Top trauma doc re: Richardson death: Montreal's "system isn't set up for traumas"

[pnwmom]

http://www.huffingtonpost.com/2009/03/20/kin-friends-gather-for-ri_n_177517.html

SNIP

Montreal's top head trauma doctor said Friday that the lack of medical helicopters in the province of Quebec may have played a role in Richardson's death.

"It's impossible for me to comment specifically about her case, but what I could say is ... driving to Mont Tremblant from the city (Montreal) is a 2 1/2-hour trip, and the closest trauma center is in the city. Our system isn't set up for traumas and doesn't match what's available in other Canadian cities, let alone in the States," said Tarek Razek, director of trauma services for the McGill University Health Centre, which represents six of Montreal's hospitals.

Being driven by ambulance to two separate hospitals, rather than airlifted by helicopter directly to a trauma center, could have cost Richardson crucial moments, he said.

SNIP

[havocmom]

1. Driven to hospital after NOT GOING for a few hours

Let us not forget that part.

[pnwmom]

6. This doctor knows that, and he's the head of trauma for Montreal.

I think he offers an educated point of view.

Hopefully, this tragedy will lead in the long run to better trauma care for Quebec.

[havocmom]

81. Thinkin you missed my point

Sometimes, TIME makes a lot of difference. She delayed because she was not too disturbed initially. Sometimes too much damage to be reversed happens BEFORE person goes for care. Sometimes the answer is 'nothing we can do', no matter who or how good a doctor is.

[pnwmom]

120. The head of the trauma system in Montreal says that critical moments

might have been lost in those final hours before she arrived at the trauma center, due to their inability to put her on a medivac.

But you're sure that because there was an initial delay of 2.5 hours before the second ambulance arrived, that it wouldn't have made a difference if a helicopter could have then flown her to Montreal in 15 minutes as opposed to 4 or more hours.

I wonder if you'd be that sure if it was your daughter or spouse.

[uppityperson]

128. And it is REALLY too bad that she refused treatment at first. Seriously too bad.

[pnwmom]

130. Of course it is. And the worst part is, she might have been trying

to be extra brave because her young son was with her.

[uppityperson]

155. I don't know her personally and can't have an opinion on that.

It will be a good reminder for all to go get seen when you have a head injury. What with how long it takes to get through the ER, you might have time to have issues while you are there.

[tonysam]

98. The Richardson Case Has NOTHING to do With "Trauma Care."

Richardson made the choice not to get immediate medical attention. That has never been disputed, and because she didn't get immediate attention, she got worse and died.

Blaming others because somebody made a bad choice does nobody any good.

[pnwmom]

119. The head trauma doc of the trauma system in Montreal disagrees with you.

He says there might have been a different outcome if she had been helicoptered into Montreal.

[nadinbrzezinski]

154. two points

1.- she refused the initial care... it is the MEDICS who request the helo, not the patient

2.- KNowing how the game is played... every time you have VIP die in your system, you use that tragedy to point to real or perceived failures

Yes, call me a cynic, but that's how the funding game is played

What you're seeing there is a dash of medical knowledge, with quite a bit of system politics

I know... seen this game played

[crim son]

2. Don't want to hear this.

Fuck. She might have had a chance? Fuck.

[dflprincess]

4. That's the hardest thing with an accidental death

there are way too many "if onlys".

As hard as it was when my dad died, it was a heart attack and it was fast and I just had to accept it as the way things were. (It was also 1965 so even if he'd been able to get to a hospital what they knew about sick hearts and how to treat them back then could have been written on the head of a pin.)

[pnwmom]

12. And the worst "if only" in this case

her mother was quoted as saying that she didn't even know why she'd gone skiing -- that Natasha didn't even like to ski.

Assuming that she went for the son who accompanied her, what a terrible loss for him.

[northernlights]

84. huge grain of salt

My mother often declared that ham is my favorite meal. It is not. It never has been. I never said it was. I corrected her repeatedly. It mattered not. She decided what my favorite food was, period, end of story.

The fact is, people lie. Mother's lie, to themselves and to others. And sometimes children lie to their mothers, sometimes just to get them to stfu.

Maybe she didn't like to ski and maybe she did. We don't know that for a fact. Maybe she told her mother she didn't like to ski or maybe her mother imagined it. Maybe she told her mother she didn't like to ski just to get her mother to stfu about how dangerous skiing is. We don't know that. All we really know about their relationship is that she chose to live on a different continent from her mother. In the world of psychology and social workers, that can mean a lot. Or not.

We do know that she took a skiing lesson, chose not to wear a helmet (with one or both son's watching, to boot), refused an ambulance, and died as a result.

It is very, very sad because it was very preventable. But we all make bad choices sometimes, and sometimes they catch up with us.

[northernlights]

82. she might have had a better chance

if she'd gone with the first ambulance.

The drive was a couple hours.

But her choice not to go lost 2 hours to waiting and another 2 hours+ hours to stabilizing her for transport.

Not to say that having medivac available would be a good thing, because you'd think for a region that populous they would. And in that case maybe her disastrous choice not to take the first ambulance could have been rectified.

But people also have to make responsible decisions around things like helmets and things like getting checked out when the resort staff advises it and calls an ambulance for you.

[DaLittle Kitty]

113. Seemingly Innocuous Appearing Circumstances Can And Do Have Tragic Consequences!

DaLittle Kitty (1000+ posts) Sat Mar-21-09 02:08 PM


by DaLittle Kitty
I can picture the Bunny Hill incident... Considerable force can be generated if the skis went out from under Ms Richardson generating rotational force as she fell back something like the forces involved in a golf swing only with the end result she strikes the back of her head.

To my understanding she was not knocked unconscious. The problem is there are many times delays in an injury "declaring" itself... That is why we have a trauma system... but even still she was not being observed or questioned by professionals... so the delays mounted all the while the pressures were building in the closed compartment of her skull... Whomever Blocked the EMS From Questioning Her!!! :think:

By the time she reached the hospital she apparently was not taken to a hospital w/ neuro-surgical capabilities and therefore was not in a place where the pressure could be relieved and her brain function saved. This can happen anywhere... that is why we have trauma centers so that we minimize the potential for patients w/ injuries requiring specialized care do not end up going to the WRONG hospital with the subsequent loss of precious time that can and will result in negative outcomes.

