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Commentology > More On Natasha Richardson

Dr. Cory Franklin dropped us a note in response to THCB contributor Sarah Arnquist’s piece on the controversy surrounding the death of British actress Natasha Richardson, “Leave Natasha Richardson Out of the Healthcare Debate.” 

“I wrote the article and have been reluctant to respond to criticisms
but since I read your blog I will here. So many people, both sides, are
tied into their political beliefs about health care that virtually no
one is actually looking at the record as we know it and asking a quite
logical question.

1. Here’s what’s important- the facts of this case- check the 911
transcripts in the Globe and Mail. The paramedics document the patient
has a Glascow Coma Score of 12 upon arrival to the first hospital at
St. Agathe. That is the key. The medical literature is quite clear –
patients who present with scores in that range on presentation almost
always survive. Where are the Canadian neurosurgeons and trauma people
commenting on that? The questions that should be asked in light of that
are who made the diagnosis and when, who treated and when, and what was
the condition upon treatment. But it is clear that at 4 PM she was
neurologically intact enough to survive with the appropriate treatment.
By the way, this major ski resort is no further from Montreal than Vail
or Breck is from Denver. And the Canadian defenders talk about how
close it is by ambulance to minimize the medevac issue. You can’t have
it both ways.

2. I am not criticizing all Canadian health care. This is merely one
case and it looks like there is a hole somewhere in the regional trauma
system. It is disturbing more people aren’t focusing on that. We have
our problems in the US, I mentioned that in the article and have
written about them and my point is that policymakers on both sides of
the border should be examining this case. I hope that happens.”

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  1. The comments made about the flying doctor service in Australia being attributed to the best marine rescue survival rates are somewhat misleading. Firstly there is no data which can back this up. Secondly, this service although very well respected in Aus, has never had anything to do with marine rescue or helicopters. The service provides fixed wing aircraft only – mostly to remote inland areas.

