I have been reading more on the Natasha Richardson story overnight, and it appears the story has moved into blame-placing mode. (For the original discussion of the story, read this.)
Possible places to lay the blame (that I have read thus far):
- The absence of mandatory helmet laws
- Canadian medicine’s failure to administer rapid CTs
- Quebec’s inadequate air ambulances
- Inadequate patient education
More on these under the fold.
I said before about mandatory helmet laws (and many others said in the comments of the previous post) that while I don’t have a problem with mandatory helmet laws for children, I don’t think they should be enacted for adults. I think adults should be allowed to make risk assessments on their own. Furthermore, as many people have pointed out, a helmet might have saved this woman, but then again it might not have. Helmets can be effective for some things, but it would still be possible to get a deceleration injury with one. Further, there are lots of ways to get hurt on the ski slopes, and it would be unfortunate if helmets gave people the illusion of safety in what is a still dangerous sport.
With respect to the Canadian medicine/CT thing, I agree with MDOD a lot, but not in this case. If Richardson had been taken to the ER and languished there waiting for a CT, I would say that there was a medical system problem, but it doesn’t look like that was the case here. Rather, it looks like she felt fine and didn’t want to go to the hospital during what would have been a critical period for treatment:
Yves Coderre, director of operations at the emergency services company that sent paramedics to the Mont Tremblant resort, told The Globe and Mail newspaper that he reviewed the dispatch records and the first 911 call came at 12:43 p.m. Monday.
Coderre said medics arrived at the hill 17 minutes later. But the actress refused medical attention, he said, so ambulance staffers turned and left after spotting a sled taking the still-conscious actress away to the resort’s on-site clinic.
At 3 p.m., a second 911 call was made — this time from Richardson’s luxury hotel room — as her condition deteriorated. An ambulance arrived nine minutes later.
“She was conscious and they could talk to her,” Coderre said. “But she showed instability.”
The medics tended to her for a half-hour before transporting her to a hospital a 40-minute drive away.
Further, in trying to compare American and Canadian medicine, I have written before that American medicine exceeds other countries on some benchmarks, fails on others, and is equivocal based on differences in patient populations on still others. As a result, I certainly wouldn’t make a judgment based on this single incident, and in general I think that such comparisons are a waste of time.
Whether a helicopter would have saved her? I doubt it. Not unless she wanted to go to the hospital.
Which brings us to the issue of patient education. I am certainly not blaming this poor woman for what happened to her. Do I think she should have gone to the hospital? Yes. Is there any reason that she would have known that? No. And I understand the point of view of the paramedics in this case. You can’t force her to go in the ambulance, even if you very much think her life is at stake. She may have even thought that the ski resort was being excessively risk averse and trying to avoid a lawsuit. The real world isn’t like House: we don’t get to bully patients into doing what we want. We have to persuade them.
The sad fact of this situation is that majority of the public has no idea how head injuries work, how we treat them, and when a good time it is to go to the hospital. And it isn’t just head injuries. Otherwise healthy people — i.e. not elderly, not immunocompromised — come to the ER with the flu all the time, when there is not a damn thing anyone can do about them.
If there is one thing that should come out of this, it should be a greater awareness that even innocuous head injuries can be serious. Be safe, not sorry. If you have a head injury, have it checked out.
But that is just my two cents, what do you all think?