Head injuries from such circumstances should initially be directed as a matter of mandatory policy to hospitals w/ neuro-surgical capability and helmets should be worn by participants!

:nuke: To the MORONS that would say that this is the stinking socialist Canadian system... In this respect the Canadian and U.S. health care systems are identical. The exact same thing can and does happen here... It is the decision as to which hospital the patient is taken to and how much time elapses from the incident and presentation to a tertiary care center with the appropriate spectrum of medical services... Neuro-Surgery in this case!

Trauma helicopters obviously are a big time saver... Their availability saves lives and is consistent with delivering critical patients from accidents, strokes and heart attacks to the critical services that these patients require. There are specific criteria that are standard for employing air transport. Natasha's initial presentation as reported thus far in the press does not point out details that indicate at least initially after her accident the parameters being met for air transport even if it was available? Precious time was lost, but that is often the nature of these injuries... That is why there are tragic outcomes such as that of Ms Richardson.

[Critters2]

3. I lost a cousin to a similar accident at Christmastime.

My cousin's husband, actually. He fell off a ladder and hit his head. Perfectly healthy before that. He felt fine for about an hour afterwards, but then began to vomit. She feared it was a concussion, and got him to an ER 20 minutes away. He was unconscious by the time they got there. He never woke up, was in intensive care for 5 days before dying. He got good care, as quickly as anyone could've known he needed it. He still died.

I really think the end result would've been the same with Natasha Richardson, regardless of the care she received. I feel terrible for her family, and I don't think there's anything to be gained by asking what might have been done differently. Having been touched by a similar situation, I only hope that something good comes of this--so others don't have to go through this.

[Baby Snooks]

35. Reality...

Natasha Richardson assumed she was fine as many people do after a fall and a "bump on the head" and that is what killed her.

The real legacy of Natasha Richardson will be the reminder that assuming everything is fine is the one assumption we should never make.

[pnwmom]

39. The real "reality" is that we don't know whether she might have survived

if the medics had been allowed to speak with her, and/or if there had been a helicopter available to take a 15 minute flight to the trauma center in Montreal.

[MilesColtrane]

74. Chances are when the first responders got there...

...there were no outward symptoms indicating a hematoma. So, seeing them probably wouldn't have made a difference.

She didn't report feeling unwell until at least an hour later. There wouldn't be any indication by looking at her pupils while she was still on the slope because the rate of hemorrhage was slow and just beginning.

I'm beginning to doubt that the first hospital she was taken to had a CT scanner.

Surely, if they had done a cat scan on her there they would have found the bleeding and operated immediately to relieve the pressure.

[northernlights]

85. THE MEDICS WERE ALLOWED TO SPEAK TO HER

You just keep trying to make it the resort's fault.

SHE REFUSED TO SEE THE MEDICS. Nobody prevented them from speaking to her...except her.

Seriously, what happened to your friend's son is very sad. But you need to stop trying lying in order to blame resorts on the bad choices made by an adult. SHE REFUSED TO SEE THE MEDICS. NOBODY PREVENTED HER FROM SEEING THEM.

[bottomtheweaver]

99. Can you link to a report of this conversation?

Thanks.

[bottomtheweaver]

107. '"They never saw the patient," said Mr. Coderre,

whose company, Ambulances Radisson, serves Mont Tremblant. "So they turned around."'

http://www.theglobeandmail.com/servlet/story/RTGAM.20090318.wrichardsontremblant0318/BNStory/Front

According to the owner of the ambulance company, they didn't speak to her.

[uppityperson]

125. after she told someone to tell them to go away.

"Aha!" he proclaims. "At last! Someone says 'someone' told them to go away! See! It WASN'T Richardson who told them!"

She told whomever that no, she did not want to be seen. They passed on her wishes to the medics. She had the right to refuse to speak directly with them, to refuse treatment. Which she did. If they had gone ahead and accosted her, it would have been illegal.

[nadinbrzezinski]

90. SHE SIGNED AN AMA

that is Against Medical Advise

Read the story, EMS crew evaluated and was rebuffed on the first try to take her to a hospital

(and it happens more often than people think)

[bottomtheweaver]

97. Can you link to the AMA she signed?

Thanks.

[uppityperson]

105. No. HIPAA rules.

Until she releases her med records to public view, they are private. If anyone else released them without her permission, they would be breaking the law.

[bottomtheweaver]

106. Then we don't know if she signed such a doc. n/t

[uppityperson]

129. I was wrong. This was Canada. I don't know what privacy laws they have.

Here is another article for you. She refused to see the medics. She did not have to tell them directly, but to express her refusal through someone else. Then, when she was showing signs, they were able to see her beyond her refusal and not have it be assault.

You may disagree with the law, but that is what it is. As an adult, you have the legal right to refuse, barring some circumstances, which she didn't fit at first. Once she was showing signs, then they could see her. Legally, this is how it is.

http://www.people.com/people/package/article/0,,20266545_20267163,00.html

Minutes later, their dispatcher called them and said they were free to go because the actress had refused treatment.
(clip)

"The protocol in these situations is that the person is told that she would be wise to seek medical attention but she always has the right to refuse," said Coderre. "The only time a person can be overruled is if she is thought to be under the influence of drugs or alcohol or if she is showing visible signs of head trauma and seems to be intellectually incapacitated in some way." Skiers are asked to sign a document if they refuse medical treatment. "They'd never let her go without her signing it," said Coderre of Richardson.

Richardson left the clinic still accompanied by her ski instructor and returned to her suite at the nearby luxury hotel where she was staying. Once there, her condition began to deteriorate. "She came back to the hotel and the instructor was right with her and took her to the room," a source tells PEOPLE.

