That's my best estimate based on a recent article by the Globe and Mail.
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IM_Golum — 17 years ago(March 19, 2009 08:21 AM)
It certainly is up to the family in many respects, but at the same time, if there's room for improvement in medical procedures and policies, or if there's some medical negligence involved over at Ste-Agathe's (just speculation on my part), then the public has a legitimate right to know.
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Danusha_Goska — 17 years ago(March 19, 2009 08:39 AM)
http://www.abcnews.go.com/Health/MindMoodNews/story?id=7116273&pag e=1
Good article addresses many questions.
Perhaps immediate medical attention, or even a helmet, would not have changed things. -
IM_Golum — 17 years ago(March 19, 2009 07:32 PM)
Perhaps immediate medical attention, or even a helmet, would not have changed things.
That is certainly possible, but at this point, based on the very limited information I have, I think there's a good chance she might have been saved had she been taken by ambulance or, better yet, chopper, directly to Sacre-Coeur from the resort, perhaps (just being "creative" here rather than medically knowledgeable) with ice packs on her head and neck to slow down the swelling and bleeding. (Sacre-Coeur has neurosurgeons; Ste-Agathe probably not.) -
PhantomPhan222 — 17 years ago(March 19, 2009 12:34 PM)
That's where you have to be careful with the media. Often the media will deliberately seek out people with two differing opinions simply for the purpose of what they might call "balance".
"People always sing 'Part of Your World' at auditions that's why I only know one lyric." -
lillandra_ — 17 years ago(March 19, 2009 08:40 AM)
How many people fall on beginner's slopes every day? And how many end up in an unfortunate death? I've seen people fall harder while playing soccer (not that I saw the ski mishap, but I've seen other's on slopes). Could be that Yves Coderre is just covering his butt in case anyone asks why 'no ambulance'. Maybe he should answer how many other times the ambulance was sent home from ski hills when the skiier appeared to be fine and probably said that they didn't need an ambulance? (I've worked in the Canadian Rockies at ski resorts it happens a lot, actually)
Hospitals go by the symptoms they're given when the patient arrives, and her being a star doesn't guarantee her any better or special treatment than anyone else. Had this been 'Jane Smith' from down the block, would you be asking and assuming 2000things?
People are already coming out of the woodwork with 'what if's' and the only ones that can answer are those that were there and patient records are not for public consumption in Canada.
The only people that really need to know the answers are her family.
It's a terrible accident and a terrible end result. I've been a fan of her acting since I first saw The Handmaid's Tale in the early '90s. and I hope her family gets the answers they need, and that the public and press show some respect during this time.
My opinion can differ from yoursit's allowed.
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IM_Golum — 17 years ago(March 19, 2009 06:58 PM)
The only people that really need to know the answers are her family.
I couldn't DISAGREE more.
This is a matter of compelling public concern, because it involves the public health and well-being.
Should ski resorts send people with Natasha Richardson's symptoms to a hospital that is not equipped to do neurosurgery?
That's just one question among many that fall under the rubric of the public's right to know. -
jlb5947 — 17 years ago(March 19, 2009 09:29 AM)
It is very possible that Natasha already had a brain aneurysm waiting to burst or some other brain ailment. Yes, people do hit their heads everyday. When I worked at a fast food restaurant as a teenager, I hit my head very hard on the sharp edge of the ice chest in the drive thru. I felt like crap for the rest of the day but I was fine. Or maybe, Natasha just hit her head harder than she realized. Not everyone loses consciousness after head trauma.
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Over64 — 17 years ago(March 19, 2009 09:47 AM)
A medical professionals POV
A. That initial decision by the patient herself NOT to be seen is unfortunately the deal breaker in this case. In a relatively young brain, though initially feeling fine there is little room for extra volume, (blood) in the head. The added pressure (ICP) is what causes the seeming sudden medical decline. Thats why in Trauma there is the (golden hour)
B. What most patients/families and lay people fail to understand is that it is possible that this smaller community hospital did everything right and still the outcome is what it is. Even if she had a CT immediately on arrival and they knew what they were dealing with there are still procedures that must be followed in order to transfer a patient
EMTALA the laws created to prevent hospitals from dumping patients with no insurance REQUIRE a patient be stabilized to the best of their abilities prior to transportin this case most likely given certain medications and securing an artificial airway.
