Talk and Die: Six Questions (and Answers) About Natasha Richardson's Ski Accident

Natasha Richardson's death is a shock and tragedy for so many reasons. The 45-year-old actress was taking a private lesson on a beginner's run in Mont Tremblant, Canada. When she fell at the bottom of the trail, everything seemed okay. She didn't hit anyone or anything. She wasn't wearing a helmet, but there was no sign of injury or need for a stretcher. She walked to her hotel room but within an hour complained of an extreme headache. Then she was rushed to local hospitals and flown to New York where her family held a vigil.

While every thought and prayer go to her grieving family, the accident and injury raise a number of basic questions:

1. How can someone seem fine one moment and then quickly deteriorate?

In the field of trauma medicine, it's called "talk and die syndrome" -- patients who can speak after some kind of head trauma who then deteriorate rapidly. Researchers have found that some of these patients are potentially "salvageable" -- i.e. lives can be saved -- if the problem is identified in time. But even with early detection, some of these patients simply can't be saved.

2. After her fall, could Richardson -- or anyone for that matter -- have done anything differently?

Richardson reportedly left the slopes and returned to her hotel. Apparently, the ski patrol stayed with her during that time. Until she began complaining of a headache, everything seemed okay.

These cases are quite rare, doctors say. In one 10-year study of head injury deaths in a major Australian trauma center, 2.6 percent of all cases involved "talk and die syndrome."

Still, if you take a fall or bang your head, you should be mindful of the warning signs and seek immediate medical attention if you experience dizziness, drowsiness, headache, slurred speech, loss of consciousness or confusion, nausea, numbness, or weakness in arms and legs.

3. Are Beginners Especially Vulnerable to Injury?

It may seem counterintuitive but experts say the better you are, the greater your risk. Above average male skiers suffer the most serious injuries and deaths, according to the work of ski injury researcher Dr. Jasper Shealy of the Rochester Institute of Technology. Above average skiers move at high rates of speed on intermediate trails. Typically, they're males in their early twenties all the way up to their mid-40s. That's essentially the same demographic group that gets into more car accidents.

4. Could a Helmet Have Saved Richardson?

The answer is maybe, but it's too soon to tell. In general, helmets are helpful, but they aren't perfect. "The sad fact is that we now have 45-50 percent of the snow sports population using helmets," Dr. Shealy explains, "but the fatality rate has not changed." Over all, the rate of head injury has declined 35 to 45 percent, he goes on. That's because helmets are very effective at preventing head lacerations and other less serious head injuries. However, helmets "are less effective for more serious head injuries that typically involve greater kinetic energy and/or speed."

Most fatalities are the result of relatively high speed impact (probably greater than 27 mph) with a fixed object (like a tree), Dr. Shealy notes. "Under those circumstances, it will probably take more than a helmet to save your life," he says.

"I agree with the proposition that everyone should wear a helmet while engaging in a winter snow sport," he concludes. "If you hit a tree at typical maximum skiing speeds, you will still probably die, but if you fell on hard-pack snow (a much more likely scenario) and hit your head on the hard surface, a helmet can likely change what would likely be a serious head injury into a minor, less serious head injury."

In addition, Dr. Shealy's work suggests that helmets may actually encourage riskier behavior among some skiers -- because they feel safer -- and lead to more severe injuries. However, Dr. Shealy says that's not a good reason to skip wearing a helmet. "I encourage everyone to wear a helmet, but ski (or snowboard) as if you were not wearing a helmet. I don't know if realistically anyone can do that, since I suspect that the increased level of risk-taking is sub-conscious."

5. How Often Do People Die or Get Seriously Injured While Skiing?

What happened to Richardson is exceedingly rare, especially for a beginner. Around 15 million Americans are skiers. An average of 39.8 people die each year skiing or snowboarding, according to the National Ski Areas Association, the industry trade group. That means there are .88 fatalities per million days of skiing and snowboarding. On top of these deaths, the NSAA says there are 43.6 serious injuries every year.

In the last 25 years, experts say, the overall injury rate has declined 50 percent. Today, there are 2.5 serious injuries per 1,000 skier visits (i.e. ski days). If you think about the number of days per year that you put on skis -- say, seven -- that means you can ski 61 years on average before really hurting yourself.

6. Is Skiing is More Deadly than Snowboarding?

The death rate for snowboarders is 40 percent lower than for alpine skiers, according to Dr. Shealy's research. When they wipe out, skiers are three to four times more likely to hit something while snowboarders don't slide as far or hit as much. The snowboard acts as a kind of anchor, stopping you before you strike something, according to Dr. Shealy. In terms of over all injury rates, however, snowboarding is twice as risky as skiing, he says.

Natasha Richardson's death is a terrible loss. Like Sonny Bono and Michael Kennedy before her, Richardson's story may serve an important cause: Raising awareness about head injuries and ways to prevent and detect some of them.

