Thursday, August 27, 2009

The right response to a head injury

When Natasha Richardson died from a head injury sustained in a minor skiing accident at Mount Tremblant in Quebec, many in the media immediately spent hours examining and, in many cases, attacking the Canadian health care system and the quality of the health care available in Quebec in particular.

The big story in the media seemed to be the lack of a helicopter to transport Richardson to a hospital in Montreal. "Helicopter transport is common practice in the United States," CNN bragged.

To promote a segment on Natasha Richardson's death on America's Newsroom, Fox News ran an on-screen grabber: "Did Canadian-Style Health Care Hasten Richardson's Death?"

Now, the Johns Hopkins Medical Letter, Health After 50, has waded into the issue with an adult view of the event. There is no mention of Canada in their take; not a one. Why? I imagine it is because the issue is - what is the right response to a blow on the head?

Many bloggers correctly pointed out that a number of deaths from the type of injury incurred by Richardson occur annually throughout the United States and not only as a result of a skiing accident. Health After 50 quotes Vani Rao, M.D., director of the Brain Injury Program at Johns Hopkins, "A person can trip over a carpet, end up with a minor bump, and not think anything of it." But, one may have unknowingly sustained a serious, life-threatening, brain injury.

Brain injury symptoms vary depending upon the seriousness and the type of damage. If you have had a traumatic brain injury (TBI) where the brain has smashed against the hard bone of the skull, incurring injury, you will most likely have immediate symptoms: confusion, dizziness, disorientation, or with more serious injury, headache, vomiting, seizures and even loss of consciousness.

A head blow can also result in subdural hematoma, bleeding in the layers of tissue surrounding the brain. If this bleeding continues, blood trapped between the skull and the brain will cause pressure to build, leading to possible brain damage and death.

If you strike your head and then suffer headaches, nausea, double vision, speech difficulties, confusion, memory loss, weakness or difficulty walking or with balance, get to the hospital. These symptoms may not appear for hours - be alert.

If there is a loss of consciousness, even momentarily, get hospital attention.

"Most head injuries are going to be mild to moderate," according to Dr. William Stiers with the Department of Physical Medicine and Rehabilitation at Johns Hopkins. Because moderate to severe head injuries can have lasting effects, even causing death, do not be quick to refuse care.

Natasha Richardson's death made it clear to everyone how important it is to seek immediate treatment - with brain trauma minutes count.

And what is the best defense against brain injury? Obviously, wearing a well-fitted helmet when skiing helps. But, these injuries are not just encountered on the slopes. Remember the loose carpet example?

Health After 50 says avoiding a fall in the first place is the best response. Exercise often and regularly as this will improve your strength, reduce your risk of falling and improve your balance.

Have your vision checked regularly and fall-proof your home. Tape down that loose carpet. And limit your alcohol consumption. But then I didn't have to tell you not to drink until you are falling down drunk, did I?
Health After 50
12 issues $28 in U.S. or $36 + 7% GST in Canada (Can. funds)

This is not an ad. I am posting this because I like the health letter.


  1. Even after declining evaluation, after her initial encounter with EMTs, there was nearly four hours in which to get MS. Richardson to a neurosurgery evaluation which was in Montreal, 73 miles and 1:15 minutes, from where she was.
    Even if we give Canadian medical care the benefit of the doubt (and they have given us little reason to do so), the system is hopelessly remiss in failing to order a public inquiry - releasing any details of what decisions were made and by who. Why EMTs took nearly 40 minutes before transporting her, why they took her to a small local hospital and why that hospital kept her for an hour and a half before making the decision to go to Montreal, 45 minutes away.
    Say whatever you want about Canadian medical care and whether you want to compare this with the US is a matter of opinion but they chose to be less than forthcoming about what happened and took a "blame the victim" approach (for not wearing a helmet and declining care when asymptomatic).
    Those are the medical facts- it is those who have whitewashed the case who have taken a political stance.

  2. Thank you for your comment. You seem to have given this a lot of thought, more than CNN, FOX and the others. I've made the trip from Montreal to Tremblant many times and the time you estimate for the trip is far more accurate than the times I heard reported on television. I'll bet the rest of your response shows the same thought.(My major goal was simply getting out the word on what to look for, according to John Hopkins, after a fall involving possible trauma to the head.)

  3. Correction to above: It is Johns Hopkins; Note the 's'.