Richardson death: Health spokeswoman claims they "always" use private helicopters

[pnwmom]

if they need to quickly evacuate a patient.

Apparently they didn't see the need in Natasha Richardson's case.

"We decided to give priority to replacing aging air ambulance planes with the purchase of two new airplanes," Ms. Bédard said in an interview yesterday. "We don't exclude the possibility of introducing a helicopter service, but we insist on noting that if we need to evacuate someone rapidly we always call on civil emergency services for a helicopter to evacuate people."

http://www.theglobeandmail.com/servlet/story/LAC.20090321.RICHARDSON21/TPStory/National

QUEBEC -- The Quebec government is making no excuses for the lack of a helicopter air ambulance service to transport trauma patients such as actress Natasha Richardson, who died of a head injury after skiing at Mont Tremblant this week.

Purchasing a helicopter ambulance is not a priority and there are no plans to acquire one, a government spokeswoman said yesterday.

Health and Social Services Minister Yves Bolduc refused to be interviewed regarding Ms. Richardson's accident. His spokeswoman Marie-Ève Bédard said Mr. Bolduc was concerned that anything he said could be used in any potential legal action against the government.

SNIP

François Rivard, who runs a private, non-profit medical helicopter service in Quebec called AirMédic, said he has approached the provincial government several times about integrating his service into the Quebec health-care system, without success. Mr. Rivard, a paramedic who has served with the Canadian Forces in Bosnia, said prompt delivery of trauma victims to specialized care can be crucial in saving lives.

SNIP

[Belial]

1. Gov't healthcare at its finest.. Gee.. I cannot wait..

[hlthe2b]

4. Ohh, puhleeze... This is a system failure, but not a single payer

failure. We have plenty of similar localized system failures as well--take the recent increase in cases where the patient died in the ER waiting room after waiting for nearly a day or more.

[pnwmom]

10. Absolutely right. Just because the freepers can't recognize the difference

doesn't mean we shouldn't.

[Belial]

21. Whatever makes you happy.. at what point do you think

this is going to be any different? You think ours is going to be any different? When people in Canada couldn't get the services they wanted.. private practices opened to service those.. the Govt shut those down because it couldn't compete with those practices. They provided a better service at a lower price. Your health is going to be determined by a Govt bean counter..

[hlthe2b]

23. STEP AWAY FROM THE EIB network...

Try worshiping Limbaugh from afar for just a few weeks.... You really can think for yourself. I know you can. :eyes:

[DaLittle Kitty]

31. Francious Should Get The Contract. Helo Would Likely Be Used INFREQUENTLY

Due to rural geography and low population density. Not every day multiple trips like Tampa General or bayFlight!

[fascisthunter]

16. Well... I'm Looking forward to it

and you don't know what you are talking about since the government healthcare system has nothing to do with this. Nice try..

[cali]

32. uh, Canada has a much lower infant mortality rate than the U.S. and

they live, on average, three years longer than americans. three years. oh yeah, and your stupid tagline sucks shit.

[slackmaster]

2. If the accident had occurred in Utah or Colorado or Wyoming or Idaho or Vermont

She could have been taken to a trauma center and possibly would have survived.

In before Canadian Healthcare Lottery apologists.

[likesmountains 52]

3. Only if she requested or agreed to go.

[pnwmom]

8. All she did was sign a release from liability, which is not the same as

an "against medical advice" form. To do that, she would have had to actually have some medical advice, from a medical person, such as the medics who were turned away without getting a chance to speak with her.

[pnwmom]

5. Or in several other Canadian provinces.

This isn't about Canadian healthcare in general. It's about a flaw in Quebec's trauma care.

[hlthe2b]

7. Most of the CO resorts would still require an airlift of an hour or more

to a level 1 Trauma Center--at least those most popular along the I-70 corridor. So, the initial delay would likely have produced the same result.

[pnwmom]

11. It took her 4 hours just to get from the 1st hospital to the 2nd.

Also, when she was at the resort the decision was made to drive her to the local hospital, rather than enlist a private helicopter to take her to the Montreal hospital (a 15 minute helicopter flight).

None of us can know what the outcome would have been, but the odds would have been better if she had arrived at the trauma center within 3 hours instead of 7.

[hlthe2b]

13. It doesn't sound like any targeted care whatsoever was given

at the first hospital... While they may certainly not have been prepared with a neurologist on staff, MRI, or the ability to remove part of the brain, drill bore holes or other measures to alleviate swelling-- a telephone consult might certainly have resulted in a recommendation for mannitol and steroids, which might have been of some help during the transport. I'm betting they flooded her with fluids, making it all the worst.

