Friday, March 20, 2009

Ski Accident Highlights Risk of Brain Injury

Natasha Richardson

It would appear to be true that Natasha Richardson could have been saved after her fall if she had been treated faster. But exactly who turned away the first ambulance is an unknown detail, as is why more attention isn't given to details of her injuries.

Most troubling was the general news:

...There is no helicopter or airplane-based ambulance service in the Laurentian hills where Mont Tremblant is situated.*

She and those around her must surely not have understood the urgency of the problem. If she had asked about emergency services, she might have suspected that she couldn't receive quick and aggressive medical treatment. But she probably didn't know the possible consequences.

.... Mont Tremblant frequently calls for ambulances after skiers experience minor falls. And just as frequently,...the ambulances are turned away*....

How many others suffer a similar fate after leaving a ski site accident?

Ms. Richardson, who suffered an epidural hematoma — an accumulation of blood between the brain and the skull — after her fall, could have been saved had she been treated faster.

A brain surgeon not involved in her treatment, Dr. David J. Langer, the director of cerebrovascular neurosurgery at St. Luke’s-Roosevelt Hospital, Beth Israel Medical Center and Long Island College Hospital, said that a clot can develop from the bleeding following such a trauma.

Dr. Langer added that if a patient undergoes surgery — ideally within an hour of the injury — to relieve the pressure, remove the clot and stop the bleeding, the patient can recover.

“It can be quite dramatic,” Dr. Langer said. “It’s one of the most acute neurological emergencies. It’s one of the few times where it’s life or death, where you can truly save somebody’s life, or they die if you don’t get to them.”*
The New York Times

Bonnie Fuller's wonderful blog entry at HuffPost gives three results of a head injury and hers was found to be the third:

1. "She may have a fairly rare underlying hematology condition called hypocoagulation, in which she lacks a blood clotting factor," says Dr.Sun
[neurologist Dr. Dexter Sun, who practices at New York Presbyterian Hospital/Cornell in New York City]. This could be a genetic factor which had gone unnoticed throughout her life until now. When the clotting factor is missing, a minor bleed can become a hemorrhage.
2. It's possible that Natasha could have been taking a blood thinner like coumadine, for another medical condition, that would have made it much more likely for her to bleed after any head injury, according to Dr. Sun.

3. Finally, and most likely, she did have a harder spill than what has been reported. Sometimes when this happens "you can have a high level cervical spine fracture or a fracture at the base of the skull," says Dr.Sun. When this occurs, and the injured person continues to move around as Natasha did -- not realizing that she was seriously hurt -- the spine can touch the brain stem and cause a severe brain injury.

The third result, which is what an autopsy ruled was the case with Natasha Richardson can itself cause three types of injuries:

A high impact fall on the head can also cause three different types of bleeding within the brain: 1) an intracranial hemorrhage, which begins as a microscopic rupture of a blood vessel deep within the brain, 2) a subdural hematoma, which is a bleed that occurs in the dura, which is the outer layer of the brain, or 3) an epidural hematoma, which is a hemorrhage, that takes place between the outer skull and the dura.*
*The Huffington Post article

While this could be useful information to anyone with a head injury, my intention is not to frighten my reader, or my friends who ski, and some who ski at Mont Tremblant....

But my burning question is, would other ski resorts have saved her, possibly by operating on her within the hour? Which resorts can offer that assurance of quick surgery when called upon?

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