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After all, she and her family are entitled to medical privacy so the ambulance people and hospitals can't really say much without transgressing privacy laws; in essence, you accuse and they can't respond.
Here is where I adamantly disagree. This is a case involving public health and the public's right to know. The family's grief is a private matter. What steps were taken after Natasha's fall is a public matter.
Also, the fact that the ski resort had helicopters available for tours doesn't mean they could be used to transport someone with a brain injury.
That's true, but at least we know there were helipads in the area.
But to make the accusations you do at this stage seems irresponsible to me. "Natasha lost a precious FOUR hours to resort/paramedic mishandling" is libelous, for your information.
I don't think so, but I'll rephrase it in the form of a question, to make sure some joker doesn't put in a false abuse report. I made it clear that my conclusion is based on articles from the WP and the Globe and Mail, citing 911 records. Medical experts in recent interviews have reaffirmed that anyone manifesting signs of brain trauma should be taken to a trauma center, not a hospital that can't perform neurosurgery.
But you don't have the medical facts to fit into that timeline to know whether any of the steps taken fit into appropriate medical care.
I believe the resort spokesperson has said enough to indicate that Natasha's symptoms were handled with shocking negligence.

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"I don't blame Natasha for not knowing better. I blame whatever "system" is in place which decrees that you send what appear to be trauma patients to a hospital that can't properly deal with them."
I agree with you entirely.
For poetry makes nothing happen.
R.I.P.
Natasha Richardson

But shouldn't the paramedics have persuaded her in order to get her checked?
At the time she didn't have any overt neurological symptoms. Thousands of people fall at ski resorts and even get concussions without developing signs of neurological "instability" (to use the words of paramedics who arrived two hours later.)
, losing four hours right after the accident occured is not the same than losing four hours after the symptoms began to show.
It's certainly true that if Natasha had left right away, she would have been at Ste Agathe at about 1:40. Then at around 3:30 or so, after her symptoms had manifested and a CT-scan was performed, she could have been rushed by ambulance and arrived at Sacre-Coeur by 4:30 (instead of 7) or earlier if she had been airlifted there.
But most people feel it's silly to make a big fuss over a fall on a "bunny slope" when they don't feel any worse for wear. I don't blame Natasha for not knowing better. I blame whatever "system" is in place which decrees that you send what appear to be trauma patients to a hospital that can't properly deal with them. Quebec is not Soviet Russia or ex-communist Romania and Natasha shouldn't have been "Mr. Lazarescu."
http://en.wikipedia.org/wiki/The_Death_of_Mr._Lazarescu
http://www.imdb.com/board/10456149/

But shouldn't the paramedics have persuaded her in order to get her checked? Maybe send her to Montreal right away? You always lose time when you have an accident in a location were there are not many facilities around. Still, losing four hours right after the accident occured is not the same than losing four hours after the symptoms began to show.
I don't know. I'm not a doctor.
For poetry makes nothing happen.
R.I.P.
Natasha Richardson

I think the crucial mistake was made when they send the ambulance back
I don't know how firmly they argued with Natasha about it, but even if she had gone, she would have lost precious time. According to news reports, the ride to Ste-Agathe took 40 minutes, the observation there took almost 2 hours, and the ride to Montreal took another hour. This is a needless waste of time and it reeks of incompetence.

I remember reading something about Epidural hematomas (the cause of her death). It is extremely important that the person gets checked right after the accident, even if they don't show any neurological symptoms (dizzyness, nausea, etc.) An EH works just like that: there's a period of conciusness before the symptoms began to show, and the more you wait, the worse it gets.
I think the crucial mistake was made when they send the ambulance back. Of course, maybe the injury was so bad it wouldn't have made any difference, but at least her family would not have to replay the scenario and wonder what could have happened.
This is
so
sad
For poetry makes nothing happen.
R.I.P.
Natasha Richardson

This is a horrible tragedy that could have been avoided. I live in England and in the area where I live if anyone has an accident and has signs of a neurological injury they are not transported to the hospital 15 mins away but are transported to the hospital 45 mins away that has one of the best neurological departments in the country. I dont understand why this was not done in Natasha's case.

