How Dangerous Can a Skiing Concussion Be?

[mgb_phys]

Informed consent regulations seem to be very similar in US and Canada, as well as Australia.

But in Canaa and Australia anyone trying to sue the paramedics for forcing them to go to hospiial is going to get laughed out of court.

It came up here with the local mountain rescue team - they have no legal power to force anyone to be rescued but as they said, who is the RCMP going to side with?

 

[Evo]

Are you exaggerating? Head trauma is serious, but hospitals and paramedic companies would likely be too concerned about lawsuits to actually use force against a human who seems completely coherent. I'm pretty sure that the law says that anyone who is capable of making informed consent is responsible for their own well-being. But, if someone is obviously acting like their mental health is in danger, they can be hospitalized without consent. This may have actually had something to do with the first paramedics letting her be. If she was acting completely normal, her refusal would have been taken seriously.

Did you bother at all to read the article I posted about the lack of life flight helicopters and trauma facilities in Quebec?

 

[Brilliant!]

Did you bother at all to read the article I posted about the lack of life flight helicopters and trauma facilities in Quebec?

Yes. But regardless of terrible rescue capabilities, speculation in the form of "couldas" and "shouldas" is a pointless thing to waste your emotions on. Unless you'd like to delve into some string theory and discuss the possibility of another universe where Bizarro Canada has the most amazing medical facilities in the known gragnar, and the tripedal people of Queb-91-479 never have to worry about trauma to their spikbar.

 

[Evo]

Yes. But regardless of terrible rescue capabilities, speculation in the form of "couldas" and "shouldas" is a pointless thing to waste your emotions on. Unless you'd like to delve into some string theory and discuss the possibility of another universe where Bizarro Canada has the most amazing medical facilities in the known gragnar, and the tripedal people of Queb-91-479 never have to worry about trauma to their spikbar.

Well, you certainly seem to completely miss the issue of adequate care for trauma victims and your post is nonsensical and off topic.

I however, would like to discuss the situation there. So please do not respond unless you have something of value to say on the subject.

 

[Brilliant!]

Adequate care for trauma victims would involve a complete revamping of a socialized health care system. Either levy more taxes, or change ideologies.

Or did you mean you wanted to discuss my sensibility?

 

[Evo]

Adequate care for trauma victims would involve a complete revamping of a socialized health care system. Either levy more taxes, or change ideologies.

Or did you mean you wanted to discuss my sensibility?

Yes, there are many problems with socialized medicine. You have to ask if the lack of trauma facilties in Quebec is a result of that?

 

[Brilliant!]

No, I just don't see what else there is to discuss on the subject. We could drone on and on about how sad it is for the people of Quebec, or how unfortunate they are to have to worry about the system they endorse not being able to take care of a bump on the head. We could even make a chart pointing out the pros and cons of socialized health care.

But that will do us no good. The only issue here is ideological, and I would be happy to discuss that with you to no end.

 

[Moonbear]

From everything I've heard, nobody knew she had such a serious injury until too late. It's surprising, since usually you need a skull fracture to impinge upon the artery that would lead to an epidural hematoma. But, it's also the sort of thing that once you start to see symptoms, if you're not already in a hospital or on the way, you may not make it to a hospital still alive.

I don't know of any lack of trauma facilities in Quebec, and none of the linked articles suggest that either. It's more that most times, people bump their heads and are fine. It's not until the bleeding has gone on long enough to begin compressing the brain that symptoms beyond a headache become evident, and depending on how badly the artery is severed, you might not have much time at all.

 

[Evo]

I don't know of any lack of trauma facilities in Quebec, and none of the linked articles suggest that either.

The article was changed since I first posted it, so it's not there now.

This is what it said.

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 2½-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.

After Richardson fell and hit her head on a beginner ski slope at the Mont Tremblant resort in Quebec, the first ambulance crew left upon spotting a sled taking the still-conscious actress away to the resort's on-site clinic.

A second 911 call was made two hours later from Richardson's luxury hotel room as the actress deteriorated. Medics tended to her for a half-hour before taking her to a hospital about a 40-minute drive away.

Centre Hospitalier Laurentien in Ste-Agathe does not specialize in head traumas, so her speedy transfer to Sacre Coeur Hospital in Montreal was critical, said Razek.