[pnwmom]

15. I think I read they gave her steroids at the trauma center, but I haven't

read anywhere about drilling a hole. Maybe it was too late for that.

[hlthe2b]

19. Mannitol would have been more helpful than steroids...

though less so than a well placed bore hole. There is a seeming fear of using mannitol for some reason, though not to flood with enough fluids to cause a herniation...:shrug:

[newfie11]

14. Depends on where you are in Colorado and Wyoming.

The distance from a trauma unit to some rural areas are can be hundreds of miles. She would first have to be see at a local hospital such as what was done in Canada.

[pnwmom]

17. Hundreds of miles isn't a problem in a helicopter or medivac plane.

And we routinely bypass local hospitals if the patient needs high level trauma care.

[newfie11]

18. who calls you to come?

If someone is at a ski slope I assume it is the medical personal but she was acting normal when she left the slope.
If this happened in a rural area most likely she would have been taken from her hotel room to a local hospital for evaluation first.

[pnwmom]

20. She was acting "normal" in the opinion of non-medical personnel.

Someone at the resort turned away the medics who arrived with the first ambulance, which was a big mistake IMHO. They should have had a chance to speak with her and to try to persuade her to accept treatment. They would have been much more likely to pick up the subtle signs of a head injury than the university student/ski instructor who was with her -- and much more likely to have been able to convince her that she needed to go to the hospital ASAP.

Here, in a rural area, it would all depend on the situation. At a ski resort with access to medics, the medics would call for the medivac -- which would most likely take a head-injury patient not to the closest hospital, but directly to the closest trauma center.

[hlthe2b]

22. Interesting... I think most of the CO resorts would transport first to

the local community hospital for initial evaluation/stabilization--EXCEPT when there is evidence of overwhelming overt signs of trauma (rock climbing falls, wrecks, avalanche, etc.). The orthopedic care from these hospitals is really really good, which are the bulk of ski-related injuries. But, certainly in Vail, Summit County, and near Aspen, the local hospitals are more equipped to make an initial evaluation and start appropriate care. Telemedicine is big in CO, so that she could have been evaluated to some extent by trauma docs in Denver.

But, I've seen mixed stories on the timeline for Richardson... Rather than it taking 4 hours from local hospital to level 1 Trauma Center, I'd heard there was a two hour delay in deciding to seek treatment. If this is the case, two hours from local hospital to trauma center is far from optimal, but not as bad as I'd thought. The delay in seeking initial evaluation might well have made the difference.

[pnwmom]

24. The trauma head in Montreal was saying yesterday

that critical time was lost because a helicopter wasn't available for the 15 minute flight from Mt. Tremblant to the trauma center in Montreal. If a trauma center was within a 15 minute flight, it wouldn't make much sense to take her to a local hospital first.

Here's a link you might find interesting:

http://insidesurgery.com/

Natasha Richardson's Death From Brain Injury - Baffling Course of Events / Musings

The editors of Insidesurgery.com are following the news reports of the apparent head injury from a skiing accident that has caused the death of actress Natasha Richardson. Although none of the editors at InsideSurgery.com are participating in her care we are baffled by the course of events as described in the news reports.

As is being reported today by news organizations, Ms. Richardson was not seen by the paramedics who were dispatched to examine her from the local ambulance service. Rather she was accompanied by her instructor back to her hotel room.

It is not clear who turned the paramedics away and why. Although trauma victims often refuse treatment, it is never a good idea to do so.

Often patients say they "feel fine" but trained medical personnel can sometimes pick up subtle physical findings (signs or symptoms that the patient may be unaware of) or have a high index of suspicion for what is termed in the trauma field as "mechanism of injury." A competent paramedic would be schooled in the mechanism, clinical course, and rquired urgency of care for an epidural bleed, which may be the injury that Ms. Richardson sustained.

SNIP

In the United States in a suspected head bleed being transported from the scene, it is not uncommon for the "life flight" nurses and paramedics in contact with base command to direct the patient directly to the tertiary care facility, bypassing the smaller hospitals that can not give definitive care.

The goal in large epidural and subdural hematomas is to get to the operating room as quickly as possible and quite bafflingly current news reports do not mention attempted operative intervention to control the bleeding and drain the clot. There is very little chance of survival in these injuries if that does not occur.

SNIP

[hlthe2b]

25. Yup... they certainly share the same questions we've pondered...

Although in the United States it would not be unusual for a local hospital to not have a neurosurgeon on staff, she almost universally would receive a head CT with a positive finding activating an emergency transfer to a tertiary care hospital and a ready and waiting operating room.

In the US, patients with brain bleeds are typically transported by helicopter if they are traveling more than a few miles to get to the needed level of care most expeditiously.