Spare us, Ben, we already caught your act in Monty Python

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TIMETIMETIME WAS TICKING BY
I am a physician, and I can say that I thing FIRST thing I wondered was why they were schlepping her from the resort site out some 100 odd Kms north of Montreal to a (presumably) community-level hospital, one with probably little to no neurosurgical backup.Then there is the added time taken to transport her to yet another hospital (this one with obviously more neurosurgical capability).
As frustrating as these cases go, the paramedics are correct in that one can deteriorate extremely rapidly from a closed head injury. SOMEONE made the decision to transfer to to the smaller hospital, and, in addition to the turning away of the paramedics the first time, this was probably the next crucial mistake in judgment.
The minute she showed signs of deterioration (which was documented as occurring while she was still at the hotel), she should have been CHOPPERED to the closest level 1 trauma center. Had this been done then, saving perhaps 3 1/2 hours to 4 hours off the entire drawn-out saga, I do have to wonder if her chances may not have been improved.
It really depends on what time the herniation of her brain (the swelling brought on by the bleed and the local trauma) started occurring.
At that point it was a matter of minutes and seconds, not hours. My guess is that at the hotel, when she was conscious, but starting to become "unstable" (their words, not mine) should have been the tipoff to the imminence of herniation, and THAT is when a LifeFlight chopper (or its Canadian equivalent) should have been called to transport her to a proper trauma center. There, a decompression of the skull could have very quickly been undertaken and that may have made the difference between life and death.
Thank you! The first thing I thought about was a chopper, because we have an excellent medevac system. Where I live, which is also about an hour's drive from a ski resort, a skiier with head trauma is minutes away from emergency care via chopper.
So one question is whether there's any reason why a chopper couldn't have taken her from the resort to the hospital in Montreal? Who makes the decisions about this?
Second, what's your opinion about paramedics spending half an hour with a patient who may have suffered a head injury, is complaining of headaches and is appearing unstable?

which I knew to translate to "nausea, possible vomiting, blurred vision, horrible headache," all signs of at least a bad concussion.
Quite right. I'm still wondering what paramedics were attempting to do for half an hour at the resort.
This tragedy should certainly call for changes in the decision making process about the way way head injury patients are transported and which hospitals are prioritized - we can go on and on and say that this was perhaps a "fluke fall" and maybe it was - but the key was getting her to the correct hospital ASAP and that certainly did not happen.
Very well said!
If the mainstream media and tabloids want a "good story", they should continue to investigate the circumstances in this case and make sure that whatever changes are needed to save lives in the future will in fact be implemented.
As I've said several times (but will say again because it bears repeating) it just infuriates me to think that the resort features scenic helicopter tours but no emergency chopper services for skiiers with head injuries.

It's completely irrational to send patients with Natasha's symptoms and circumstances on a 40 minute ambulance ride to a hospital that can't do emergency neurosurgery! In cases like hers, it's like sending them to their deaths.
I agree 100% - before I'd read your postings, I had assumed (and we all know what a mistake that is) that she had indeed been AirLifted from the resort directly to a hospital with Neurosurgery capabilities. That was based on statements of "paramedics being called after Ms. Richardson reported having a headache and feeling quite unwell" which I knew to translate to "nausea, possible vomiting, blurred vision, horrible headache," all signs of at least a bad concussion.
This tragedy should certainly call for changes in the decision making process about the way way head injury patients are transported and which hospitals are prioritized - we can go on and on and say that this was perhaps a "fluke fall" and maybe it was - but the key was getting her to the correct hospital ASAP and that certainly did not happen.
"As the Philosopher Jagger said, you can't always get what you want."

Did she not realize the seriousness of her condition and was a reluctant patient or did the paramedics completely underestimate the situation?
Good question. Someone needs to go back to the paramedics and ask them what they were doing for half an hour.
They certainly should have LifeFlight'd her to Sacre-Soeur; of course, by the time the decision was made to take her there, it could have been to late to do anything at all
That's not the impression I get from the limited amount of information we have from Ste-Agathe. It doesn't sound like it was too late when she arrived there, which was around 4:20.
Had she been choppered immediately (let's say around 3:30PM) she would have arrived in the Sacre-Coeur emergency room around 3:45-4PM, or earlier than she arrived in Ste-Agathe.
I hope this information causes ski resorts, hospitals and medical officials to reform the system.
It's completely irrational to send patients with Natasha's symptoms and circumstances on a 40 minute ambulance ride to a hospital that can't do emergency neurosurgery! In cases like hers, it's like sending them to their deaths.

