Lack of INTEGRATED TRAUMA SYSTEM cost Richardson her life ?

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Let's start from the ground up, an decompress this conversation a bit by
admitting that (from all that the public has been allowed to know) Ms.
Richardson herself played a huge part in her own trajectory.  She was both
exceedingly unlucky and tragically unwise.

She was unlucky, not for cratering on a bunny slope, or even incurring a
mortal head injury in the mix; but rather, for (apparently) showing little
or no loss of consciousness followed by a truly world-class lucid interval.
Bright lucidity, we must admit, can occasionally be wasted on the owner. 

As for that, her un-wisdom traces to at least two bad decisions: first, to
not spend eight bucks renting a helmet (though why a ski school wouldn't
provide this free of charge is beyond me); and second, to decline medical
treatment in the immediate aftermath of her crash -- presumably because she
felt largely uninjured, at least moderately embarrassed, and didn't want to
dampen her vacation over a bump on the head.  Here, a show of hands: who
among us would have done otherwise?

So.  Four hours later, as her brainstem squeezes out the bottom of her
skull... WHERE are the SURGEONS?  

Forgive me when I suggest that this is at least an unnecessarily obtuse, if
not altogether silly, question.  There is zero assurance that her outcome
would be any better had she been injured in any resort in Montana, Utah,
Colorado, or Maine.  Speaking only for Maine, I'm confident that she would
have been at a trauma center in well under an hour (probably half of that)
from the time of the second EMS call.  (Sorry, Ken, but I base this
exclusively on the integration and efficiency of our HELICOPTER program.)
Yet I think we're all flattering ourselves if we think that would have made
much difference so late in the game.  There are indeed miracle recoveries in
such stories; but there are also fates worse than death.

I'm less willing to criticize the Quebec EMS system because I'm more than
90% ignorant of its architecture.  Generally speaking, though, I hope that a
mechanical fall with objective and isolated loss of consciousness --
anywhere in the world -- would be triaged in favor of the closest hospital
with a neurosurgeon.  (Practically anybody can do a head CT these days; but
that's the problem.)  I'd prefer the destination be a trauma center; but if
that's gonna add hours to the trip, she can be out-transferred after the
burr holes.  And all this admits that I have no idea whether or to what
extent the Canadian healthcare system has centralized the neurosurgery
resources of one of the largest nations on the face of the earth...

These are generalizations, of course, and defy systematization in the
absence of a broad enthusiasm from local, regional, and provincial
government; prehospital and EM providers; and yes, SURGEONS.  But I should
think they'd all have significant and very useful input.

Pret Bjorn, RN
Bangor, ME USA


-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of KMATTOX at aol.com
Sent: Saturday, March 21, 2009 10:50 PM
To: trauma-list at trauma.org
Subject: Re: Lack of INTEGRATED TRAUMA SYSTEM cost Richardson her life ?

WHERE are the SURGEONS ???
 
 
In a message dated 3/21/2009 12:45:42 P.M. Central Daylight Time,  
c_brault at yahoo.com writes:

Once in  a while you hear stories through the EMS grapevine that EMS crews 
were  sanctions for bypassing local regional hospital and taking the wild
risk 
of  doing diret transport to the Level 1 Trauma Center (this can only happen
in 
 certain regions near Montreal and Quebec city)


When I  came back from the States 1988
Their were no Board recognised Emergency  Physicians that were allowed to 
exercise as such (McGill Univ has the 2nd  oldest EM program through)
Basicaly, I found that the GPs did not trust  themselves and there emergency

medicine very much (and rightly  so)

They
Therefore

Did not trust their nurses  either (French Quebec nurses have clearly less 
autonomy than their Anglo  counterparts)

And

They absolutely did not trust the  "Ambulance Drivers"


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or 
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