her outta there and to a neurosurgeon! Now!

Could she have been saved three hours and 15 minutes after the injury?

Maybe yes, maybe no.

Could she have been saved 6 hours after the injury?

Now you are really pushing it (no pun intended).

(See Post 166)

[fanfan]

What I'm saying is that the details of that Yahoo story are likely incorrect.

The 911 call times might be right, but not the result.
There is no way it could have taken them 4-6 hours to get her to Montreal , after she knew she was in trouble.
It is not a 2 1/2 hour trip from Mont Tremblant to Montreal. It's closer to an hour and 15 mins., 1:25 at most in an ambulance.
Yes, they stopped at a clinic that had a CT scanner, that was ON the way down the HWY towards Montreal.

I am suggesting she was past the point of no return before she even left the resort.

[Snowyman]

I am suggesting she was past the point of no return before she even left the resort.

All I know is she delayed her own treatment by at least 2 hours. When she did seek help the so called "golden hour "was gone and she had a CT scan and suffered a stroke before she left the Centre Hospitalier Laurentien for Montreal. That was reported in several papers .

What I find ironic is at no time did the Quebec health care system fail to respond in a timely manner, in what many would regard as a wilderness location , yet is regarded by some as the demon here . Because Quebec had no helicopter.

What happened to being responsible for yourself and your actions . Perhaps we truly surrounded by closet socialists .

[fanfan]

What happened to being responsible for yourself and your actions . Perhaps we truly surrounded by closet socialists .

Good point. I couldn't figure out why I was compelled to reply to this thread and others like it, but you nailed it.

All the posters bashing Canada are saying that a government funded Medivac helicopter would have saved her.

I've noticed some FReepers being sort of "touchy" lately, and I can't say I blame them. Everything the FReedom lovers stand for is being torn from them, right before their eyes, and the rage must be overwhelming. :-(

When Canada seems to be a freer country, hearts break. Including mine.

[Polybius]

All I know is she delayed her own treatment by at least 2 hours. When she did seek help the so called "golden hour "was gone and she had a CT scan and suffered a stroke before she left the Centre Hospitalier Laurentien for Montreal. That was reported in several papers .

The "Golden Hour" is a "Get Your @ss Moving" theoretical concept that is not engraved in stone. You are not automically saved if you get to surgery at 30 minutes or automatically domed if you get to surgery at 3 hours. It depends on the injury.

Over the years, I have lost count of how many intracranial bleeds with mass effect with injuries more than one or two or several hours or even days old I have seen and we have helicoptered out to neurosugery in Seattle.

VOLUME of blood and VOLUME of edema inside the non-expandable skull, not TIME determines how much pressure the brain is under.

In Richradson's case, maybe the outcome would have been the same. For thousands of Quebecois over the decades who were never famous enough to get worldwide media atention when they arrived at Montreal D.O.A., a helo might have been the difference betwen life and death.

So, she did something stupid. Absolutely true. Guess what? Patients do all sorts of incredibly stupid things to injure themselves. That's part of medicine.

What I find ironic is at no time did the Quebec health care system fail to respond in a timely manner,

The demon is not the health care providers. The demons are the Province of Quebec bean-counters that deprived them of a basic tool of First World medicine in an area 75 miles away from a major metropolitan area large enough to support a MLB team.

... in what many would regard as a wilderness location , yet is regarded by some as the demon here.

Ummm ... That's the whole point of helicopters.

Helicopters don't deal with "wilderness". They fly over forests and 2,900 feet elevation foothills and lakes and rivers just as easily as they fly over downtown Montreal at rush hour.

Because Quebec had no helicopter.

Again, the fault of the political bean counters and not the health care providers.

The head of trauma at McGill University Health Centre was screaming bloody murder about the lack of helos in Montreal.

"This is like not having a fire department in a community," said Dr. Tarek Razek, head of the trauma team at the McGill University Health Centre. .... Timeliness is crucial after major head traumas, he stressed. .... "You need to get to a trauma centre fast, and the faster we can organize that, the more likely you are to live," he said. .... He stressed that Quebec is one of the few jurisdictions in North American and Europe that don't have emergency medevac helicopters. ..... even the smaller province of Nova Scotia has this service.

What happened to being responsible for yourself and your actions . Perhaps we truly surrounded by closet socialists .

There is no doubt that Natasha Richardson contributed to a bad outcome. But, as I said, patients do all sorts of stupid things to get themselves into trouble. That does not excuse the fact that a Hospital District would therefore decide to replace expensive motorized Aid Cars with horse drawn Aid Cars to save money because, in their Hospital District, everybody is really stupid.

For a major metropolitan area in the First World to forgo a helicopter medevac system in order to save money in the year 2009 A.D. is as irresponsible as a major metropolitan area in the First World to forgo motorized ambulances in favor of horse drawn ambulances in the year 1949 A.D.

[Atomic Vomit]

You Canadians are well-versed in your defense of your health-care system. This was a system problem. The system let down a critically injured woman by not having a critical component of an emergency healthcare system that could have given her a chance at survival. In a world class city, no less. It’s shocking, really.

She bears some responsibility for her own actions, absolutely. Does she bear the ultimate responsibility for her own death? I don’t know the answer to that, I don’t think I have enough information to make a fair judgement.

I have worked with many fine Canadian nurses over my career and count more than a few as friends. Your system is made up of many fine people who have the good of the patient at heart. The fact remains though, the system itself is a cold unfeeling monster bureaucracy that cares not one iota about the individual. That’s the problem with centralized control.
It’s just a shame no one gave her and her family the option
of air transport when it could have done her some good. The paramedics are prohibited from calling private transport services and I assume physicians are too. The family may have been unaware of this difference - such a thing would not be tolerated here. So, she died.

Mrs AV

[fanfan]

We agree that medivac helicopter would/could be helpful.

Other than that, why are you so seemingly angry?

[Snowyman]

That does not excuse the fact that a Hospital District would therefore decide to replace expensive motorized Aid Cars with horse drawn Aid Cars to save money because, in their Hospital District, everybody is really stupid

I don't quite follow that statement . However , we know the Quebec government has been looking at the issue and one would suppose the availability of helicopter evacuation from other areas has been a problem. Or maybe it hasn't . We don't know.

Ottawa , for example is 100 miles by road , less by air , from Mont Tremblant , and they do have helicopters. Unfortunately Ottawa is in Ontario and I don't know how much cooperation there is between the two health systems.

Hind sight is wonderful.

[fanfan]

It’s just a shame no one gave her and her family the option of air transport when it could have done her some good. The paramedics are prohibited from calling private transport services and I assume physicians are too. The family may have been unaware of this difference - such a thing would not be tolerated here. So, she died.

The option of air transport was available if someone had googled to find it. Google is not rocket science.

I am not defending the Quebec health care system in any way.

[Snowyman]

She bears some responsibility for her own actions,

Some? She bears all the responsibility of her actions. She refused to wear a helmet and she refused help that was right in front of her.

She refused protection and when she hurt herself she refused help.

The fact the Quebec Government didn't have a helicopter , as unfortunate as that is, had nothing to do with her death.

The last time I made a mistake I corrected it myself. I never expect or depend on any government to bailed me out.

The fact remains though, the system itself is a cold unfeeling monster bureaucracy that cares not one iota about the individual.

And the US style of health care does?