"The instructor called the general manager and said Richardson had a headache and she was not feeling well. The GM went to see her and said she was going to call an ambulance. Richardson said she didn’t need an ambulance or a doctor – and the GM insisted that an ambulance come and get her."

Another call was placed from the hotel to the paramedics at about 3 p.m. and an ambulance arrived nine minutes later, according to Yves Coderre. He says Richardson was still lucid and coherent when she spoke to paramedics, but her condition had worsened and there were signs she might be in danger.
(clip)
Witnesses agree that Richardson herself repeatedly declined to be taken to a hospital.

[nadinbrzezinski]

137. AMA is the same in the US and Mexico as well

some places, this one, it is verbal, others you have to sign

In TJ we implemented the policy of signing our EMS report, mostly for CYA from American tourists

She refused, she's free to do such

[nadinbrzezinski]

138. In the states you could not, HIPAA

in canada you could not either, privacy concerns

And if you asked for the same in Mexico, you'd need a warrant from law enforcement

I just happen to be informed on this since I did work in the field

And yes, I had many a patient sign what essentially is CYA for the medics

Read the news stories... she refused seeing the medics... the AMA is heavily implied

[bottomtheweaver]

142. The medics did NOT speak to her and there is NO record of any "AMA."

No further questions, but thanks tons. :hi:

[nadinbrzezinski]

143. She said she didn't want to see them

what do you think that is?

Translation, AMA

VERBAL AMA

I am sure this was heavily documented in both their run record, and dispatch

Oh and free clue, don't expect a link, YOU OR I are NOT persons of interest

AMA is heavily implied in every NEWS story... she said she didn't want to see the medics... that is HER RIGHT as an ADULT, and you have the same right by the way

I will have to ask, you EVER did this in the field?

Because I know you are assuming much

[bottomtheweaver]

144. Still waiting for a link to that conversation. n/t

[nadinbrzezinski]

145. You won't get it, what part of you are not a person of interest

translation, the family, EMS authorities, dispatch and for procedure law enforcement, are you missing? (Yes law enforcement does do an investigation when a patient dies at times... not all the time, but they may... see autopsy report)

You want what nobody LEGALLY can provide you

GET IT NOW?

Those of us who've worked in the field didn't need the translation, apparently you do

By the way, for your sake, and that of your doctors, learn what implied consent means, and what informed consent means

As well as how you give them. And chiefly when... as well as the meaning of against medical advise

[uppityperson]

148. Incredible, isn't it?

"but I wanna know" really isn't good enough to get the info. There are privacy laws. Some people are incredible. thanks nadin

[nadinbrzezinski]

150. You welcome and the part that is even more amazing

is that it does not matter how many times this is explained to them

I dealt with this legally for ten years... and ONCE in my whole career we assumed implied with a patient that could answer twenty questions

It was also a head injury... and there was a personality shift

Patient didn't want to go to the hospital, but the family told us... he's not acting nornal... we transported against his will... all the time being told about the lawsuit to come

He fought all the way to the hospital... they did a cat scan, after the docs talked him into it... subdural hematoma

We were on the damn edge legally, right on the knife's edge

[uppityperson]

147. Refusing medical help when they want to see her is "against medical advice". Here's link

This is to another reply in this topic, includes link to article and such.

"Skiers are asked to sign a document if they refuse medical treatment. "They'd never let her go without her signing it," said Coderre of Richardson. "

Medics "we are here to see her"
"I don't want to see them, tell them to go away"
"She doesn't want to see you, go away."
http://www.democraticunderground.com/discuss/duboard.php?az=post&forum=389&topic_id=5300238&mesg_id=5305626

[nadinbrzezinski]

151. There, he did sign an AMA

thanks

[Mind_your_head]

5. Yeah, it's not likely that there would be a trauma center

out in a remote location (that's part of the 'chance' you take). ALSO, refusing treatment (or a let's examine you, just in case).....wasn't accepted. She 'wrongly' played the "tough guy" (as many of us would) .... and it 'cost her the ultimate'. I don't see how this is any disparagement upon the Canadian healthcare system, though....not at all!

[aquart]

7. But if it makes them rethink some procedures.........hey.

Yes, it will be annoying if the new protocol is not to accept the patient's "I'm fine, I tell you, I'm fine!" and do the tests anyway...and maybe expensive...

But some extra trauma training won't hurt anyone.

[pnwmom]

9. I agree. And at least they didn't have to send the first ambulance back without

even having the medics speak to her!

If they had questioned her, they might have been able to recognize subtle symptoms that she, in her rattled condition, was hardly noticing. And they might have been more successful than the resort people in talking her into going for tests.

But we'll never know.

[Mind_your_head]

14. I agree with you in a way, but you can't FORCE someone

to undergo treatment/observation.

I suppose health professionals can explain the benefits/risks of foregoing treatment/observation.....but that trusts their diplomacy skills.....and some are better than others at that (I've met some very savvy EMP's ~ Emergency Medical Professionals ~ happy to say).

[pnwmom]

16. But the medic wouldn't have been breaking any law if s/he had questioned

Richardson about any symptom she was having, and if s/he had then tried to talk her into being examined.

It was a mistake, in my opinion, for the resort to send the medics back without being able to speak to her. (According to one report, they could view her from a distance, sitting on a guerney. But even after making that drive, they were sent back without actually observing or speaking to her.)

It's true that some medics would be better at this than others -- but they weren't even given a chance, so we'll never know if it would have made a difference.

But if it were one of my family members, I'd want them to see a medic -- not to have the resort turn the ambulance back without even seeing the injured person.

[uppityperson]

38. Where do you get "have the resort turn the ambulance back without even seeing the injured person"?

you keep writing that and I haven't seen anything on the news that says they did this. She refused to be seen, as was her legal right. They then had no right to talk with her.

Who sent them away, beyond Richardson? You keep saying "them" and "the resort" but I would like to see a link to a reputable source.

[bottomtheweaver]

40. Do you know exactly who sent them away?

I don't. But the reports said they didn't see Richardson so apparently it wasn't her.

