Would Natasha Richardson survived if she would have been in US?

[yeartolate]

An epidural bleed is an arterial bleed....bottom line is that even if immediate surgical intervention is at hand, the patient will rarely survive. This isn't a little brain bleed, this is a massive bleed.

We're talking extremely short time periods(minutes, not hours) to intervene for any chance of survival.

Exactly. She would not only have needed to have the appropriate diagnostic treatment, but the neurosurgeon immediatly available - that is a tall order - that is not just a Canada issue!

 

[yeartolate]

Very true. My aunt works at a small hospital near a few ski resorts and often they can't treat people with more severe injuries. But the hospital has access to an air ambulance system.

And realistically, she wouldn't have accepted the air ambulance at the time of the injury either.

 

[Qtips4Mick]

Hard to say since the original paramedics were turned away.

Once the amount of blood seeping into the brain gets to be too much, it doesn't matter where you are, the damage is done.

Agreed.

 

[manning]

Are you also aware that smaller community hospitals in the US may have the same delay? It is not uncommon for a small community hospital to have only a CT and no MRI? Some do not even have MRI! It would take in addition to that a neurosurgeon immediatly available (with a surgery suite and staff at the ready).

If you think that kind of care is immediatly aailable in all areas of the US, you are mistaken.

We live in a small community with a small community hospital. My mom is chronically ill. When the amblance picks her up, we take the risk to send her 15 minutes away to the better equipt hospital.

People die here as well for lack of immediate service.

But I will grant you if she had the accident by a full service Colorado hospital she would have stood a better chance. But to think it could not and does not happen here on a regular basis is wrong.

We were in several rural areas where we saw medivac helicopters arrive at major highway crashes.

You are seeing more air medivac services popping up.

 

[Stacerita]

Its a hard call if she would have survived in US instead of the accident in Canada. There are too many vaiables involved.

 

[TheZue]

From the article, it seems that problem is the Canadian healthcare system dictates what technology is available at each hospital. A CT scanner is a very common diagnostic device readily available at many US hospitals, even small ones.

The federal Canadian governement does not dictate what technology is available at each hospital. The provinces actually decide how much funding is available and the hospitals make the decisions from there. On top of any government funding they often run lotteries that supplement their cash flow a lot.

The big problem here was really 1) the ambulance service was atrocious. I'm across the country but I've never experienced anything like that. I also wonder how much the ski resort had to do with the delays...they've gone out of their way to say it was a minor fall etc. 2) for some reason the Montreal hospital doesn't have a heli pad which I don't get. I'm in a town 1/5th the size of Montreal and we have one. Not only that helicopers can land pretty much anywhere, they could have flown her to a close park and driven her from there. This seems more like a transportation issue than anything.

Our local hospital in a much much smaller area does have MRIs and CT scans, I can't figure out what the heck is going on in Quebec. Had she been in New York would it have been different? Who knows.

 

[goofy!]

There are some news reports that Natasha Richardson may have survived her ski accident had she been in the US, rather than in Canada and the CanadaCare System.

http://www.nypost.com/seven/0326200...canadacare_may_have_killed_natasha_161372.htm

According to the story, Richardson arrived conscious at the hospital, but the local hospital did not have the ability to do a CT scan to diagnose the problem due to rules in CanadaCare about what services different hospitals can provide. Further, CanadaCare does not support air ambulance in Quebec, so Natasha had to be transported to Montreal via regular ambulance, resulting in an additional hour delay before she could be diagnosed and treated.

The story says that if the accident had happened at a Colorado ski resort, that the local hospital would have had the ability to do a CT scan and then also had the ability to transfer by air to a trauma center in Denver for immediate treatment.

I think it is pretty much a crap shoot in Colorado too. My son recently broke both his wrists snowboarding. He was sent down the mountain to our local hospital for x-rays. His wrists were splinted with cardboard, bubble wrap and duct tape.Not even an ace bandage or tape out of the emergency kit. It worked perfectly but they did not have the means for even an x-ray or really, proper medical supplies. This was a very popular slope, although not one of the big ones like Breck, Copper or Vail. Much more like the resort Richardson was at.

