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April 9th, 2009
01:36 PM ET

Docs questioning Quebec's urgent care resources

[cnn-photo-caption image=http://i2.cdn.turner.com/cnn/2009/HEALTH/04/09/richardson.injury.timeline.gupta/art.natasha.richardson.gi.jpg caption="Actress Natasha Richardson died after suffering an epidural hematoma in a fall during a ski lesson."]

[cnn-photo-caption image=http://i2.cdn.turner.com/cnn/2009/HEALTH/04/09/richardson.injury.timeline.gupta/art.quintessence.hotel.cnn.jpg caption="An ambulance took Richardson from the Hotel Quintessence, above, to a nearby hospital."]

Ismael Estrada
AC360° Producer

Natasha Richardson came to Mont Tremblant ski resort in eastern Canada last month for what was supposed to be a skiing getaway.

But what she may not have known is some doctors have been arguing that if a person here is in need of urgent care at a medical trauma center, he or she may not be able to get there fast enough. The only way to get to the closest trauma center from here is to drive 2½ hours to Montreal. No helicopter medical service is available.

The Canadian newspaper The Globe and Mail obtained 911 recordings from Monday, March 16, when Richardson fell on a beginners slope on a sunny, clear day at the resort. The first request for help came in at 12:43 p.m., an urgent call that a woman had fallen on the slopes. That woman was Richardson. Seventeen minutes later, at 1 p.m., an ambulance arrived, but Richardson had been able to walk away from the fall and was headed back to her hotel room.

Ten minutes later the ambulance was told to stand down, the call canceled.

What Richardson couldn't have known is that she suffered an epidural hematoma. It's a condition where a blood clot forms between the skull and the outer layer of the brain. Too much pressure can cause brain damage and even death. Symptoms include dizziness, headaches and nausea.

"The person seems to be fine and walks it off, and that's one of the problems with an injury such as this," said Dr. Liam Durkan, a neurologist with the Montreal Neurology Institute. "Anytime there is any sort of process expanding in the skull, which is a closed space, once the symptoms are apparent, it can be a matter of 30 minutes to an hour to 90 minutes before there is a major deterioration."

Two hours after her initial fall, while Richardson was back in her hotel room, she was feeling the symptoms. The clock was ticking and she needed to get to a trauma center fast. With the closest trauma center 2½ hours away, time may have been running out on her. It's recommended that anyone with an epidural hematoma get to the trauma center within 30-90 minutes.

At 2:59 p.m., another ambulance was dispatched to the resort. This time, the paramedics went inside and worked on Richardson for 33 minutes before transporting her to the closest hospital an hour away, but it is not a trauma center. Inside the ambulance, Richardson drifted in and out of consciousness.

"It is a rapidly deteriorating situation and the distance might have been just too much by ambulance, road ambulance or air ambulance. It's difficult to say," said Durkan, who did not treat Richardson. Depending on the severity of the injury at the time, he said, even helicopter services may have been too late.

Some trauma doctors have argued for air transport here since the mid-1990s. They say the safest and fastest way to move anyone suffering a trauma injury such as Richardson's is by helicopter. Helicopter transport is common practice in the United States and other areas of Canada. But in the Quebec region, very few places have access to air transport.

In an open letter to the citizens of Quebec sent to the Montreal Gazette, Dr. Michael Churchill Smith, director of professional services at the Montreal General Hospital, said incidents like Natasha Richardson's should serve as a wake-up call to Quebec. "It is no longer morally acceptable for our citizens who, in the moment of their greatest needs, do not have access to a rapid transit system that gives them the best chance to not only survive, but to survive with a quality of life."

Daniel LeFrancois, director of Quebec's pre-hospital care, told the Gazette that cost is prohibitive when a one-hour flight costs $6,000. It's a question of resources and priorities focusing on "the biggest gain for the biggest need," he said.

Richardson was taken from Mont Tremblant to a hospital in St. Agathe, which does not have the facilities to help someone with a severe head trauma. Richardson was transferred to the trauma center in Montreal about 7 p.m., more than six hours after her initial fall. Twenty-four hours later she was flown to a New York hospital, where she was taken off life support and died.

No one can answer the question whether a helicopter service could have saved Richardson's life. She refused services immediately after her fall, but with the clock ticking immediately after she felt symptoms from her injury, 2½ hours may have been too far away even if she'd gotten help immediately.

soundoff (13 Responses)
  1. Annie Kate

    Everyone skiing should wear a helmet, especially beginners and children. She should not have been allowed on the slope without one. Even with a helmet though she should have been checked out – unfortunately though you can't force a person to get medical assistance if they refuse, thinking they are fine. I don't think she would have made a different decision knowing the distances; the fact was that at the time she felt fine. It was just unfortunate that she really wasn't. I feel for her family and hope that they are doing ok.

