Did the Canadian health system fail Natasha Richardson?

Would Natasha Richardson be alive today if she had gone skiing in the United States instead?

I don’t think it would have made a difference.

To recap the tragedy, Ms. Richardson died from an epidural bleed, after she fell while skiing. Her presentation was somewhat classic, with the well-described “lucid” period before she deteriorated.

According to Canada’s Globe and Mail, “ambulance workers were not called to Ms. Richardson’s luxury hotel room until more than two hours after she tumbled and hit her head at the Quebec ski resort.” It should be noted that an initial ambulance was refused and sent away, some 17 minutes after her fall.

After picking her up from the hotel, there was a 40-minute drive to the community hospital, the Centre Hospitalier Laurentien. She did have a CT scan there, and the decision was made within 2 hours to transport her to a tertiary care center, another hour away in Montreal.

She later died from her epidural bleed.

Epidural bleeds are treatable, by drilling a hole in the skull to relieve the pressure from the bleed, and often results in complete recovery. However, time is of the essence, and some are wondering if Ms. Richardson would have fared better Stateside.

Blogger Dr. T has been commenting on the case, and notes that, “In the United States, we pay a lot for health care, but that care is widely dispersed, into communities, with high-level diagnostic and therapeutic options available in fairly wide-flung areas.”

But in remote resort areas in the United States, small community hospitals would likely lack neurosurgical coverage. In fact, because of the huge malpractice risk associated with the field, even if there was a neurosurgeon available, whether he or she would take emergency call at a community hospital would be in question.

It is very likely that Ms. Richardson similarly would have been transported to a tertiary care center if her accident happened here. The difference, however, is that I think she would have been flown by helicopter, rather than taking hour-long drives by ambulance.

Would that have made a difference? Perhaps, but that can’t be a huge factor.

The biggest loss of time was when the initial EMS response was declined, the fact that several hours passed before a CT scan was performed, and the delay before making the decision to transport her to a tertiary care center in Montreal.

Those delays could conceivably happen in the United States as well.

Update 3/21:
As a speculated earlier this week, the fact that Quebec does not have some sort of med-flight system is coming into focus. Says Montreal’s top trauma doctor:

“It’s impossible for me to comment specifically about her case, but what I could say is … driving to Mont Tremblant from the city (Montreal) is a 2 1/2-hour trip, and the closest trauma center is in the city. Our system isn’t set up for traumas and doesn’t match what’s available in other Canadian cities, let alone in the States,”

And, over at Kennedy’s Tumor, the fact that Canada is tremendously short of neurosurgeons stands in start contrast to the United States. Did this “artificially created shortage of subspecialists” play a role?

Finally, Dr. Crippen from across the pond in the UK, blames the American wussification of today’s doctor, saying that the brave physician would have drilled the burr holes without the benefit of a CT scan:

It would be a career making or career breaking decision. Few American doctors are brave. Defensive medicine is the order of the day. You cannot have a migraine in the USA without someone ordering an MRI scan.