EMTALA also REQUIRES an accepting hospital and physician, arrangement of app2000ropriate transport, reports to both Dr and nurses at the receiving facility.
Remember the physician and nurses responsible for the ACTIVE care of the patient also have to do all of the work and callsIt would not be out of the realm of normal for all of those things to take at least an hour, add that to the diagnostic hour and you have a two hour minimum prior to transfer.
My point of course is while it is normal to want to place blame, especially at the medical community, there may be no blame to place at all. Simply a bad choice by a woman who thought she was fine after a seemingly minor injury. -
josborn828 — 17 years ago(March 23, 2009 10:13 AM)
As a Paramedic that has spent years working for the offshore oil industry, I have experienced many difficulties getting patients to an "appropriate" facility. The first hassle these medics probably had to face was a "consent issue". If someone doesn't want to go to the hospital, the only legal way to get them there is to have a police officer arrest the patient and put them into the medic's custody. You can imagine how often that occurs.
When you finally have consent to treat and transport a patient, you have to choice the most appropriate facility. Most modern ambulances are considered Mobile Intensive Care Units (MICU) and can do some awesome life saving procedures. However, when it comes down to apples and oranges, the medic is alone in the back of a moving 1 ton truck treating problems systematically as they arise. A hospital, any hospital, with lab and imaging capabilities can give most patients a life saving intervention that help to improve the patients chances of a positive outcome.
Another factor that was against Mrs. Richardson was her celebrity itself. Look at the death of Princess Diana, moments away from a large hospital but her transport was delayed and even halted, with those golden minutes that she so needed ticking away. On the night of Diana's death there was an M.D. on scene who took control for her care and if the medical system is anything like the US, the medics are required to follow that doctor's order. I can only imagine the frustration when Diana's ambulance was stopped within sight of the emergency room because the Doctor in back felt that he needed to stabilize her. Pre-hospital protocols are there for a reason, they save lives.
When I read the previous post and saw the poster's father had an MI and was taken to a Boston area hospital and survived. I wondered if one of the family's doctors arranged the transport to New York hospital versed in the care of celebrities, instead of a Boston hospital where they would have less control. Celebrities and their families seem to hire doctors on their reputations of dealing with other celebs. I cannot say for sure this is the case but I wonder if a non famous patient suffering the same injury would have been handled to same way.
I am not trying to blame anyone because it is easy being a Monday morning quarterback in an emergency. Not to mention playing in a system that doesn't have adequate protocols in place to deal with this type of situation. I am sure the Neesom and Redgrave families are going through hell, trying to replay the entire incident praying desperately for a different resolution.
EMS is a very young field and hopefully some good will come from this terrible incident. Stronger protocols, an improved transport system or just a lesson learned to those involved that may help them affect some changes that save many more patients than Mrs. Richardson could have ever done with her films.
I personally will miss the lady and give my thoughts and prayers, although they are so humble in nature, to her friends and loved ones. -
IM_Golum — 17 years ago(March 24, 2009 06:29 AM)
EMS is a very young field and hopeful1354ly some good will come from this terrible incident. Stronger protocols, an improved transport system or just a lesson learned to those involved that may help them affect some changes
Hopefully all three! Thanks for your thoughtful, informative post. -
Starbuc1 — 17 years ago(March 19, 2009 10:05 AM)
Completely AGREE. I very interested in the timeline of events from the initial fall, to first symptom, to first action of the hospital as far as testing, medications, etc. Something is NOT right here. I'm a resident physician and recently completed my neuro surgery rotation. "Talk and Die" is not a joke and when things go bad they go bad in a hurry. However, the "fall" seemed to be fairly minor in nature. She was ok for about an hour then had onset of a headache with nausea and vomiting, CLASSIC signs of increased intracranial pressure. Any doctor or other medical professional worth a dam would look these events and know immediately you were dealing with an acute neurological event, most likely a epidural hemorrhage. Rapid intervention should have taken place including everything to the basics of maintaining an airway and adequate circulation, to dozens of medication, STAT CT scan, getting a neuro surgeon in house, operating room on standby etc. It's organized chaos but every SECOND is important in these cases. I've seen patients in the operating room in less than an hour from the onset of symptoms and/or from the initial injury.
