April 8th, 2009
01:44 PM ET

Calculating the risks of skiing in Quebec

Program Note: Tune in to hear more on Dr. Sanjay Gupta's report Thursday on AC360° at 10 p.m. ET.

A view from the base of the Mont Tremblant ski resort in Canada.

A view from the base of the Mont Tremblant ski resort in Canada.

Dr. Sanjay Gupta
CNN Chief Medical Correspondent

I just returned from Mont Tremblant, Canada. It is one of the more beautiful ski resorts in eastern, Canada, and it is also the place where actress Natasha Richardson fell and suffered a fatal brain injury. What caused her death is now well known, but there were some other details that struck me while I was there. Let me try and work through this with you.

What no one knew at the time was that she had hit her head hard enough to cause a fracture in her skull. Just underneath that fracture is a small blood vessel that runs just on top of the brain, and it was that blood vessel that started to bleed. By many reports, Richardson got up after her fall and felt well enough to go back to her room and wave off paramedics who had been called. In neurosurgery, we refer to this as a lucid interval. She may have lost consciousness briefly, but now felt fine. The problem for Natasha or anyone with an epidural hematoma is that the pressure continues to build up in the brain.

A little while later, now in her room, Natasha started to feel sick. The most likely symptoms were headache, nausea, disorientation and lethargy. 911 was called again, and now the clock was definitely ticking. If you ask a dozen neurosurgeons, how much time someone has after starting to develop the symptoms Natasha had, you will get varied answers. Anywhere from a few minutes to 90 minutes, but the message is the same: Speed matters. The problem for Natasha was she was 2.5 hours away from a trauma hospital by ambulance, and there was no helicopter available to take her more quickly.

By the time she got to the hospital, too much pressure had built up on her brain and we know she died 24 hours later. The medical care in Canada is world class and the neurosurgeons there could have performed a lifesaving operation, if only she had arrived sooner.

There are doctors in Canada who have been calling for more air ambulances, long before we learned about Natasha Richardson. Others argue that the cost-benefit analysis comes down on the side of not having them.


Filed under: 360° Radar • Dr. Sanjay Gupta • Health Care • Ismael Estrada
soundoff (11 Responses)
  1. Michel Montreal, Quebec

    I agree some of the comments above. You failed to mention that Mrs. Richardson was not wearing a helmet. Doing so would have saved her life. And the Montreal hospital were she was transferred is at the most 75 minutes away by ambulance (and probably far less). While Mrs. Richardson's death was very sad and tragic, your report, sadly, simply did not give the real facts to the viewers.

    April 10, 2009 at 12:21 pm |
  2. Barry-Mansfield,Ontario

    I appreciatethe that Dr.Gupta has done a follow up report on the Richardson accident. As Mike,from Westmount, pointed out in the blog ,some of travel time frames may not have been correct, however, the important fact is that Richardson would most likely be alive today,if the people around her were aware of the seriousness of any head injury.
    I think CNN has done an admirable job of educating the general public on the dangers of such a fall and symptoms that may occurr shortly afterwards. I am also disgraced as a Canadian,to hear in Dr.Gupta's report ,that our government would not return a phone call to CNN
    to at least offer a "no comment". It seem's that "the old method" of "if we ignore them ,they will go away", prevails here in Canada.
    Not very admirable of a government who has spent over 70 million in the Mt.Tremblant area to make it a world class ski destination,and who has come up short on the medical side of the equation.

    April 10, 2009 at 12:20 pm |
  3. Danny - Lindsay, Ontario

    It appears that Dr. Gupta's intimation that the Canadian (Quebec) Health Care System and Mont-Tremblant are somehow responsible is unjust. His narrow sighted, poorly investigated, politically motivated commentary was a slight on both the Country of Canada and its Citizens.

    I don't believe that it is fair to Natasha Richardson's family to be playing the "what-if" game. This was a very unfortunate accident inherent to the sport of skiing. The blame should not be placed on anyone or anything specifically. I truly believe that CNN reports fair and accurate journalism, however, I was disappointed with the need to lay blame by Dr. Gupta.

