In the ideal world this is true...but there are MANY small rural hospitals in the US that do not have neurosurgery access and have family practice MD's running the ED. Not to mention a CT scanner running 24 hours a day if they even have one. I have been a flight nurse for 5 years on a medical helicopter and prior to that worked in a level 1 trauma center in our area. You would be surprised on how many ED's are run by non ED trained physicians.
With a epidural head bleed, she had CLASSIC symptoms (in fact when I heard the news..I turned to my husband, also a flight paramedic, and we both said she had a epidural). By the time she started having sign of neurological changes, the damage was already beginning. She was too far away from someone that could do any type of intervention. The CT scanner wasn't going to save her life...the neurosurgeon was. You would be surprised how often this same scenario happens in the US!!