    April 9, 2009 at 8:38 pm |
  2. David, Indiana

    Very sad to go over the details of this heartbreaking event. If we are going to take up the topic of how available emergency care is in this part of Quebec, we should consider the many areas, probably in Canada, and in the US that lack ready access to sophisticated emergency care. Some places even have shortages of doctors. There are a lot of needed improvements yet to be made to our healthcare system.

    @Canadianmom I can't imagine anyone ignoring an SOS in the snow by a ski resort. Don't the ski patrol people automatically look into any distress signal?

    April 9, 2009 at 8:15 pm |
  3. Michael B

    I think it is silly to bring up the point of whether Quebec should have air transportation or more trama centers without focusing on the fact that maybe beginner skier's and children should wear helmets.

    I believe a $50-$80 per person cost (the average price of a New helmet) should be addressed BEFORE addressing $6000 air transportation (per person). I am sure that many of the trama related injuries began on or near the slopes during this time of year.

    I do not believe she is the first person or celebrity for that matter to pass as the result of head trama caused from a skiing accident.

    My thoughts.

    April 9, 2009 at 4:19 pm |
  4. Arthur Grynspan

    How often are we mildly injured and tell everyone we are all right? Didn't she refuse to be helped? Didn't she laugh it off? The ski patrollers were at here side in minutes, but she denied any offer of assistance. The real root of the problem is the same as it is everywhere – money! Money for the diagnostic tools at hospitals, money for doctors to be on standby, money to helicopters, money, money, money. This is not unique to Quebec where you can walk into a hospital and walk out without spending a penny for the care you receive – no questions asked. How many Americans can do that at any of their local hospitals? Accidents happen and people will die – and if every government had tons of money, perhaps fewer people will die. But don't take one case and whitewash the whole system.

    April 9, 2009 at 3:51 pm |
  5. Canadian mom

    Not too long ago a lady died when several SOS messages in snow over the course of weeks were ignored near a ski resort, dismissed as a prank. So very, very horrible. Her husband managed to survive.

    April 9, 2009 at 3:37 pm |
  6. Canadian mom

    Not too long ago a lady died when a several SOS in snow over the course of weeks were ignored near a ski resort and dismissed as a prank. So very, very horrible. Her husband managed to survive.

    April 9, 2009 at 3:36 pm |
  7. Phatgemi

    Well you would think such a "great" medical system they have in Canada would be better prepared!

    April 9, 2009 at 3:30 pm |
  8. Tina Autry

    I agree with Marian. I wonder if she had known about where the nearest level one trauma center is located and how long it would take to get there, if she wouldn't have made a more catious decision. We will never know. My thoughts and prayers go out to her family.

    April 9, 2009 at 3:24 pm |
  9. Joanne DeVries

    The fact of the matter remains that emergency medical help was called and arrived in sufficient time to help Ms.Richardson...and SHE sent them away. In Canada as in the USA, a person cannot be forced to seek medical treatment against their wishes. If she had accepted the treatment the first time the paramedics came then she would most likely be alive today. The ultimate responsibility for her death does lie with a decision that she, herself, made.

    April 9, 2009 at 3:22 pm |
  10. Marian B.

    This story makes me really sad!! She should have been told by ski resort officials or paramedics about the distance to a trauma hospital and the urgency to be checked out to make sure she was okay. She may have changed her mind if she knew all the details.

    April 9, 2009 at 3:12 pm |
  11. Stan

    In Regards to the Sea Pirates: Secertary of State Hilliary Clinton and President Obama along with our alies, need to deal with these type of people in the most direct ways possible. We can not ever allow these type of people to think they can just take a ship over and hold the crews and the ship for ransom.

    April 9, 2009 at 2:50 pm |
  12. DC Addict

    I never liked MONT Tremblant – too cold and too crowded the times I was there ... there WAS something NOT nice about the how area or something.

    April 9, 2009 at 2:32 pm |
  13. Michelle Johnson, Lomita, CA

    Much attention is focused on obtaining helicopter medical service at the ski resort because Natasha was a celebrity. There must be similar cases in the resort's history where the deceased were not high-profile people. Media should address such problems when the fatal accidents happen to anyone, not only to celebrities. The implication seems to be that a prominent person's life is more important than others.

    April 9, 2009 at 2:19 pm |