"It's one of the classic presentations of head injuries, 'talking and dying,' where they may lose consciousness for a minute, but then feel fine," said Razek.

 

[Brilliant!]

That's terrible. I wonder why it's that way.

 

[Moonbear]

It's still hard to say if that made the difference in her case. I think the real reason she died is she refused treatment when emergency services were first called, and it wasn't until 2 hours later when she started experiencing more severe symptoms that they were called again. If they were tending to her for a half hour, that would suggest she was already bad enough that they needed to spend time trying to stabilize her for transport. Had the first set of medics been allowed to evaluate her, she would have already been in a hospital by the time her condition began deteriorating.

 

[russ_watters]

The probability of an epidural or subdural hematoma should have been cause enough to send straight away to hospital with the appropriate TBI care unit.

What Probibility? That's what's so scary about these accidents, they often don't seem bad at all. Everyone bumps their head every now and then and popping a blood vessel is extremely rare. You can't do a cat scan on everyone who bumps their head and shows no immediate concussion symptoms. Heck, you can't even do a cat scan on everyone who has a concussion! According to Wiki, there are about 1.8 million of them a year in the US.

Most head trauma patients feel fine initially, paramedics know this. When I fell and hit my head and someone called an ambulance, the paramedics refused to leave without taking me to the hospital for a scan. I argued with them for almost 45 minutes before I realized they were taking me even if it meant by force.

With no symptoms, that is very surprising. I once bumped my head playing soccer as a kid. I didn't remember hitting the ground and had a bump and bad headache for a couple of days, but no real concussion symptoms. No ambulance was ever called.

 

[Moonbear]

What Probibility? That's what's so scary about these accidents, they often don't seem bad at all. Everyone bumps their head every now and then and popping a blood vessel is extremely rare. You can't do a cat scan on everyone who bumps their head and shows no immediate concussion symptoms. Heck, you can't even do a cat scan on everyone who has a concussion! According to Wiki, there are about 1.8 million of them a year in the US. With no symptoms, that is very surprising. I once bumped my head playing soccer as a kid. I didn't remember hitting the ground and had a bump and bad headache for a couple of days, but no real concussion symptoms. No ambulance was ever called.

Exactly. If she had an obvious fracture, she probably would have sought immediate care, but rupturing a meningeal artery without any fracture is such an incredibly rare event that there is no reason anyone would have suspected a problem. It truly is a freak accident. Nobody even knows if a helmet would have protected her from this injury, since it didn't seem to be caused by an actual skull fracture.

 

[Brilliant!]

I am officially declaring my entrance into the 2012 race for the Presidency of Earth. I vow to put an MRI in every room that has at least 3 walls and a door: bathrooms, storage units, your mother's basement. No one will die of head trauma again, not as long as I have something to say about it.

 

[russ_watters]

It's still hard to say if that made the difference in her case. I think the real reason she died is she refused treatment when emergency services were first called, and it wasn't until 2 hours later when she started experiencing more severe symptoms that they were called again.

But what could really have happened? Since she wasn't showing any symptoms, why would they have bothered taking her to a hospital at that time?

If they were tending to her for a half hour, that would suggest she was already bad enough that they needed to spend time trying to stabilize her for transport.

Perhaps, but the articles imply she went back to her home under her own power. It is hard to tell.

A parent of a friend of a friend recently died from similar causes. He was elderly enough to need occasional (daily?) home nursing care (not sure what exactly for). He fell in the bathroom and hit his head on the doorknob one afternoon when the nurse was there. He refused to go to the hospital. The next day, his daughter was there and the nurse told her about it. By then, I think he was starting to feel the symptoms and he was taken to the hospital. Shortly thereafter, he dropped into a coma and never woke up.

People are stubborn, especially when they aren't feeling anything that unusual. 99.99% of the time when you hit your head, you get a bump and a headache for a few days, and then you're fine. The rarity of these things makes forcing treatment on someone very sticky.

 

[russ_watters]

Exactly. If she had an obvious fracture, she probably would have sought immediate care, but rupturing a meningeal artery without any fracture is such an incredibly rare event that there is no reason anyone would have suspected a problem. It truly is a freak accident. Nobody even knows if a helmet would have protected her from this injury, since it didn't seem to be caused by an actual skull fracture.

