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Tue Mar 24 23:48:14 GMT 2009

I think a National or provincial legislation is lovingly stomping on individual rights

But
If you purchase a ski ticket
Or register in a national park

You come under a contractual agreement

That is just as likely to include the compulsory wearing of a helmet
... imposed by the State or Province on the ski hills or other
 (in exchange on tax breaks, subsidies or inlieu of a "hospital" surcharge)

All the Ski hill really need to worry is that the competition is submitted to equal legal constraints
Best to be a national initiative than a Provincial one

Charles

----- Original Message ----
From: "Paul.Harrison at sth.nhs.uk" <Paul.Harrison at sth.nhs.uk>
To: trauma-list at trauma.org
Sent: Tuesday, March 24, 2009 1:20:51 PM
Subject: RE: Preventable death?

Do helmets make a difference - Swedish research suggests a 50% reduction
in incidence is possible. However, legislation for majority is for
voluntary use although a good case put forward for mandatory use by
children and adolescents.

http://www.cpsc.gov/library/skihelm.pdf

Also up-to-date review on best UK ski safety site:

http://www.ski-injury.com/specific-injuries/head

Types available:

http://www.ultimate-ski.com/Features/Ski-Helmets/index.html

Paul Harrison
Clinical Development Officer
Princess Royal Spinal Injuries and Neurorehabilitation Centre
Sheffield, UK

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Errington Thompson
Sent: 24 March 2009 16:36
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: Preventable death? 

Well said.  

E

Errington C. Thompson, MD, FACS, FCCM
Trauma/Critical Care
Talk Show Host - WPEK 880 AM
www.whereistheoutrage.net

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]
On Behalf Of Paul.Harrison at sth.nhs.uk
Sent: Monday, March 23, 2009 6:01 AM
To: trauma-list at trauma.org
Subject: RE: Preventable death? 

Preventable death or avoidable injury? Go back to the root cause. Risk
is a fact of life, manageable risk is a fact of economics. Recreational
activities are a lucrative business. We work hard, we make money, we
look for outlets to spend it. For some of us our 'buzz' is found no
further than the High Street or Mall, for others, our needs for release
requires more effort and risk. We are (at least for the moment) still
allowed by government to put ourselves in harms way (within budget or
credit limit and possibly in defiance of domestic restraining
influences)to relieve our bodies and minds of the weekly torpor of work.
Some of us do it regularly, others occasionally, far more of us once
only (for the memory). Whatever the risk, we trust ourselves our others
to manage the risks appropriately. But do they? Why legislate for
motorcycle helmets and ignore other forms of head protection where
statistics show it can make a difference? No helmet, no ski. It would
have to apply everywhere or else those with personal reasons for
non-compliance would go elsewhere - or would they? In the early 1990's
the question was asked - Do you buy your car for how it looks, how fast
it goes, or how safe it is? - Today we have car manufacturers trying to
sell us cars that are fast, stylish AND comply with all safety
specifications. Or as the Aussies say - we've fixed everything except
the nut behind the wheel. Would you avoid somewhere that advertised 'Ski
with us in safety'. Would a helmet have made a difference here? Cause of
death was as reported here was due to bleeding following an arterial
rupture, not an impact trauma or fracture but the kinematics of
tumbling/rolling down the slope - multiple force vectors. Was there an
underlying weakness in the blood vessel? The potential for this kind of
fall was recognised by a) the instructor, b) the ski patrol c) the
attending ambulance crew; all of whom suggested attending the local
hospital in accordance with their training and SOPs. So concerned were
they that they accompanied her to her hotel (tenacious blighters these
Quebecois). Up to this point the system worked fine and if she had
agreed - maybe then the limits of the local system would have been a
point of debate. Certainly in the UK she might have needed to wait up to
4 hours unless the triage reflected or 'respected' the Ski Patrol and
Ambulance assessment. By the time she became 'symptomatically' unwell,
in truth she may have survived but not unscathed. As a celebrity death,
she may enable change in the same way as the media suggests Jade Goody
might. But as a celebrity survivor with permanent and significant brain
injury from a scenario that may influence others to change things for
the better - maybe so much more. After all how many remember that
Princess Diana died from not wearing a seatbelt rather than .... well
there are so many.  

Paul Harrison
Clinical Development Officer
Princess Royal Spinal Injuries and Neurorehabilitation Centre
Sheffield UK

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Joe Nemeth, Mr
Sent: 23 March 2009 01:28
To: Trauma &amp; Critical Care mailing list; Trauma &amp; Critical Care
mailing list
Subject: RE: Prevetable death? from a Qc MD

Ken, Pret et al...

Just got back from vacation. This is what I know:
While away a VIP went skiing WITHOUT a helmet. She fell, struck her head
with +/- LOC. Was well after followed by a rather rapid decline in her
MS. Due to the lack of air transport she was transported by ambulance
appropriately to the one of two Level 1 trauma centers in Montreal
(approximately 80 miles away), ours at McGill being the other. By that
time, from what I know, only the Grace of God would have saved her.

Issues:
1) do we need air transport, specifically helicopter transport...yes!
Negotiations (arm-twisting) is on-going with the powers that be...Would
it have made a difference? Perhaps.
2) besides Point 1, I don't think anything else could've been done...

Agree with Pret's summary: the only surgeon who could've made a
difference would have been a Neurosurgeon...

Joe
McGill University
Montreal General Hospital

________________________________

From: Pret Bjorn [mailto:p.bjorn at netzero.net]
Sent: Sun 3/22/2009 10:46 AM
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: Lack of INTEGRATED TRAUMA SYSTEM cost Richardson her life ?

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"

**************Feeling the pinch at the grocery store?  Make dinner for
$10
or
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