Natasha Richardson dies

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Natasha Richardson, 45 years old, died today after suffering a fall to her head during a beginners ski lesson. See CNN.com

According to the article, she had fallen on her head and seemednperfectly fine, getting up under her own power and talking and joking win ski patrol. Ski patrol examined her and found no sgns of head injury but insisted she rest and see adoctor. She was transferee to a hospital in new York where she later died.

This is a tragic situation but a wonderful learning oppertunity. Emts and paramedics need to learn the s/s of closed head injury,and their potential fatal progression from a seemingly ok patient to a dead one.
 
It sounds like the Ski Patrol did a pretty good job of encouraging her to get checked out once she started complaining of a headache. I wouldn't be shocked if it's determined she had a pre-existing aneurysm that was ruptured by the fall, or that she was on blood thinners or something. Even not wearing a helmet, a fall from standing isn't a very significant MOI.
 
I wouldn't be shocked if it's determined she had a pre-existing aneurysm that was ruptured by the fall, or that she was on blood thinners or something. Even not wearing a helmet, a fall from standing isn't a very significant MOI.

This is even more reason to do a thorough assessment and NOT take a fall even from a standing position lightly. Too many just assume "it wasn't that far so no damage" when they should be assessing if there are any additional risk factors that may increase the chances of more serious injury.

There is a good interview tonight on Larry King(CNN) with UCLA's Chief of Neurosurgery which is proving to be very interesting. Right now he is discussing that pain may not initially be present since he performs some neurosurgery without sedation.
 
Right, and what would a through assessment have found immediately after the incident? They could have done a through assessment, but if there is no pressure build up, there are no symptoms.
 
Right, and what would a through assessment have found immediately after the incident? They could have done a through assessment, but if there is no pressure build up, there are no symptoms.

Risk factors? Blood thinners, head-aches, clotting disorders, previous head injuries or surgeries can build a case for a person to see a doctor sooner rather than later.

Of course if a Paramedic or EMT came along and gave her a "clean bill of health" that might have delayed her from going to the hospital sooner.
 
Sure, it may have revealed some flags in the history, but there would have been really no physical symptoms that quickly after the incident (unless she blacked out, I haven't read that she did or didn't in any reports).
 
Sure, it may have revealed some flags in the history, but there would have been really no physical symptoms that quickly after the incident (unless she blacked out, I haven't read that she did or didn't in any reports).

There are those in medicine that do have knowledge of what can happen and see minute signs or who believe in erring on the side of caution. The ski instructor saw this by just understanding mechanism. Sometimes the "training" EMT(P)s get limit them to only the obvious. But, to EMS this probably would have been a BS call since there may not have been any blood or guts showing. This is why I am not for the treat and release or deny transport protocols until the education level is raised for Paramedics. More disease processes and assessments must be understood.
 
In my experience it's usually the patient that doesn't want to go (I never approach calls intending to not transport. I do not talk a patient out of going, period). And sometimes no matter how much I argue otherwise they just do not want to go. I used to work in a place with a lot of patients that had the "There are no blood and guts I'm fine" mentality, not me.

My stance is that if you've been hit in the head you should get checked out because the symptoms don't always show up right away. So just because you feel fine right now, doesn't actually mean you are fine (This is verbatim part of my speech to patients). I'm also not in the habit of kidnapping patients though, and if they think they are fine and don't want to go, I can only do so much.

There is always the chance that the Ski Patrol members were not paramedics or had any training beyond basic FA, and thus weren't as educated on head injuries.
 
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My stance is that if you've been hit in the head you should get checked out because the symptoms don't always show up right away. So just because you feel fine right now, doesn't actually mean you are fine (This is verbatim part of my speech to patients). I'm also not in the habit of kidnapping patients though, and if they think they are fine and don't want to go, I can only do so much.

How many patients have been checked out by Paramedics only to be given a false sense of security of seeing "someone like a doctor"? Maybe the Paramedic says something like "I don't see anything obvious" or "There doesn't seem to be a problem" or "Everything is checking out okay" or "Your vitals are normal". Whether you mean to or not you may have given patients the reasons they were looking for to refuse transport or not have a fuss made over them.