It is not clear what resources were available in the local Canadian Hospital, but there almost certainly would be a CT scanner and neurosurgeon available in the large hospital in Montreal that she was transferred to.

It is also not clear how Ms. Richardson was transported from the ski resort town to Montreal and how much care and evaluation she received at the local Canadian Hospital.

snip

The goal in large epidural and subdural hematomas is to get to the operating room as quickly as possible and quite bafflingly current news reports do not mention attempted operative intervention to control the bleeding and drain the clot. There is very little chance of survival in these injuries if that does not occur.



I guess the one question that has been answered is the possibility of a pre-existing aneurysm--which should have been detected at autopsy...

Tragic, all the way around. Imagine the impact on the one child that accompanied her...

[pnwmom]

27. Those boys have been uppermost in my mind.

Especially since I read a quote from Vanessa saying that she didn't understand why her daughter had gone skiing -- that she didn't even like to ski. What a horrible burden for those boys if she went just to make them happy . . . .

(Today I read that both boys were with her, but I don't know whether it was one or two.)

There's someone else who's probably suffering in her own way -- the university student who was her ski instructor, who stayed with her in the hotel room after the fall. How could she not be questioning herself at this point -- whether she could have insisted sooner that a second call be made for an ambulance. (Reports today say that the general manager finally called for the 2nd ambulance, despite Richardson still saying she didn't want one.)

[Kitty Herder]

34. You don't live in Utah, do you?

That much is obvious. I live 35 miles from the closest hospital and it is not equipped to handle much. If there is an accident or other emergency they take you there by ambulance first. Then, if necessary they life-flight you to Salt Lake City. All of that takes a lot of time. It's just that it's a big state with all the decent hospitals in one area. That makes it tough to get there in time even with the choppers. Don't get me wrong. I'm very grateful that we have the life-flight helicopters; those of us who don't live on the Wasatch Front would be screwed without them, but if Natasha Richardson had her accident where I live or worse, in the far-flung outdoor recreational areas near here, she still wouldn't have made it. That's just a fact of geography.

It's obvious to me that Quebec needs to get with the program as far as having life-flight helicopters, but that is not an indictment of the Canadian health care system. My understanding is that Quebec has been behind the rest of Canada in healthcare for a while.

[OmmmSweetOmmm]

6. I mentioned on another thread that if she just wasn't there with her child but w/her husband/friend/

family who could help think for her, she would have been helicoptered directly out of the resort to the trauma center in Montreal. She was in no position to make decisions for herself once the headache came on.

[hlthe2b]

9. Agree.... Her denial was an effort to protect the child....

[pnwmom]

12. I think so, too. Such a shame. n/t

[malaise]

26. Good grief she refused the first help that arrived

It was an awful tragedy - a freak accident which might not have led to her death if she accepted the first offer of a check up. If anyone is to blame for her death it is the beautiful and talented actress herself.

[pnwmom]

28. The head of the entire trauma system in Montreal says that critical time

was lost because of their inability to put her on a medical helicopter for a 15 minute flight to the trauma center. And he's in a better position than any of us to know.

How do you know she refused the first help that arrived? Because of something said by the resort spokesman? The resort shouldn't have prevented the medics from speaking to her. They, not the university student/ski instructor, were trained in identifying possible signs of brain injury. Richardson cannot be said to have made an informed decision to act "against medical advice" because no medical person advised her.

[bottomtheweaver]

29. A "freak accident" the day before Bushler gave a speech in Calgary.

Maybe, but I wouldn't be so quick to blame this particular victim:

Four arrested as hundreds protest Bush speech
Richard Cuthbertson, Calgary Herald
Published: Tuesday, March 17, 2009

CALGARY - A crowd of roughly 400 noisy protestors gathered outside the Telus Convention Centre in downtown Calgary on Tuesday to demonstrate against a noon address by former U.S. president George W. Bush.

Blowing whistles and chanting "war criminal," demonstrators carried signs and shouted "shame on you" at people attending the event at a cost of $400 each.

http://www.nationalpost.com/news/story.html?id=1398586

[pnwmom]

30. I think some people are more comfortable blaming the victim

because they can convince themselves that they would be smarter than she was -- and therefore they're safe from this kind of tragedy.

[bottomtheweaver]

33. It's like the Hitchcock movie where the patient tells her psychiatrist

she thinks someone is trying to kill her, and it's the psychiatrist who's trying to kill her. Spellbound I think. Sadly this wasn't a movie and whoever wanted her dead got their wish. It's pretty clear to me and what makes it worse seeing everyone blaming Richardson. It's beyond horrible and I hope her family takes some solace in the truth when they learn it, but I imagine they knew the second they got the news, like Bobby Kennedy did in 1963. Jackie figured it out pretty quickly too.