And with the air ambulance service, that is also dependent on weather. Flight For Life has to come from Denver. If the weather is bad over the divide, they can't get to the major slopes. There are plenty of times that the air ambulances are grounded. That leaves a 1.5 hour drive down the hill if it is not Sunday afternoon when everybody is leaving.

Unfortunately, plenty of people have died on our slopes. Our system is not perfect. If we had never had a skiing fatality on our slopes, then maybe you could suggest she might have lived.

 

[yeartolate]

We were in several rural areas where we saw medivac helicopters arrive at major highway crashes.

You are seeing more air medivac services popping up.

She would have had to accept the service. As she turned away emergency services when initially offered.

But medivac has to take the person to a place that had a neurosurgeon on the ready.

I do not chalk it up to Canada...I chalk it up to her luck sucked that day.

 

[DznyLvr2005]

Probably same outcome in the US if she still refused hospitalization.

 

[wowsmom]

I really am not a fan of Monday-morning quarterbacking of this sort. It won't bring her back and it's not going to save anyone else's life, so I'm not sure what the point is other than to start a diatribe against managed health care as used in Canada.

My thoughts exactly. It won't bring her back and it sure won't make her relatives feel any better.

 

[Kickapoo Joie Juice]

And realistically, she wouldn't have accepted the air ambulance at the time of the injury either.

I also wonder at the ambulance people-here in the US I've seen them really bully people onto the ambulance who insisted "I'm fine" (at a car accident that I was a witness to).

I wonder if they would have even let her refuse it...

 

[DawnCt1]

Of the 33 acute care hospitals in Ct, all of the have CT scanners, which is what would be needed to diagnose her epideral hematoma. So yes, I think she would have survived had she been injured in most areas of the United States. Rather than risk the hour's drive, attempting surgery for what, clinically seemed to be an epideral might have been useful as well. Even if the small hospital didn't have a helipad, a chopper can land anywhere. The ambulance could have met it five minutes away. I don't think that this very survivable injury was handled well.

 

[CowboyCO]

When my DW's water broke at 30 weeks, we rushed to the hospital. It was a rural hospital in Wyoming and they did not have NICU facilities there, so they told us they had called for flight for life and they were going to work to stabilize her & the baby until we could get to Denver.

But they do have an MRI, CT, X-ray, etc.

I think the major point of the article is that Natasha came to the hospital conscious and that if conscious and properly diagnosed, the prospects are good for survival. The author, who is an American doctor, seems to think that the lack of CT, combined with no available flight for life, were major contributors to her death.

There are some Colorado ski resorts that are more remote, like Crested Butte, and Wolf Creek are not that close to hospitals, but flight for life is available throughout the country.

As for the Conn. state government dictating what type a care a hispital can provide? I'd need to see a link. The government doesn't dictate medical care and never should. (This is not to open a poltical debate -- just a statement.)

 

[yeartolate]

Of the 33 acute care hospitals in Ct, all of the have CT scanners, which is what would be needed to diagnose her epideral hematoma. So yes, I think she would have survived had she been injured in most areas of the United States. Rather than risk the hour's drive, attempting surgery for what, clinically seemed to be an epideral might have been useful as well. Even if the small hospital didn't have a helipad, a chopper can land anywhere. The ambulance could have met it five minutes away. I don't think that this very survivable injury was handled well.

But didn't she initially refuse emergency care? She has to accept the help in a timely manner to get the help.

Also, do all the hospitals with scanners in your area have a neurosurgeon attached to it? Diagnosing it does little good if you cannot treat it correctly.

That is very nice that you have very well equipt hospitals in your area, but I can tell you with absolute certainty that every hospital in every state is full service.

 

[declansdad]

There are teo many variable to give an answer to your question, the first being she refused treatment.

How many hospitals in small communities (9000 in this case) would have a neurosurgeon in the hospital?

 

[TheZue]

Of the 33 acute care hospitals in Ct, all of the have CT scanners, which is what would be needed to diagnose her epideral hematoma. So yes, I think she would have survived had she been injured in most areas of the United States. Rather than risk the hour's drive, attempting surgery for what, clinically seemed to be an epideral might have been useful as well. Even if the small hospital didn't have a helipad, a chopper can land anywhere. The ambulance could have met it five minutes away. I don't think that this very survivable injury was handled well.