Just like for chest pain, the patient hears the words that confirm their own denial.
 
And so you suggest what? Not telling the patient anything? Lying to them?
 
And so you suggest what? Not telling the patient anything? Lying to them?

Lie to the patient? No, you tell them the truth.

"Considering the fall itself and the fact that you are over 40 along with taking blood thinners, it might be a good idea you get checked out at the hospital since I am only able to do a limited assessment here at scene".

BTW, this may not be the facts as they pertain to Ms. Richardson since I do not have all the details but this is an example of what could be said.
 
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Right and if they ask you "What are my vitals" and you give them numbers and so they ask "is that normal?" in your opinion we are doing them a disservice by saying "yes", so what is someone supposed to say?
 
Thats no better than any of the alternatives since patients stop listening after they hear the words good, ok, normal, etc from what Vent has implied.
 
Right and if they ask you "What are my vitals" and you give them numbers and so they ask "is that normal?" in your opinion we are doing them a disservice by saying "yes", so what is someone supposed to say?

How would you even know if the vital signs are normal for that patient given different circumstances?

You can give numbers and make the statement: "Vital signs are not always the best indicators for all injuries or illnesses. Alot will depend on the medications you are taking and other illnesses in your history or the nature of the injury itself. As well, The anxiety of the accident and just having us here can change your vital signs. Do you monitor your BP and HR regularly?"

What do you tell patients if they ask if your partner is a good paramedic even if you know he/she is the worst in your state? You can still give a decent answer so not to imply that fact but also not to lie about being that great either.

For patients, you can still be vaguely truthful while not lying. You can redirect the attention to do further assessment and remain in control of the situation by anticipating their questions and deflecting them back toward the patient.
 
So if you were called to help Mrs. Richardson, and she told you that she slipped and fell, did not loose consciousness (I haven't read any reports that she KO'd), was not taking anticoagulants, and only complained off mild head pain (5 mintues after the fall), would you really urge her to go to the ER?

I would have to say no, I would not.

By the way, here's a link to an L.A. Times story quoting the UCLA doc:

http://latimesblogs.latimes.com/booster_shots/2009/03/richardsons-inj.html
 
So if you were called to help Mrs. Richardson, and she told you that she slipped and fell, did not loose consciousness (I haven't read any reports that she KO'd), was not taking anticoagulants, and only complained off mild head pain (5 mintues after the fall), would you really urge her to go to the ER?

Yes especially if she complained of a headache and there was a witness to her fall to describe the hit. Head and spinal trauma are two areas I would rather error on the side of caution. Both are difficult to diagnose even with good equipment inside the hospital and both can lead to debilitating deficits and/or death. If the patient insists on not going, provided I have not used any of the words I mentioned earlier to state a clear bill of health, then I will have to accept that but insist that the patient and family listen carefully to instructions for any signs of change and for them to schedule a follow up exam with a doctor before a refusal is signed.

As the interview also pointed out, by the time the more severe symptoms present, it may be too late.
 
I always tell people to go. Always. However I can not force people to go.

I recently had a similiar call. When the patient insisted on an RMA, I called Medical Control, informed them what was up and had them talk to the patient. Vital signs were fine. Patient still insisted on the RMA. I am sure the patient was fine but I was afraid of something like this. At least I covered my behind.
 
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Vent,

Would an ER doc order a CT scan on someone who has no KO, not a senior, no med Hx, and no other symptoms other than some minor head pain a half hour after a slip and fall?

Should we really tell every patient that they absolutely must go to the ER after they bump their head? I'm not challenging you on this; just trying to learn because it just seems excessive to me, even after following the Richardson story with great concern.
 
As, someone that has had many closed head injuries before. I can tell you that symptoms may not show up for hours or days. Even Dr's can miss them and have. So a pt may be just fine on scene and symptoms show up 3 hours later. So the Paramedics may find nothing wrong, on assessment. The Dr may find nothing wrong. sometimes it just takes time.

I always try and convince any head trauma to be seen at the ER. I explain how it can go from good to bad in minutes. It is all up to them, then.

Paramedic schools do not teach a lot on head injuries and that needs to change. Most do not even know that there are different grades of closed head injury. But, I have ran into a few Docs that did not know it either!
 
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