A helicopter medevac, if available, would have been quicker, presuming patient cooperation and immediate availability of the equipment.
A second call for an ambulance went out about 3 hours after the fall at which point her condition was deteriorating. That ambulance responded within 45 minutes (about the same response time or less than a helicopter called from another locale). Within a few minutes she was at the local hospital which lacked neurosurgical facilities. It took another two and 1/2 hours to get her to the referral center in Montreal.
With a helicopter the last two and 1/2 hour transit time could have been cut in half and the outcome possibly altered, but that is uncertain considering the initial delay and her deteriorating condition.
We shouldn’t be too certain that speed of transfer would be better in the U.S. In Illinois, for example the mean time to transfer emergent cases is a mean of 5 hours 42 minutes as noted below:
“Two-hundred thirty emergent neurosurgical transfers occurred during the study period. The most common diagnoses were parenchymal intracerebral hemorrhage (33%) and subarachnoid hemorrhage (28%). Sixty-six percent of neurosurgical transfers to academic medical facilities originated at hospitals without full-time coverage. The mean time to transfer for all patients was 5 hours 10 minutes (standard deviation, 3 h 42 min; range, 1-20 h 12 min). A decline in Glasgow Coma Scale score was seen in 29 patients. A shortage of neurosurgical intensive care unit beds occurred on 55% of the days in the study. only 19% of emergency cases were related to cranial trauma, and only 3% of transfers came from level 1 trauma”
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For some reason, it makes my blood boil to hear such things as: “If there were a helicopter based system it’s likely that she would have refused that as well.” Blame the victim. How easy one escapes from the blaringly ineptness of the Quebec EMS system. It is a fact that time is what matters in cases of TBI. It is a treatable condition if attended to in efficient manner. She didnt stand a chance without air EMS, plain and simple. You wont see me taking my family skiing in Quebec.
I hope this brings about changes to Quebec such as having air EMS or at least a surgeon on call to the ski resort’s local hospital to perform burr holes when indicated.
Quebec’s emergency system is an outlier and needs to improve. It’s slowness certain was a major part of the problem. But a patient’s decision to forgo suggested interventions also needs to be examined.
For example, in oncology, patient denial of a lump in the breast or use of alternative ineffective therapies that delay definitive treatment may contribute to poor outcomes. Is that blame the victim?
No that is not the same thing. Apples and oranges. Your cancer patient is informed and she has a right to choose. A person who falls on a ski slope and hits their head is a potential brain injury. Are you going to just accept “No Im fine” and walk away? Or would you linger making sure she understands that some brian bleeds have no signs at first and a person needs to know what to look for to call 911? Bottom line is, her initial refusal should not have been a death sentence. In other areas of Canada than Quebec and in the US, she would have been airlifted and had better chances of surviving.
A patient who feels a breast lump and delays treatment is most often uninformed and in denial, hoping it’s not anything serious and that it will go away. Believe me it happens several times a year in our community.
In this case Natasha Richardson declined the initial offer of transfer to a medical facility, apparently believing that she was fine. The staff there were worried enough to keep her under observation and when she later developed symptoms the second ambulance was called.
There is no question that she would have been better served if there were no delay and she had been taken for care immediately by ambulance and/or aeroevacuated.
This was a disaster for all concerned but