You and I have come to the same conclusion - and major unanswered question - after I went trough the mental gymnastics of the timeline last night: why was Ms. Richardson NOT Medivac'd (LifeFlight'd) directly from the Resort to Sacre-Soeur (sp?) when it was obvious that her condition was rapidly deteriorating?
Did she not realize the seriousness of her condition and was a reluctant patient or did the paramedics completely underestimate the situation?
It sounds, unfortunately, as if the paramedics completely underestimated the seriousness of the situation; as did the the first hospital to which she was taken.
They certainly should have LifeFli1c84ght'd her to Sacre-Soeur; of course, by the time the decision was made to take her there, it could have been to late to do anything at all.
What an enormous tragedy; and my heart certainly goes out to her family.
"As the Philosopher Jagger said, you can't always get what you want."

TIMETIMETIME WAS TICKING BY
I am a physician, and I can say that I thing FIRST thing I wondered was why they were schlepping her from the resort site out some 100 odd Kms north of Montreal to a (presumably) community-level hospital, one with probably little to no neurosurgical backup.Then there is the added time taken to transport her to yet another hospital (this one with obviously more neurosurgical capability).
As frustrating as these cases go, the paramedics are correct in that one can deteriorate extremely rapidly from a closed head injury. SOMEONE made the decision to transfer to to the smaller hospital, and, in addition to the turning away of the paramedics the first time, this was probably the next crucial mistake in judgment. The minute she showed signs of deterioration (which was documented as occurring while she was still at the hotel), she should have been CHOPPERED to the closest level 1 trauma center. Had this been done then, saving perhaps 3 1/2 hours to 4 hours off the entire drawn-out saga, I do have to wonder if her chances may not have been improved.
It really depends on what time the herniation of her brain (the swelling brought on by the bleed and the local trauma) started occurring. At that point it was a matter of minutes and seconds, not hours. My guess is that at the hotel, when she was conscious, but starting to become "unstable" (their words, not mine) should have been the tipoff to the imminence of herniation, and THAT is when a LifeFlight chopper (or its Canadian equivalent) should have been called to transport her to a proper trauma center. There, a decompression of the skull could have very quickly been undertaken and that may have made the difference between life and death.
It may have still been nip and tuck for her (no pun intended) - but I have to believe that had this been done, she would have had a better chance at survival.
As far as the helmet situation goes, well, in Quebec it is not mandatory (at least not now, but I'll bet that that's going to change!) And the helmet will only protect someone traveling at speeds up to about 15 MPH. If the tips get crossed, then the process of falling involves additional acceleration as one is tossed forward or sideways, and that little bit extra may or may not afford full protection. Can it hurt? No - but I think that it will be impossible to divine whether a helmet would have helped Natasha without knowing the specifics of the physics involved (her speed, how she fell, etc.)
I am heavy hearted to hear of the losb68s of this beautiful, classy, vivacious woman. My sincere condolences to Liam, her sons, and the rest of the family.

sevenof9fl,
if you go by the Globe and Mail, which seems to have done the best investigative work so far,
My digest of the G&M article:
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 load her by stretcher into the ambulance after tending 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.
Then it was about
6 1/2
hours between the time of the accident and her arrival at a location that could have saved her life!

Wow. An intense and troubling thread. I don't have much to add.
Sad confluence of events.
"Yes ma'am, I'll have a cup a coffee, but I can't eat no cake just now."

Humm.. SO.
2 hours between fall and 2nd Ambulance call
+/- 40 minutes to 1st Hospital - No neuro unit, I'm presuming. Stabilizing efforts completed.
+/- 50 minutes to Sacre Soeur Hospital for CAT/PET Neuro Analysis.
It would have been from 1pm, time of accident to 5pm before she was at a place for proper care; appx four hours.
Hummmm four hours is a lot of time for a bleed. It can be, if, as they say, there was a skull fracture involved with bone tearing a vein or artery.
It is possible to have small fractures that don't break the skin; the ME report did not reference that but then again it was very short on details.
I'm surprised they did not air ambulance her straight to Sacre-Seuer (sp?) if she so obviously had a serious head injury.
Do they not have that capability, I wonder? Oh no. Now I AM beginning to wonder wtf??
"As the Philosopher Jagger said, you can't always get what you want."

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

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

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.

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."