Did this 1st hospital even have any of that available? She was transferred to second hospital in Canada so I doubt they had the capability to treat her effectively, losing only more valuable time. The timeline from initial injury to "brain death" seems unbelievably fast in her case. What does that mean? One the injury was so catastrophic no intervention would have worked. However, this does not match up with a minor fall on the "bunny slope" after which she was not unconscious, had no external injury and was alert and oriented. Second, perhaps she had an underlying condition such as an arterial/venous malformation, a weakness in circulatory structures of the brain which was put into motion by the fall. Third, someone dropped the ball and this beautiful wife and mother paid the ultimate price.
People get hurt skiing and participating in other winter sports. It is irresponsible to NOT have a trauma center within an hour of this location. Vale Colorado is a perfect example. A small town whose population swells during the winter. Although they are not far from Denver, they built and staffed a state-of-art trauma hospital with all the bells and whistles capable of treating a case like this one.
I understand an autopsy is to take place today, perhaps it can shed some light on this tragic event..
My thoughts and prayers are with her family and friends i2000n this the most difficult of times. I commend their desicion the remove life-support. "Brain death" is very difficult concept to grasp especially when it involves a loved one. Rest in piece Natasha, your talent and charm will be missed. -
IM_Golum — 17 years ago(March 19, 2009 05:48 PM)
Completely AGREE. I very interested in the timeline of events from the initial fall, to first symptom, to first action of the hospital as far as testing, medications, etc. Something is NOT right here
Ahh, the timeline of events, something I've posted on before.
To recap: [EDIT: PROBABLY INCORRECT, SEE REVISION IN GREEN, BELOW]
@3PM, Monday - Natasha falls. We don't know how bad a tumble it was except that it caused a blunt trauma to the head and ski instructors were sufficiently alarmed to call an ambulance. They may well have seen her head make contact with the snow-covered ground and/or felt that she might have suffered from head or neck trauma due to the abruptness and nature of the fall.
@4PM, Monday - Natasha suffers headaches and is feeling quite unwell. An ambulance is called and we assume it arrives quickly. From the Mont Tremblant resort it takes 20 minutes to the Centre Hopitalier du Ste-Agathe.
@4:30PM, Monday - how soon is Natasha seen by a doctor, how soon does she get a CT-scan? Why are they even doing that given that the hospital probably isn't equipped to treat serious head injuries. By now she must be feeling quite sick given the shockingly rapid progression of her symptoms.
Any doctor or other medical professional worth a dam would look these events and know immediately you were dealing with an acute neurological event, most likely a epidural hemorrhage. Rapid intervention should have taken place including everything to the basics of maintaining an airway and adequate circulation, to dozens of medication, STAT CT scan, getting a neuro surgeon in house, operating room on standby etc. It's organized chaos but every SECOND is important in these cases. I've seen patients in the operating room in less than an hour from the onset of symptoms and/or from the initial injury
And this is where the negligence part comes in.
If it is true that Ste-Agathe was holding her for "several hours" or even one hour, what in the Sam Hill were they doing with/to her?
How long did it take to Sacre-Coeur, what condition was Natasha in when she left Ste-Agathe, when did she arrive at Sacre-Coeur? All we know for sure is that she was there Monday night. What did the doctors do for her? Was it already too late?
EDIT: NEW TIMELINE FROM THE GLOBE AND MAIL
12:43PM: first 911 call from the resort
1PM: medics arrive
3PM: second 911 call for an ambulance
3:09: medics arrive; Natasha is reportedly conscious but showing signs of "instability"
3:39: medics tend to her for half an hour. HALF AN HOUR???