  2. Great information and analysis. I hope that is what we can learn from Natasha’s unfortunate demise as well.

  3. To their credit, Montreal trauma and neurosurgeons are speaking out on the issue now, refuting some of the mistaken information being put forward on blogs and the MSM. This was part of the point I was trying to make, made eloquently here in the Montreal Gazette. And while I am not sure that the point about American helicopters is true (though the issue is out there and should be discussed) one hopes, we in the United States approach our problems with the same level of candor.
    Exclusive: Leading MD calls for air ambulances
    APRIL 1, 2009 2:02 PMCOMMENTS (1)
    A leading Montreal doctor says Quebec has a great trauma system in place but with a deadly flaw. In an open letter to all Quebecers, Dr. Michael Churchill-Smith, director of professional services at the Montreal General Hospital, an associate professor of medicine at McGill University and an attending physician at the MUHC, makes the case for air ambulancesin the wake of the death of Natasha Richardson.
    Churchill-Smith is also medical director of Skyservice Air Ambulance, an emergency jet air ambulance company run out of Montreal.
    Dr. Michael Churchill-Smith, MD, FRCPC
    Over the last few days, many articles about the death of Natasha Richardson have appeared in the North American media. Unfortunately, the rhetoric is now reaching epic proportions and we run the risk of losing proper perspective on the lessons that we need to learn from this tragedy. I believe it is important to take a few steps back and examine the context carefully in the light of the facts as we know them.
    Between 1989 and 1993, Drs. Pierre Frechette and Pierre Lapointe implemented a regional trauma system across Quebec. This model was based on a hugely successful American program that had been in place for several years.
    Today, as a result of their tireless efforts, the data demonstrate that our survival and disability rates have improved significantly. There is no better example than to compare the integrated teamwork of the shootings at the Polytechnique in December,1989 and Dawson College in 2007 where Quebec and its trauma system showed its mettle and stood out like champions throughout the western world. It is the ultimate irony of all professionals to reflect quietly on the joy of a life saved and the despair for those who were lost and this is why each member of the chain of workers that yielded such a positive outcome in the Dawson shootings have a full appreciation for what we have learned over the last 20 years. We know how to get the job done well.
    Working at the Montreal General Hospital at that time, and having studied trauma
    systems in the US and Europe, we became concerned that our most serious trauma
    victims who were outside of the immediate urban environment ie. Montreal and Quebec city may not be receiving rapid enough care to give them the best chance to live and make the greatest recovery possible. We also knew that 87% of the Quebec population “lived, worked and played” within 250 kilometres of the US border and that a significant percentage of trauma victims were(and are today) between 20 and 45 years of age. This has important implications because young people have a greater chance to survive an accident but if they do not receive high quality “definitive” care as soon as possible, they will never have the chance to return to being a full and active member of society. Therefore, they would live long, impaired lives and the cost per individual to the state would be significant.
    An examination of other transport systems is useful. In the early 1970’s,.Germany started to examine this question when they determined that their motor vehicle death and disability rates were unacceptably high. Today, they have some of the best statistics because they made a series of changes that, in their entirety, resulted in this dramatic improvement. They made structural changes to their roads, installed proper medians and also passed a law which required that the state have an integrated system with a medical helicopter having a 50-75 kilometer radius throughout all of Western Germany. By 1979, they had cut their mortality rates massively and also published economic articles that demonstrated the financial benefits to the state.
    Switzerland had a base of 15 helicopters distributed throughout their country and, like all well thought out systems, was specifically adapted to serving their terrain.As an example, in the 1980’s, they realized that each year, a number of people were dying in the mountains by falling into crevasses. Originally, there was 100% mortality but today 1 in 4 to 5 are actually saved in the following manner: as soon as an accident of this type is reported, a helicopter leaves with a portable generator and a compressor. “Crack” mountain guides then descend into the crevasse with a jack hammer and literally extricate the victim from the ice into which they have become embedded.
    In London, England, there is today a helicopter service which is for urban use only. At the time, there were 2 principal reasons:1) they did not have many integrated trauma hospitals for their population and 2) the urban congestion was so bad that the only way to deliver a victim to the right care in the right place was to airlift them.( An analogy in Quebec would be our bridges) off the streets.
    As a final point, Australia and the Royal Flying Doctor’s Service which dates back to 1928, has a system which is adapted to their maritime environment and they are the world’s experts in saving victims of the sea using specially designed helicopters with winch systems..
    The critical message behind these examples is that these major countries have adapted the most expedient systems to bring their sickest citizens in their hour of greatest need to the right hospital to receive the best care. This is the point that our government must confront.
    In the light of these observations, we undertook a study in 1994 where we compared head injured victims that the Montreal General Hospital received from outside the urban environment. We measured the difference from the time of the accident to the time that the patient received the care that would make the most difference to their outcome(definitive care) and compared our population to the data of similar victims in London (HEMS) and to the Traumatic Coma Data Bank, a huge registry in the US. At that time, the average time for a head injured
    patient from 100 kilometres outside of Montreal to receive definitive care was 9 hour and 40 minutes. We knew from major studies that the faster these victims received medical care that would make the biggest difference, the better the final outcome. And 10 hours was beyond reasonable and we believed that we surely could do better than this.
    We also knew from our analysis that excellent integrated transport systems could reduce the transport time of enough of these victims to under 4 hours when significant, improved outcomes begin to be evident from the data and the closer one approaches 2 hours, the better the outcomes were yet again. We also knew that each year, approximately 150-200 victims around Montreal and proportionately less around Quebec city, met the criteria where a huge difference in the quality of their lives could be made by installing an integrated rapid transport system, one in Montreal and one in Quebec that could each service 250 kilometeres around each city.
    Once this was evident, we commissioned an actuarial study to examine our data and attempt to determine whether this transport system could pay for itself. Even in the most conservative mathematical model, and without even a good handle on rehabilitation costs, the system paid for itself.
    We presented this data regularly and over a period of 10 years to many levels of the government without success. My sense is that, at the time, many authorities had been adversely influenced by American media where anybody and everybody flies a medical helicopter producing more crashes than saving people. It is interesting to note that, to the best of my knowledge, there have been 0 crashes and loss of lives in all Canadian rapid transport programs and today they exist in almost every province and Ontario has recently expanded their program significantly. Therefore, it can be done and done well.
    Also times have changed. On the one hand, we are now more experienced and
    understand the virtue of well integrated trauma systems. On the other hand, it is no longer ethically or morally acceptable for our citizens who, in their moment of greatest need, do not have access to a rapid transport system that gives them the best chance to not only survive but to survive with a quality of life.
    This is what we can learn from Natasha Richardson’s tragic death and make a
    difference for the next person who suffers such an unfortunate accident.

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