Could Natasha Richardson Have Lived if She had Access to a Medical Helicopter?

Yes, we all know that Natasha Richardson refused a helmet. Yes, we all know she refused medical treatment when she first fell.

However, once she did collapse, could she have been saved if she had gotten to a trauma center faster?

When Natasha Richardson collapsed, the ski resort called an ambulance that took her to the local hospital. That local hospital knew after examining her that she needed care that they didn’t have. That’s not unusual for small hospitals.

The problem is there isn’t a medical helicopter system anywhere in the entire province of Quebec, so Richardson had to be driven by ambulance to Montreal, a 2 1/2 hour drive. Now people are asking if a medical helicopter system could have saved her. From the AP:

The province of Quebec lacks a medical helicopter system, common in the United States and other parts of Canada, to airlift stricken patients to major trauma centers. Montreal’s top head trauma doctor said Friday that may have played a role in Richardson’s death.

“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,” said Tarek Razek, director of trauma services for the McGill University Health Centre, which represents six of Montreal’s hospitals.

While Richardson’s initial refusal of medical treatment cost her two hours, she also had to be driven to two hospitals. She didn’t arrive at a specialized hospital in Montreal until about four hours after the second 911 call from her hotel room at the Mont Tremblant resort, according to a timeline published by Canada’s The Globe and Mail newspaper.

Not being airlifted directly to a trauma center could have cost Richardson crucial moments, Razek said.

What a shame. The question is why doesn’t Quebec have a medical helicopter system, when some, albeit not all, provinces have them? It seems Quebec officials decided to spend their money on medical airplanes.

The Quebec government is making no excuses for the lack of a helicopter air ambulance service to transport trauma patients such as actress Natasha Richardson, who died of a head injury after skiing at Mont Tremblant this week.

Purchasing a helicopter ambulance is not a priority and there are no plans to acquire one, a government spokeswoman said yesterday.

Quebec decided to buy two airplanes for its air ambulance service after a report in October, 2007, called for the consolidation of ambulance services in the province and the expenditure of $10-million to improve it.

The report made no major specific recommendation regarding air ambulances, but the government decided in January of 2008 to spend $40-million on two fixed-wing aircraft.

Why would Quebec buy airplanes? They require a lot of land for a runway, whereas a helicopter can land almost anywhere, like along side a highway, which my cousin witnessed after calling 911 because of a car accident, and near a ski run. The patient could then be flown directly to the hospital instead of to another airport, which would require transport to the hospital.

In researching the cost differentials between fixed wing aircraft and helicopters for medical transport, I found this abstract from 1990:

We determined the differences in transport times and costs for patients transported by fixed-wing aircraft versus helicopter at ranges of 101 to 150 radial miles, where fixed-wing and helicopter in-hospital transports commonly overlap. Statistical analysis failed to show a significant difference between the trauma-care patients transported by helicopter (n = 109) and those transported by fixed-wing (n = 86) for age, injury severity score, hospital length of stay, hospital mortality, or discharge disability score. The times in returning patients to the receiving hospital by helicopter (n = 104) versus fixed-wing (n = 509) did not differ significantly. Helicopter transport costs per mile ($24), however, were 400% higher than those of fixed-wing aircraft with its associated ground ambulance transport costs ($6). Thus, helicopter transport is economically unjustified for interhospital transports exceeding 100 radial miles when an efficient fixed-wing service exists.

That makes complete sense. When you’re strapped for cash you want to conserve that cash, so you do what is the most economical, not necessarily what’s fastest. So why wasn’t Richardson then driven by ambulance to Mont Tremblant International Airport and then flown to the Montreal hospital instead of driven to the smaller hospital first? Wouldn’t that have been the most efficient course of action to save someone’s life?

Interestingly, this report from Montreal Gazette contradicts what the Globe and Mail report says, and the Quebec government is in fact looking into implementing a medical helicopter service.

Quebec’s chief coordinator of air-ambulance services says the provincial government wants to put in place a new helicopter service to provide quicker transport of trauma patients to hospitals in Montreal and Quebec City.

André Lizotte, air medical officer for the ministry of health, acknowledged in a telephone interview this afternoon that Quebec has no helicopter service feeding trauma centres in hospitals.

While he said he couldn’t comment specifically on the Natasha Richardson case, he said the government wants to see the Montreal General Hospital get a helicopter pad, and wants to see the province equipped with its own helicopter transport service. Such service is relatively common outside Quebec.

“A serious analysis is underway within the ministry on these questions,” he said.

Paramedics and trauma experts have been warning that a tragedy like Richardson’s could happen. So the government knew the risks but still didn’t do anything:

The death of actress Natasha Richardson, following a ski accident in Quebec, is raising questions about the province’s emergency medical system. The actress had to be driven in an ambulance from a hospital in Sainte-Agathe to a Montreal trauma centre because unlike most provinces, Quebec has no emergency helicopter system. The trip took about an hour while a helicopter ride would allowed her to be in Montreal in 15 minutes. Paramedics and trauma experts have been warning of the problem for years, saying it could lead to unnecessary deaths. “This is like not having a fire department in a community,” said Dr. Tarek Razek, head of the trauma team at the Montreal General Hospital.

Unfortunately, this is a hard lesson for a government to learn. When it is more concerned about cost saving than life saving, which is what ends up happening to all government run health care systems, you will get this kind of tragedy on top of government waste. Now the Quebec government is going to have to spend more millions of dollars in a medical helicopter system, which is what it should have done from the start, after spending the original $40 million for its seemingly useless airplane medical system.

Unfortunately, it seems Natasha Richardson and her family may have had to pay the ultimate price for this lesson.

Some More Late Thoughts
Not Enough