[uppityperson]

46. If she denied medical help, they may not have gotten to see her.

It was her choice, at that point, whether or not to talk with them. If she said "no, I don't want to talk with them", then they had to go away. She denied medical help. It was her choice. Whomever passed that on to the medics was acting as she told them to.

If they had forced themselves on her, it would have been assault. She said "no", they did not get to assess her.

[bottomtheweaver]

48. She said no to whom, and who exactly conveyed this message?

That's what I'd like to know. Also, has anyone actually seen this waiver she's supposed to have signed, and if so, when is she supposed to have signed it?

[uppityperson]

52. Well, I'm in WA so I haven't seen it.

[bottomtheweaver]

54. Neither have I, so it looks like it's unanimous.

Seriously, have you seen any mention in a published account of such a doc, or just speculation here?

[pnwmom]

41. It's all over the place. For example:

http://www.nypost.com/seven/03202009/news/nationalnews/vanessa_redgrave_sang_lullaby_to_a_dying_160510.htm

SNIP

The first paramedics to arrive were turned away after Richardson declined treatment - though those same medics reported seeing the 45-year-old actress briefly from a distance sitting on a stretcher, according to ambulance dispatch records obtained by The New York Times, and not laughing and walking off her fall as a resort spokeswoman had said.

The discrepancy introduces new questions about whether Richardson, who suffered from an accumulation of blood between the brain and the skull, could have been saved had she been treated faster.

SNIP

____________________________________________________________

As to your other point, she declined medical treatment, but that wouldn't prevent the medics from speaking with her. Legally, just speaking with her isn't treatment. And if they had done so they might have noticed symptoms that she hadn't and they MIGHT have been able to persuade her to agree to an examination. But we'll never know.

[bottomtheweaver]

42. And: "They never saw the patient," said Mr. Coderre,

whose company, Ambulances Radisson, serves Mont Tremblant. "So they turned around."

http://www.theglobeandmail.com/servlet/story/RTGAM.20090318.wrichardsontremblant0318/BNStory/Front

I'd be very interested in knowing exactly who sent them away before they could see the patient. I know this isn't your take but mine is that the whole thing stinks, starting with why she was there in the first place.

[pnwmom]

45. I expect it will come out eventually. n/t

[uppityperson]

60. "At that point, the wounded actress refused medical attention, he said. "

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

[bottomtheweaver]

62. He also said "'They never saw the patient,'" so who spoke to them?

http://www.theglobeandmail.com/servlet/story/RTGAM.20090318.wrichardsontremblant0318/BNStory/Front

[uppityperson]

65. Or maybe the Rods.

[bottomtheweaver]

72. Not to be unduly pessimistic,

but this reminds me of nothing so much as the "confusion" surrounding the death of Pat Tillman.

[uppityperson]

88. If Rods or Orbes were involved, it does get "confusing".Or do you mean was murdered by "friends"?

[bottomtheweaver]

94. Didn't you ever watch Mission Impossible?

How about Get Smart? Or do I have to spell out everything for you,,

[uppityperson]

100. I don't read minds. The Rods won't let me do that.

[bottomtheweaver]

102. This might be a good time

to see how far you are the nearest level 1 trauma center.

[uppityperson]

103. No Worries! The Rods and teh Orbes, they comfort me.

They lay down beside me and probe me. They bring Me CofFeeE

[bottomtheweaver]

108. I understand.

Have you tried bowling?

[uppityperson]

111. “Thy staff and rod, they comfort me.”

Orbes are balls. Rods are pINS!!!! OMG, it is allcoming TOGether nOW111

[uppityperson]

43. She denied treatment so of course they left. Where does it say the resort

denied them access to her OR sent them away.

She said no medical treatment, the first part of which is assessment. So no, the paramedics did not get to even talk with her since she had said no.

If she had allowed them to assess her, perhaps she might not have died now. Perhaps not. But I still don't see where "the resort" sent them away except maybe after having her say "go away".

[bottomtheweaver]

44. Who told them to leave? She didn't.

Don't you see the problem here?

[uppityperson]

47. She did.

Hey, the medics are here!

I don't want to see them, tell them to go away.



Whomever then talked directly to the medics is not the problem. It was her choice.

[bottomtheweaver]

49. No, she didn't. She didn't speak to them.

So who told them to leave?

[pnwmom]

51. The medics were not obligated to stay away from her even if your scenario

were true. The discussion should have been between the medics and Richardson and/or her legal representative -- not some resort person. No one should have put himself between her and the medics, even if that appeared to have been what she wanted.

[uppityperson]

55. They were obligated to stay away from her once she said no treatment.

Against Medical Advice (AMA) is a really hard thing to accept, but it happens. As a legal adult, she had the right to refuse treatment, which she did. They had no right to approach her once they were notified of her decision.

[pnwmom]

63. She didn't tell THEM. No one at the resort was legally entitled to speak for her.

Her husband wasn't there, and there is no reason to think anyone else was who could have intervened.

They had every right to speak with her unless and until she herself told them not to.

[uppityperson]

64. Maybe the Orbes did it.

[pnwmom]

73. You lost me.

:shrug:

[northernlights]

86. bullshit

Nobody has a "right" to speak to an adult if they choose not to speak to them.

Now, where is that ignore button? Your continuous attempts to blame the resort with thread after thread full of empty claims is simply ridiculous...

[uppityperson]

87. Thank you. Take over, please.

When I get to the point of offering Orbes, I am done.

[bottomtheweaver]

96. Get well soon. n/t

[pnwmom]

50. She didn't speak to them so SHE didn't turn them away. That's all we really know.

It would have been perfectly legal for them to approach her, but someone -- not she -- turned them back. There is no evidence that she told them not to speak to her -- they weren't ever close enough for that to happen. And no one in the resort is her legal go-between.

[uppityperson]

53. She said no medical treatment. She did turn them away.

As for who passed on her message, you keep saying the resort did and I don't think you really know that.

[bottomtheweaver]

56. You're inventing a part of the story that's missing.

No problem, humans do, but it's still missing, and it happens to be important.

[uppityperson]

57. what, that she said no treatment? That she said no to the medics?