    April 10, 2009 at 12:16 pm |
  4. Francois Nadeau, Montreal, Quebec

    3 things i have to say:
    -She had no helmet on.. Almost everybody that ski in Quebec wears a helmet
    -It does not take 2 1/2 hours from Mont-Tremblant to Montreal.. were did you got that info???
    -People at Mt-tremblant insisted that she goes to the hospital.. she was lucid and she refuse.. she s the one to blame
    -obviously, you are calling the wrong people in the gouverment to get your info..
    I have always like your show but if you give wrong info like that to the public.. is that the same with the others news?

    April 10, 2009 at 9:52 am |
  5. Lynn

    The piece on last night's program provided no new information - certainly not enough to warrant a ski resort junket by the good doctor and his camera crew - ostensibly in the name of public awareness. Why not let the poor woman rest in peace?

    April 10, 2009 at 9:49 am |
  6. Tim -B.C. Canada

    Sadly the topic of the day showed to be "Calculating the risks of skiing in Quebec" and less about Natasha Richardson's passing, the simple and sad fact is that someone fell injured themselves and died from the injury later on. It was simply really,really bad luck. No one to blame, she wasn't pushed. Things of course could have been done to prevent her death but that is true anyone who has died before their time. Some precautions were taken: paramedics were immediately dispatched and called off, some were not: no helmet and no armour were worn. Either way other things could have been done to prevent this loss of life. In this case no one can blame the deceased; but there is no need to blame any other factors. Sadly this story lost focus.

    April 10, 2009 at 6:15 am |
  7. Mike - Westmount, Quebec

    An objective assessment of what led to this tragedy is fully warranted but sensationalizing the apparent lack of air service in Quebec, in this case, is simply poor journalism. I live in Montreal and have a chalet at Mont-Tremblant so I can state with absolute certainty that the nearest trauma centre to Mont-Tremblant is not 2 1/2 hous away but only one hour and fifteen minutes at normal highway speed. An ambulance with sirens blaring would probably reach Sacre-Coeur Hospital in about an hour. I have no expertise in this subject but suspect that if you consider the preparation time required to get an ambulance in the air any saving in time would not have been significant. The sad truth is that an arguably preventable series of events led to Natasha Richardson's death – what if she had worn a helmet, what if the first ambulance had not been waived off, what if the second ambulance had opted to by-pass the Ste-Agathe hospital (which is only 40 minutes and not one hour away as reported by CNN) and had gone directly to Montreal. Hours and a life would have been saved even without an air ambulance.

    April 9, 2009 at 12:32 pm |
  8. Virginia

    I agree with the previous comment that a helmet should be worn during extreme sports. The other point that I feel like you are not "investigating", after following the story of how a ski lesson lead to the death of Natasha Richardson's, according to the news stories, is that after her initial fall paramedics were turned away when they came to check on her. I believe, helicopter or not, they would have been able to access the situation and have come to a conclusion that she should have been taken to the hospital sooner than she was. I am not putting the blame on anyone here, but frankly there are countries all over the world where a paramedic, hospital or doctor isn't even something that can be considered. If you want to investigate something, how about you investigate the lack of health care for the peoples of the world that can't afford it, rather than those who have it and still complain about the lack of it.

    April 9, 2009 at 10:26 am |
  9. Vicky

    Thanks for the 360 folo. Tremblant is one of my favorite places in the summer and fall, and driving the back roads from Ottawa, I'm very aware that it's distant from major centres. While I'm used to medical helicopters from Ottawa flying in the Ottawa region, I had always assumed that there was a similar system in Quebec. There are also great trauma centres in Montreal and Ottawa, so it's such a tragedy that Natasha Richardson was relatively close and yet so far from specialized services. In such distant areas, I guess it's best to be extremely cautious if you even suspect a head injury. I expect each year that there are others who need trauma-related care, either from serious falls, or head injuries, at Tremblant and other resorts in the Laurentians.

    April 8, 2009 at 2:54 pm |
  10. Cheryl - Fonthill, Ontario CAN

    I agree that air-ambulances should be made available, but let’s not forget the importance of wearing a helmet while skiing.

    Maybe there would be less need to emergency air-ambulances if it was law to wear a helmut skiing for adults as well as children.

    April 8, 2009 at 2:37 pm |
  11. Monika

    Skiing is an extremely dangerous sport. People who engage in extreme sports cannot have the expectation of having the most expensive medical care available at the expense of society while other people who are just trying to survive on a daily basis are being refused the most basic medical services.

    This is not something one should have to ponder; it's common sense.

    April 8, 2009 at 2:15 pm |