@4:20: ambulance arrives at the small hospital in Ste-Agathe. (This is not a 20 minute ride as originally reported! So why on earth would she be sent there if she is showing signs of neurological instability when Sacre-Coeur (I believe) was just about half an hour farther away (or far quicker by chopper).
@6-6:15PM: Natasha is sent by ambulance to Sacre-Coeur in Montreal.
@7-7:15PM: Natasha arrives at Sacre-Coeur.
I would like to know point blank from Sacre-Coeur what Natasha's medical condition was when she arrived!
My guess is she was in a vegetative state by them.
This is horrible, folks, and I suspect some resort officials were practicing CYA rather than reporting the exact truth.
It is irresponsible to NOT have a trauma center within an hour of this location
Good point.
I understand an autopsy is to take place today, perhaps it can shed some light on this tragic event.
It only confirmed what medical experts had guess from yesterday: epidural hematoma.
I say it again: I think reporters should be asking the ski instructors to describe the fall in greater detail; they should be interviewing paramedics staff, nurses and doctors to figure out what actually happened before and during her stay at Ste-Agathe; and they should be conducting interviews at Sacre-Coeur to find out when she arrived, what condition she was in, and what was done for her. -
sevenof9fl — 17 years ago(March 19, 2009 06:11 PM)
My money says that she had a contrecoup injury; she developed symptoms about an hour later, was rushed to the hospital, probably seized in the ambulance and may even have coded before they could get her into emergency.
By that time brain death had probably occurred and most likely the bleed was sufficient to be clearly visible on a CAT scan.
From that point it was most likely only an issue of sending her home to allow family to say their goodbyes and perhaps get a 2nd opinion from the NYC hospital.
That's my best guess, based on the rapidity in which the events occurred.
I don't think anything untoward happened except for the fact that Ms. Richardson didn't realize how ill she was until it was too late.
"As the Philosopher Jagger said, you can't always get what you want." -
IM_Golum — 17 years ago(March 19, 2009 06:34 PM)
My money says that she had a contrecoup injury; she developed symptoms about an hour later, was rushed to the hospital, probably seized in the ambulance and may even have coded before they could get her into emergency.
I read a news report which indicated that she was at Ste-Agathe "for several hours." Now that may be wrong, but that's what I read. And I haven't come across a single article indicating what was done for her there.
Bear in mind that Ste-Agathe may not have been equipped to "get her into emergency." And if they were (highly unlikely I would think), one wonders why they medvacced her to Sacre-Coeur some 80 miles away. That doesn't make sense if she was already brain dead.
I don't think anything untoward happened except for the fact that Ms. Richardson didn't realize how ill she was until it was too late.
Have you been reading my exchange with Starbuc1 carefully?
The salient question is, why should a resort send anyone to Ste-Agathe who suffered a worrisome fall and is complaining of headaches and nausea just an hour later? Shouldn't they have immediately rushed her to Sacre Coeur?
I think something VERY untoward may have happened on Monday. I'm not convinced of that, but I'm very concerned. -
IM_Golum — 17 years ago(March 19, 2009 07:43 PM)
Finally some valuable info from the WP. Ste Agathe held her for TWO HOURS! YIKES!
The other two hospitals are not talking.
Where and when she first got a computerized axial tomography, or CAT, scan, the usual way subdural hematomas are discovered, was not known.
The actress was first taken to Centre Hospitalier Laurentien, in Sainte-Agathe-des-Monts, 25 miles from the ski area, arriving shortly after 4 p.m., said hospital spokesman Alain Paquette. That hospital does not have neurosurgical services, so she was stabilized and transferred by ambulance two hours later to Hpital du Sacr-Coeur, a trauma center 50 miles away in Montreal.
She was ultimately flown to Lenox Hill Hospital in New York, where she died Wednesday at 7:26 p.m.