Are you seriously saying that she wanted to be seen and "someone" stopped the medics?
http://www.theglobeandmail.com/servlet/story/RTGAM.20090319.wrichardsonhours0319/BNStory/National/home

"At that point, the wounded actress refused medical attention, he said. "

[bottomtheweaver]

58. She did not say no to the medics, because she did not speak to them.

So who did? Can't you see why this matters?

[uppityperson]

59. Try this link. Who conveyed her refusal is not important. That she refused is.

http://www.theglobeandmail.com/servlet/story/RTGAM.20090319.wrichardsonhours0319/BNStory/National/home
"At that point, the wounded actress refused medical attention, he said. "

[bottomtheweaver]

61. That's the owner of the ambulance company.

She obviously didn't speak to him either, and he wasn't there. And not that he says, as in the earlier account, that the medics didn't speak to Richardson, so it wasn't her who sent them away. So who did?

[pnwmom]

66. That's where you're wrong. Who conveyed her refusal is very important.

No one at the resort was legally delegated to intervene on her behalf. She should have conveyed her refusal directly to the medics.

[uppityperson]

67. Everyone has an opinion.

[pnwmom]

70. delete (dupe)

[pnwmom]

71. The likelihood is that it was some resort employee, don't you think?

If I were that person, I would be regretting that I listened to a woman who turned out to have a serious brain injury, and that I told the medics that they didn't need to speak to her. And I would be asking the resort if I were covered under their liability policy.

Just imagine if you had an adult daughter with a head injury, and found out that a medic was RIGHT THERE and that SOMEONE -- someone totally unconnected with your family, who didn't know your daughter, who wasn't her legal representative -- prevented that medic from approaching her . . . . when time was of the essence. Are you sure you wouldn't be thinking: what gave this stranger the right to intervene on behalf of your brain-injured daughter?

Suppose Natasha did say something like: "tell them I don't need them."

The best answer would have been "they're already here, Ms. Richardson, so please tell them yourself."

And if she said, "no, really."

They should have said, "you can tell them that." And then stepped away and motioned for the medics.

[MillieJo]

83. The only person with her was her son, a child who then

had to watch it all happen... He will know, if he can ever talk about it what happened.
You are right, they should have spoken to her, they should have been able to satisfy themselves that they could
leave, they didn't know if she was in a condition to say no to medics or it was the injury talking.
If they had over stepped the mark and it had saved her life, nobody would have blamed them. Now there is blame everywhere,
most of which is aimed at Natasha...

[pnwmom]

68. Who else would it have been other than the resort? Her husband wasn't there.

Her lawyer wasn't there. No one else would have been legally authorized to speak for her.

[bottomtheweaver]

69. I hope her family pursues this.

Something is very wrong.

[uppityperson]

156. What? that she was seen by first responders and refused further care?

That she was seen by the first responders/ski patrol and refused further care, as was her legal right? That someone didn't force her to have more help when legally she was capable of refusing?

[pnwmom]

8. The top trauma doctor in Montreal is pointing out that their system is lacking

compared to other Canadian cities. He isn't criticizing Canadian healthcare, he's criticizing Montreal's trauma care system. I hope they listen to him.

We don't know that she was playing the tough guy. Having a brain injury -- as we now know she had -- makes it difficult for you to think clearly, much less render competent medical judgments. If only her husband or another caring adult had been there to advocate for her, instead of her poor young son. Think about it -- if she was acting for anybody, it may have been to keep her son from being upset.

[MillieJo]

95. Yes... She went Ski=ing to spent time with her son..

She was have a few quality days with him, doing something she didn't much enjoy maybe because he did...Maybe he had begged to
be taken skiing..If she refused to complain, I am sure it was because she didn't want to ruin her son's day..not to be difficult..
Most of us bump our heads on cupboard doors, get hit by a tennis ball etc and don't give much thought after the inital pain, I am sure she thought this was no different... A medic however might have picked up information, just by talking to her, might have noticed vital signs that something wasn't right, they needed to do nothing more that let her tell them she didn't need them, in person. They might of persuaded her to let them check her out, if they have not been told be someone that wasn't her that she wasn't needed..They must of known in a place like that time was especially precious, how far away a CT scanner was...
Who would have complained about "assault" if that conversation, that chance to assess her even without touching her had saved her life?

[Jennicut]

10. I think the lesson here is if you fall and hit your head seek medical attention no matter what

Do not shake it off...you just never know.

[pnwmom]

11. Yes, we could all learn to be more cautious about head injuries.

Another risk is in sports -- when a boy is taken out of a football game because of a blow to the head, he shouldn't be sent back in until he's been given a go-ahead by a doctor.

But in this particular case, I read another doctor saying that if there had been a helicopter, it could have gotten her from the resort to the trauma center in only 15 minutes -- which could have made all the difference, even after her initial delay. As it was, several hours passed between her arriving at the first and second hospitals.

[Jennicut]

13. Boys in sports...they are forced many times to just suck it up.

Very dangerous.

[pnwmom]

15. When my son was only in 4th grade, I called the coach about canceling

a soccer game because of a lightning storm (centered very close) -- he refused to cancel. Thunder storms are rare enough around here that he thought I was being a wuss. He said no one ever gets hit by lighting around here.

I kept my son home anyway.

[Jennicut]

19. Good for you! I heard troubling stories from my husband who played football

in highschool. Thankfully I have two girls.

[pnwmom]

20. Don't count your blessings too soon.

Girls play soccer, too!

:)

[Mind_your_head]

17. Yup.....I agree.....they shouldn't just "suck it up"

It doesn't hurt to be "looked at".....it can be totally tragic to 'not go to the Doctor when you should"

--------

HEY! Wait a Minute!

What about all of the people who don't have health insurance? What do THEY do when they have 'hit their head'? OR when they feel their hear palpitating in STRANGE WAYS??? What are THEY to do?

What would YOU do? If you didn't have health insurance?

[Jennicut]

18. Most hospitals will treat you if you have a trauma injury, but the long term

care would not be covered.