Note, I edited the post a minute or two after posting - she must have had at least some symptoms to want to leave the ski slope, but it may have just been a bad headache. My understanding is that a bad headache isn't concussion symptoms unless it is accompanied by burred visions, nausea, disorientation, etc. When I hit my head playing soccer, I got a nice bump and a headache for a few days, but I didn't even leave the game (they did test me on the spot for concussion symptoms, though).

I'm wondering if she fell on something. With the other example I gave, the guy hit a doorknob. That wouldn't cause enough acceleration of the brain to give you a concussion, but a short, sharp blow to the head could cause a small fracture or rupture of an exterior blood vessel. It isn't like breaking your wrist, where every time you move you have excruciating pain - with a small skull fracture (in an immobile bone), I would think as long as you don't touch it, it wouldn't hurt more than a regular bump. A bad headache and not much more.

 

[Moonbear]

But what could really have happened? Since she wasn't showing any symptoms, why would they have bothered taking her to a hospital at that time?

There might have been some symptoms she hadn't noticed, or they might have taken her in just as a precaution. But, yeah, she still might have simply refused treatment because she was feeling fine.

Perhaps, but the articles imply she went back to her home under her own power. It is hard to tell.

I was referring to the second call, after she was feeling symptoms and the article Evo quoted said they worked on her for a half hour before transporting her to the hospital.

A parent of a friend of a friend recently died from similar causes. He was elderly enough to need occasional (daily?) home nursing care (not sure what exactly for). He fell in the bathroom and hit his head on the doorknob one afternoon when the nurse was there. He refused to go to the hospital. The next day, his daughter was there and the nurse told her about it. By then, I think he was starting to feel the symptoms and he was taken to the hospital. Shortly thereafter, he dropped into a coma and never woke up.

It's not too common that these are epidural bleeds. More often, it's subdural or subarachnoid...vessels within the brain rupture when the brain smacks into the skull...not vessels lining the skull rupturing. Though, I did see my first case of an epidural bleed in a cadaver this year...quite a mess, and easy to see how it led to death when I saw how much blood had accumulated and how damaged the brain was.

People are stubborn, especially when they aren't feeling anything that unusual. 99.99% of the time when you hit your head, you get a bump and a headache for a few days, and then you're fine. The rarity of these things makes forcing treatment on someone very sticky.

Indeed. That's why I say it's much more just a freak accident than something to blame anyone about. She probably did what most people would do even with doctor's instructions...go home and just have someone around to call for help if anything changes about her condition.

 

[russ_watters]

I was referring to the second call, after she was feeling symptoms and the article Evo quoted said they worked on her for a half hour before transporting her to the hospital.

Ahh, ok, yeah. If I was feeling ok except for a little headache and a few hours later, it suddenly got so bad I needed to call an ambulance, I would think that would be a red flag that something serious was going on.

A cruel twist for that friend I just mentioned. It's the second time she's seen this in the past year: a year ago her 30 year old brother died of a sudden brain hemmorage. He was living in his parents' basement and his other sister found him sitting in front of the tv, uncoscious, with his playstation on and his lap covered in vomit. He never regained consciousness.

 

[Evo]

It's hard to piece together without any details. Why did the paramedics spend 30 minutes before leaving for a hospital? The hospital she was taken to seems to have considered her well enough for a 2 1/2 drive to another hospital rather than give emergency treatment. Did they not have sophisticated enough equipment to be able to detect a more serious condition? I have been watching way too many brain injuries on Trauma ER lately.

Russ, to answer your question, I fell from the second floor to the first floor and landed on my head on hard wood. I had blurred vision and of course apparent swelling. My vision went black and then saw "stars" little bursts of sparkling light. I did not call the ambulance, my employer did, and by the time they arrived, I felt fine except for the pain in my hip. A co-worker had died 3 months earlier from a head injury from a fall in his home. They didn't find his body for days since no one knew what happened (he lived alone).

 

[rootX]

http://news.bbc.co.uk/2/hi/asia-pacific/8058771.stm

"Immediately after his fall, Nicholas Rossi appeared stable.

But his mother, a nurse, noticed a bump on his head and decided to take him to the local hospital."