Rosseau concurred, saying that "it is a rarity that we see trivial injury causing catastrophic consequences, except in those rare occurrences where there is a skull fracture adjacent to a blood vessel or a patient is on an anticoagulant."
The prescription anticoagulant warfarin and over-the-counter painkillers such as aspirin and ibuprofen (but not acetaminophen) can promote bleeding and increase the risk of serious complications after head trauma
http://www.washingtonpost.com/wp-dyn/content/article/2009/03/19/AR2009 031902515_2.html?sid=ST2009031803239 -
IM_Golum — 17 years ago(March 19, 2009 08:09 PM)
The Globe and Mail claims that FOUR HOURS elapsed between the time of Natasha's accident and her admission to Centre Hopitalier Laurentien at Ste-Agathe!
INGRID PERITZ
Globe and Mail update
March 19, 2009 at 7:27 PM EDT
MONTREAL
Nearly four hours elapsed between Natasha Richardson's lethal fall at Mont Tremblant and the actress's admission to a local hospital, a time delay that raises questions about whether more prompt treatment might have saved her life.
Autopsy results from the New York medical examiner's office show that the Tony-award winning actress died of a traumatic brain injury caused by a blood clot between the skull and the lining of her brain. It was ruled an accident.
Trauma specialists say time is critical after such blows to the head, since blood begins to pool and quietly build pressure on the brain.
Emergency 911 records show that ambulance workers were not called to Ms. Richardson's luxury hotel room until more than two hours after she tumbled and hit her head at the Quebec ski resort, according to a paramedic who has reviewed official time logs.
The delay is greater than what was originally disclosed by the ski resort. In a statement released on Tuesday, Mont Tremblant said the ambulance was called to Ms. Richardson's room an hour after her fall.
According to Yves Coderre, a paramedic and ambulance manager who has reviewed the dispatch records, the first 911 call from Mont Tremblant in response to Ms. Richardson's accident came at 12:43 p.m. on Monday.
Mr. Coderre, whose company, Ambulances Radisson, serves Mont Tremblant, says medics arrived at the hill 17 minutes later. At that point, the wounded actress refused medical attention, he said. Ambulance staffers turned and left after spotting a sled taking the still-conscious actress away to the resort's on-site clinic, Mr. Coderre said.
Nearly two hours later, at 3 p.m., a second call was placed to 911 from Ms. Richardson's luxury hotel room, as her condition deteriorated. Ambulance technicians arrived nine minutes later.
She was conscious and they could talk to her, Mr. Coderre said. But she showed instability.
The medics tended to her for half an hour before transporting her to the Centre Hospitalier Laurentien in Ste. Agathe, a 40-minute drive away.
The hospital stabilized the actress before transferring her less than two hours later, according to a hospital spokesman. Then she was taken by ambulance for an hour-long drive to a specialized trauma centre at Montreal's Sacr-Coeur Hospital. She was finally flown to Lenox Hill Hospital in New York the next day, where she died.
The timeline shows that it took crucial hours before the 45-year-old mother of two received specialized medical help that might have led to her recovery. She was not wearing a helmet when she struck her head in what the New York medical examiner termed a blunt impact.
Experts say victims of head trauma frequently feel no immediate symptoms. In a process known as lucid intervals,da0 they feel fine despite the fact that blood buildup is forming within the skull lining.
Yet patients can be saved with prompt medical intervention. If the problem is diagnosed quickly, surgeons can relieve the pressure on the brain and stop the bleeding.
Time matters in these cases. The sooner you get treatment, the better you'll do, said Dr. Judith Marcoux, a neurosurgeon with the McGill University Health Centre in Montreal. Initially you may not feel much, but as time goes by, the blood accumulates more and more and the blood clot gets bigger. By the time you feel symptoms, it can go really fast.
Mont Tremblant did not return a request for comment Thursday. In a statement, the resort extended its condolences to Ms. Richardson's family and said it intends to fully co-operate with any resulting investigations.
MERDE!
http://www.theglobeandmail.com/servlet/story/RTGAM.20090319.wrichardso nhours0319/BNStory/National/home