[Mind_your_head]

22. So I guess I would die

sooner rather than later.......

[Jennicut]

25. You would survive but quality of life would probably be poor

Long term rehabilitation is needed for head trauma as the person could have brain damage and have trouble speaking, remembering things, communicating.

[DaLittle Kitty]

112. Wrong Assumption... Evacuation of the HematomaStoppin g the Bleeding She May HAve Survived

and gone on to live out her life perfectly normally... But for the lack of opportunity for the EMS to ask Natasha some questions which likely would have provided some answers and a BETTER decision... But now we will NEVER know... Did she undergo autopsy? The bleed may have been relatively smal but accumulating pressure over time leading to her demise.

It is all about time to treatment.. and EVALUATION BY EMS personnel would have given her perhaps the chance that she needed! Fuck the celebrity bullshit! Everyone when it comes to requiring medical treatment is the same and whomever the idiot was that was more interested in protecting privacy than the person whose privacy was so-called BEING PROTECTED is an IDIOT/FOOL of the FIRST ORDER! :crazy:

[uppityperson]

126. She refused to talk with the medics. It was her choice.

Each of us has that right. If medics had insisted on accosting her, it would have been assault. It wasn't about protecting privacy, but the legal fact that she could, as a legal adult, refuse treatment, refuse to talk with the medics.

[pnwmom]

21. They should go to the emergency room for a head injury whether or not

they have insurance.

The waste is when -- because of lack of health insurance -- they have to go to the emergency room just for routine care.

[Mind_your_head]

28. I'm SURE people would go to health clinics.....if we had them in the united states....

when they have a bladder infection. Or a yeast infection (overgrowth). Or a case of strep throat.

Do you (GUYS ~ aka LEGISLATORS KNOW how Painful any of these 'real simple conditions' are for women?).......THEY ARE REALLY, REALLY BAD/PAINFUL!

Do you "guy"/legislators know how difficult/EXPENSIVE it is to get even these simple maladies treated? (if you don't have insurance??)

Viagra? Oh, no problem man.... :eyes: take the 'blue pill' (and men "wonder" ~ if they are cogent enough ~ why womam don't really 'like'/'trust' them.)

Women have a LOT of everyday health/maintenance issues....pap smears, mammograms, etc. It's not being 'covered'. And women LIKE ME are "mad as hell" at the BAILOUTS TO SCAM/SMARMY BANKS WITH MY TAX DOLLARS THAT DENY ME HONEST HEALTHCARE!!!!

I agree with, and will reiterate, what Jon Stewart said, "F*CK YOU"!!!!!

[Fire_Medic_Dave]

30. What does viagra have to do with it?

[pnwmom]

32. Who's arguing against health care clinics? n/t

[MillieJo]

101. Read about British TV presenter Richard Hammond...

Two things saved his life in a car crash that nearly killed him and left him with a serious head injury and memory loss... the helmet he wore and the air ambulance that picked him up from the scene...

[Critters2]

79. Exactly. see my post #3 above. My family has been through this. nt

[rainbow4321]

92. Scary thing is even just hitting your head

Puts you at risk.I forget if this was a local woman or not but she was getting groceries out of her trunk and her hatchback door came down and hit her head. Didn't knock her out and normally should have been a curse for a minute and move on moment . She ended up with a slow bleed and died shortly after.

[treestar]

140. Exactly

I had a friend whose ten year old son had a bump on his head and they went straight to the ER.

ER released him but called him back a week later to take another CT scan. And later sent him for yet more tests that friend might not have thought of going to do.

With children, the medical establishment is really careful, really, really careful with kids. They don't want to get sued.

Adults have to realize that about themselves if they sustain a head injury. One can just picture them not going in with a comparable bump. Or Natasha R. - had it been one of her kids, she'd have taken the treatment and demanded it, most likely.

[dysfunctional press]

23. did our shot at single-payer die with natasha richardson...?

the right will try to use this to excoriate the canadian healthcare system.

[pnwmom]

24. This isn't about Canadian healthcare. This is about Montreal's trauma system

which isn't as good as in other Canadian cities.

No one has ever said we have to emulate the flaws of any other particular system.

[dysfunctional press]

26. i'm just saying what they may try to do...

look what they did with the special olympics thing- and there are no lobbyists with suitcases of cash involved with that one.

[pnwmom]

29. Then we need to be prepared with an answer. We have Medicare, right?

Most of us would be happy if Medicare were extended to all Americans. This has nothing to do with Canada's system or whatever particular flaws it might have.

[Mind_your_head]

33. You don't have to worry about lobbyists armed with worthless "cash"

If there is a vibrant citizenry ~CITIZENRY~ armed with knowledge, facts, desire, and "will".

It's 'pretty close'.....I can hear the heartbeat......

"I think we're alone now"

[dysfunctional press]

37. don't be too sure.

scare tactics work well on the uninformed...and our populace is getting to be more and more un/ill informed all the time

[polly7]

27. Actually, I am shocked Montreal has no air ambulance service.

I live in the sticks in rural Saskatchewan and work in EMS, we've called for airlifts multiple times. From what I've read, she signed a release form for the first ambulance, but even if she had gone then it may not have been in time. This is especially tragic and needs to be investigated. Just awful.

[pnwmom]

31. Me, too. And I'm shocked by the number of DUers

(in another thread) who seemed to think that was perfectly fine.

I hope this tragedy will help the doctors in the Montreal system get the improvements they need.

[BrklynLiberal]

34. I would think any area that has skiing would have an emergency helicopter service

for transporting injured people.

[pnwmom]

36. And that's the problem. A lot of other people besides you would have assumed that,

but it's often not true. I remember reading several years ago in the NYTimes that urgent trauma care was not available at many ski resorts -- and that many people didn't realize it.

The son of a friend of ours was a college student skiing in Oregon when he ran into a tree and had facial injuries. There was no nearby hospital, and not even an ambulance immediately available. The resort finally decided it would be fastest to put him on a BUS to Portland!

[BrklynLiberal]

121. That is scary...very scary.

Now that you mention it, I remember Sonny Bono also died after a ski accident. Now I am wondering if it might have been due to inadequate trauma response.