All of our hospitals in our health authority jurisdiction have CT scanners here too, I got curious and looked. Even our towns that only have 15k people have them. But I really don't understand how Monreal, the third largest city in Canada didn't have a heli pad. It is absolutely bizarre. We've got one on EVERY hospital here.

What I'm thinking is there might be a translation issue here in terms of what she originally went to. Our smaller comunities have health clinics that are basically walk in clinics, they are NOT hospitals. The first place she was taken to was "Hospitalier Laurentien" (Hospitalier translated to Hospital worker on the translater I used) and the main hospital she was taken to in Montreal was called "Hopital Sacre Coeur"...it sounds to me like the first place she was taken wasn't even an actual hospital. But what SHOULD have happened at that point was that they call Montreal and get a helicopter there to transport her.

 

[DawnCt1]

But didn't she initially refuse emergency care? She has to accept the help in a timely manner to get the help.

Also, do all the hospitals with scanners in your area have a neurosurgeon attached to it? Diagnosing it does little good if you cannot treat it correctly.

That is very nice that you have very well equipt hospitals in your area, but I can tell you with absolute certainty that every hospital in every state is full service.

She was conscious when she got to the first hospital. It should have been obvious to EMS that she had a traumatic head injury and arrangements should have been made on the spot for air transport. Do all hospitals have a neurosurgeon attached? Yes, they can be called in for emergencies. DH pointed out that burr holes are drilled all of the time in Iraq, but to do a burr hole you need a CT scan. They had an oncology surgeon who often did them in emergencies. It would seem that a hospital near a ski resort would be somewhat prepared to handle head injuries.

 

[DawnCt1]

All of our hospitals in our health authority jurisdiction have CT scanners here too, I got curious and looked. Even our towns that only have 15k people have them. But I really don't understand how Monreal, the third largest city in Canada didn't have a heli pad. It is absolutely bizarre. We've got one on EVERY hospital here.

What I'm thinking is there might be a translation issue here in terms of what she originally went to. Our smaller comunities have health clinics that are basically walk in clinics, they are NOT hospitals. The first place she was taken to was "Hospitalier Laurentien" (Hospitalier translated to Hospital worker on the translater I used) and the main hospital she was taken to in Montreal was called "Hopital Sacre Coeur"...it sounds to me like the first place she was taken wasn't even an actual hospital. But what SHOULD have happened at that point was that they call Montreal and get a helicopter there to transport her.

Absolutely. Perhaps the "breakdown in care" started with EMS.

 

[TheZue]

Absolutely. Perhaps the "breakdown in care" started with EMS.

I'm wondering if there was a massive language barrier as well, there are a lot of people in Quebec that don't speak English. Either way the responsibility falls with those who chose to transport her slowly. It's not the norm here either which is so sad.

A few years ago a friend of ours was playing football and by shere fluke he hit another guy helmet to helmet and was paralyzed when his spine stretched forward and ended up closer to his trachia. He was moved over to our local hospital within minutes and then within an hour he was on his way to Vancouver in a helicopter. It was fast. He has had a great outcome as well, he went from not being able to use his hands to walking with a cane It's just too bad that the people involved in this case didn't move as fast.

 

[declansdad]

All of our hospitals in our health authority jurisdiction have CT scanners here too, I got curious and looked. Even our towns that only have 15k people have them. But I really don't understand how Monreal, the third largest city in Canada didn't have a heli pad. It is absolutely bizarre. We've got one on EVERY hospital here.

What I'm thinking is there might be a translation issue here in terms of what she originally went to. Our smaller comunities have health clinics that are basically walk in clinics, they are NOT hospitals. The first place she was taken to was "Hospitalier Laurentien" (Hospitalier translated to Hospital worker on the translater I used) and the main hospital she was taken to in Montreal was called "Hopital Sacre Coeur"...it sounds to me like the first place she was taken wasn't even an actual hospital. But what SHOULD have happened at that point was that they call Montreal and get a helicopter there to transport her.

That still doesn't mean it would have been different if this was in the US. This could have happened anywhere.