[treestar]

141. Bingo!

We know it's coming.

[SoCalDem]

75. Her fame probably added to the events too..

Famous movie star falls, bumps her head.. gets up..maybe jokes about it..says she's fine and wants to go to her room..

she seems ok, so my guess is that the ski resort would just assume that she IS ok..

and hour or two later when symptoms showed up, it was already probably too late:(

That's why they call it "Talk and Die Syndrome"..

[pnwmom]

76. I wondered about that.

I also wondered if she was thinking more about her son's reaction than of her own injury -- which would be a typical thing for a mother to do. "No, really, I"m fine."

[old mark]

77. If Canadian law is like US law, SHE made the decision not to go

to the hospital after the fall. I have no doubt the ambulance personnel and the trainer tried to convince her to go, and she refused as was her legal right as an adult.
We don't always make good decisions.
ANY head injury or blow or impact is potentially very serious and should never be taken lightly.


mark

[pnwmom]

78. You are wrong about the ambulance personnel. Someone turned them back

and prevented them from speaking with her, according to the NYTimes.

If Canadian law is like US law, then SHE -- or her legal representative -- should have been the one to tell the medic to go away -- not some resort employee.

[old mark]

80. I heard that she did make the decision not to seek medical

treatment.
If the resort did, they should be sued big.


mark

[northernlights]

91. You assume correctly

The resort called the ambulance, escorted her off the slopes by toboggan, accompanied her to her room, tried to convince her to see the medics, stayed with her and monitored her when she refused to see the medics, called the ambulance the 2nd time when she started to feel ill, accompanied her to the 1st hospital.

They, obviously, were at fault...at least according to one crazed person who's friend's son got injured skiing and was put on a bus to the hospital in Washington State. So therefore, all resorts are to blame and obliged to force adults to accept medical attention under threat of eviction... :rolleyes:

[bottomtheweaver]

104. Someone sent the ambulance back before they spoke with her

according to the company's owner. Who?

[pnwmom]

116. If she didn't want medical treatment, then SHE should have been the one

to tell the medics. Legally, no one at the resort had authority to act as her representative in this matter.

[uppityperson]

127. She had, and exercised, the right to say "no, I don't want to see them, tell them to go away".

The person she told told the medics. She had that right. No matter how often you talk about "someone at the resort acting as her representative" not having any rights, she had the right to say "No, I don't want to see them. Tell them to go away." Once she said this, ANYONE who went against this and allowed the medics access to her would be guilty of assault.

It sucks, but that is how it is.

[pnwmom]

131. No one at the resort had any legal obligation to

prevent the medics from speaking with her, much less being equally guilty of assault if the medics spoke to her. That's just silly.

And the medics could have spoken to her unless and until she told them not to. And she never did.

[uppityperson]

132. "I don't want to talk with them." "go ahead and talk to her."

You are wrong. She refused to see them. She had that right. I am done with you, it is getting rather like mutual masturbation with someone I don't like.

[pnwmom]

133. "It is getting rather like . . . " I'll have to take your word on that,

not having had that experience myself.

[uppityperson]

146. having worked ER, I have had experience with AMA stuff. eom

[pnwmom]

149. She didn't sign an AMA form. The form she signed was different.

An "against medical advice" form requires you to have had at least SOME contact with SOME person in a medical-related job. That person gave you the "advice" which you then decided not to take. The form itself is not the important thing -- it merely memorializes the conversation you supposedly had with a health-care person. If the medics in the first ambulance had been allowed to speak with her, and she directly refused their care, AND they saw no evidence of a head injury or confusion (which is an exception to the patient-may-decline rule -- note that she was taken to the hospital by the 2nd ambulance, even though she was STILL declining treatment), then they would have had her sign an AMA-type form.

In her case, at the time the first ambulance was sent away she had seen no doctor and not even a medic. So she couldn't have signed an AMA form. Signing a waiver or "release from liability" for the resort is an entirely different thing.

When the 2nd ambulance came, she was still declining treatment, but the medics examined her and took her to the hospital anyway -- without giving her an opportunity to sign an AMA form. How could they do that? Because of an exception to the AMA rules.

This document on "Discharge against medical advice" is related to hospital care, but the same exceptions apply. (For a number of years, I served on a board reviewing the ethics of medical research, and matters related to informed consent are still an interest of mine.)

http://209.85.173.132/search?q=cache:WgzYMi3_1wEJ:www.moh.gov.om/nursing/1%25202%2520Discharge%2520AMA.pdf+%22against+medical+advice%22+form+%22informed+consent%22+%22head+injury%22&cd=1&hl=en&ct=clnk&gl=us

The patient has the right to leave the hospital against the medical advice of the treating area if he does not present a danger to him/herself or to othersAll adult persons presumed competent to make decisions affecting theirmedical care will be allowed to make such decisions.

The following must be present to allow refusal of care. Patient is an adult (refer to definition) or represented by a legallyappointed representative or parent (if a minor child).

a. Relatives cannot consent to the refusal of care for their relative unless he is a legally designated representative.
b.Patient is competent: Health care workers should determine the competency of the patient based on reason and carefulness,utilizing the following guidelines:
c.The patient’s presentation, physical assessment and vital signs are consistent with a person presenting in a physical condition that would support cognitive capacity. Some conditions that might diminish cognitive capacity include: • Unstable vital signs that could affect cerebral circulation or oxygenation. • Evidence of alcohol or drug intoxication.• Evidence of head injury.

[uppityperson]

152. As you said, you don't have the experience, esp with Canadian papers.eom

[pnwmom]

153. Did you even read the post?

I do have experience with informed consent issues, but you don't have to take my word for any of this. That's why I posted the links.

[fascisthunter]

89. I heard she made the decision

now you are making this about Canada's healthcare system? Wow... well guess what? Canada still has better healthcare than we do, and she denied care when she shouldn't have.

[pnwmom]

117. This is not about Canada's health care system. This is about what Montreal's

top trauma doctor had to say about his own trauma system, which he finds lacking compared to other Canadian cities.

And about the effect this might have had on Richardson's situation. If there had been a helicopter there, she could have been flown to Montreal in 15 minutes, as opposed to hours. This doctor would like Montreal to have that capability. Don't you think they should?

[Gormy Cuss]

93. Top trauma doc: "....so many variables, it's hard to speculate what might have been done differently

Razek said immediate treatment might have helped Richardson but added: "There are so many variables, it's hard to speculate what might have been done differently."

[liberalhistorian]

109. None of that makes any difference since she

refused all medical treatment for the first few critical hours, which is what ultimately killed her. She turned the paramedics away, even. She just didn't think it was that big of a deal and, indeed, I think a lot of us might have felt that way about it, that, because we felt okay, it would have been too much "fuss." Unfortunately, most of us don't know about the "talk and die" syndrome; helll, I'd never heard of it before this week and I like to consider myself fairly well-informed. Even if they'd had a trauma center, her refusal to be treated within the time window that would have saved her is what ultimately killed her. What a sad, horrible tragedy; my heart just breaks for Liam Neeson and their sons, as well as the rest of her family.

[bottomtheweaver]

110. Somebody turned the medics away, but it wasn't her.

However, there appears to be a deliberate attempt to make it appear that she did.

[pnwmom]

118. So, you know for a fact that

after two and a half hours, when the second ambulance came, it wouldn't have made a difference in her outcome if she could have been evacuated in a 15 minute flight to the trauma hospital rather than spending four more hours (in transit and at the first hospital) before she arrived at the trauma center in Montreal?

[Vinca]

114. I think I'm correct that each province administers its own healthcare system,

even thought it's national coverage. I've been told - although any Canadians here would know for sure - that Quebec lags behind some of the other provinces. In my mind, this makes the case in this country for a true, national, healthcare plan rather than separate plans run by the states as many on the right might want to see.

[OPERATIONMINDCRIME]

115. Sad To Hear That. I Hope This Helps Improve Their System There.

It's a shame they weren't set up to handle things better. Though we'll never know for certain; just the fact that it's a possibility that their lack of trauma ability might've been part of what ultimately caused her death, just adds to this total tragedy.

[merh]

122. And now the People magazine article

alleges that the hotel's time line doesn't match the ambulance services time line.

Richardson did not turn them away, they saw her sled come down from the slope and go to the hotel - they didn't talk to the party, they got a radio call to return as they were not needed.

It wasn't until a paramedic was able to see her on the second call that a hospital was called and they decided to transport her, despite her telling them she would be okay. She never saw a physician at the clinic from what I gather.

I think the hotel screwed up, if they knew she hit her head they should have let the ambulance take her to a hospital - they should have let the paramedics see her then to try to talk with her. Paramedics are trained in caring for folks, they see what others don't see and they know how to talk with injured folks.

JMO.

http://www.people.com/people/package/article/0,,20266545_20267163,00.html

[Gwendolyn]

123. I don't know... the people article doesn't seem to back that up.

It appears she didn't want the ambulance to take her to the hospital, so the ski patrol brought her to the clinic instead where she signed a waiver for the hospital treatment. The instructor and ski patrol person had tried to convince her otherwise and at least one of them remained with her.

She was a star and popular actress. I'm sure the resort treated her like a queen. The last thing they would want is bad PR.

[bottomtheweaver]

124. The ambulance company owner is only surmising that she signed a waiver.

Maybe she did, but this is just conjecture:

Skiers are asked to sign a document if they refuse medical treatment. "They'd never let her go without her signing it," said Coderre of Richardson.

[pnwmom]

134. I agree. The medics are trained to see signs of head injuries, the

hotel employees don't have the same training.

And the "instructor" who stayed with her while she was deteriorating was just a college student. How sad for that girl, too. Did she know how to identify signs of head trauma? (As their official protocol requires, if medical help is to be called for in the absence of consent). Would she have known that a little dizziness, or a little nausea, or a little headache could all be signs of a serious problem? Or sensitivity to sound? Or unevenly dilated pupils?

Would a young college student with no medical background have been assertive enough in trying to convince Richardson to accept medical help?

http://www.people.com/people/package/article/0,,20266545_20267163,00.html

"They just saw her on the sled for a split second, nothing more," said Coderre, who explained that Richardson was brought to a small clinic at the mountain, rarely staffed by a physician, where a member of the ski patrol and her instructor, a female university student, talked to her.

"The protocol in these situations is that the person is told that she would be wise to seek medical attention but she always has the right to refuse," said Coderre. "The only time a person can be overruled is if she is thought to be under the influence of drugs or alcohol or if she is showing visible signs of head trauma and seems to be intellectually incapacitated in some way."

Skiers are asked to sign a document if they refuse medical treatment. "They'd never let her go without her signing it," said Coderre of Richardson.

Richardson left the clinic still accompanied by her ski instructor and returned to her suite at the nearby luxury hotel where she was staying. Once there, her condition began to deteriorate. "She came back to the hotel and the instructor was right with her and took her to the room," a source tells PEOPLE.

[merh]

135. The fact that the ambulance dispatch records differ from

the hotel's version or timetable makes me think the hotel was trying to cover its ass. Since the ambulance was on the scene the ski patrol should have taken her to the ambulance to let the trained paramedics talk.

She didn't receive medical care or screening until they came out the second time, the clinic did not have a physician on staff.

[pnwmom]

136. I hope many people have learned from all the "what if's" of this case.

What if the ski resort had required helmet use?
What if she had consented immediately to medical treatment?
What if they'd allowed the medics to speak to her instead of sending them off?
What if her fate hadn't been in the hands of a college student for more than 2 hours?
What if a helicopter had been available to fly her to Montreal within minutes after they realized she needed trauma care?

[uppityperson]

157. Ski patrol were the first responders, they assessed her right away.

At that point in time she was capable of legally refusing further care.

[treestar]

139. Sparsity of population

If people could go skiing in the middle of NYC, trama resources would be easier to get to.

Skiing is generally not available in such places.