Comments

[ptulinski]

10,000 people take that same fall and don't even get a headache. Unfortunately, it's just bad luck if you happen to have that weak blood vessel in your head that tears with relatively minor trauma. I read that she was transferred from the first hospital to a second in Montreal, which tells me that the first hospital figured out she needed a neurosurgeon and didn't have one. The take-away lesson here, other than watching for developing symptoms, is to think about which hospital you go to. She probably ran out of time . . . 2 very unlucky facts here-- genetics and time.

[Doomestic]

I am not a Neurologist nor a Neurosurgeon, but an Internal Medicine resident hoping to become an Hematologist / Oncologist. I wrote the following on a different thread:

"This is a typical case of middle meningeal artery rupture. There is a "lucid" period after the initial injury, while the blood bleeding slowly in the temporal area is accumulating, but not enough to cause substantial pressure on the brain. Eventually once enough blood accumulates, the medulla starts to herniate through the foramen magnum and presses on the vital centers on the brain stem. Injuries like this usually happen to the thin area in the temple called the "pterion".

My deepest condolences to the family. Sadly this is one of the cases that could have been saved had it received proper medical attention earlier."

[Chaimirija]

I am not sure a helmet would have helped her---doesn't it seem like it was her brain stem that was damaged?

[Doomestic]

I think a helmet would have helped her, because in those cases the area most prone to damage is the softest part of the skull, which is the temple. Yes, the brain stem was damaged, but not by the fall. It was damaged by the pressure effect exerted from the accumulating blood in the skull. When blood accumulates, the brain has methods to compensate for the extra pressure by epxanding into cavities called "ventricles". Once the capacity to do that fails, the brain starts to herniate through the main foramen, which leads to pressure on the brainstem.

Of course those are all my speculations and I could very well be mistaken.

[Darwin48]

"Still, if you take a fall or bang your head, you should be mindful of the warning signs and seek immediate medical attention if you experience dizziness, drowsiness, headache, slurred speech, loss of consciousness or confusion, nausea, numbness, or weakness in arms and legs."

-That's fine, I'm more than willing to go to a hospital and get checked out....and I bet anything they do the same thing as they did here....send me away, tell me I'm fine, wait and see, take some ibuprofen...
a CAT scan or MRI...yeah, not in a million years.
Maybe if the doctors did a scan, a "better safe than sorry" approach...
The second time around when I herniated my disk in my lower back, I had to plead to get an MRI.
We have the luxury of the lousiest healthcare system in the world.
Sincere condolences to the family.

[OkieIntellectual]

"We have the luxury of the lousiest healthcare system in the world."

Yeah, and conservatives say that socializing healthcare would make it worse. How could it possibly get any worse?!?

Get rid of all HMOs and PPOs, as they are out to make money, not look after people's healthcare needs. All aspects of medical care should have their prices fixed at a rate that is affordable to the average American WITHOUT having to have insurance cover the costs.

That's right, I said it folks... make healthcare cheap enough that people can afford to pay for it out of pocket.

Make medical schools lower their tuition to the point that doctors don't feel the need to make 6-figure salaries just to pay off their student lonas. That way doctors will hopefully get back to an attitude of getting into medicine to help people rather than to make tons of money.

[Patriot68]

What I have yet to see reported is anything saying she hit her head directly which I find odd. Every report says she fell and sustained no visible injury but none saying she fell on her head. So did she hit her head and how hard exactly was the impact are my questions.

This really sounds like a pre existing condition that was aggravated by a minor fall. I am just curious about this tragedy and wonder how much of what happened was factually reported.

[Anthro]

I've posted this at least twice. We'll just have to wait for the autopsy. I'm not trying to intrude on the family's grief with my curiosity, by the way; I just want to know more about the medical details to be better informed should something like this happen to me or my loved ones. I'm pretty sure I would have done the same as Ms. Richardson (and have done, many times). I, too, suspect there was something unusual in this case, such as a preexisting weakened vessel or something like that.

[somethingworthsaying]

an important symptom to seek medical care that this write missed is to look for dilated pupils, esp. just one and seek care immediately!

[Anthro]

It seems she DID seek care as soon as there was a symptom. Someone was with her the whole time, but none of the reports have said whether or not anyone checked her pupils. One factor may turn out to be that she was too far from a hospital as brain bleeds require emergency surgery. But even with surgery, they often cannot be stopped in time. We have to accept that sometimes these awful things just happen and learn what we can from them.

[Whittlesey]

She was checked out by ski patrol/EMTs, and they are absolutely trained to look for uneven pupils.

[kothian1]

As the victim of a head injury I understand how the family can be so surprised after what appeared to be a relatively minor injury. Mine occurred with a fall down the stairs. While the doctors could never put a finger on exactly what the damage was (apart from wrecking my middle-ear), I have been plagued with migraines, slurred speech and a certain disconnect in physical function that's difficult to put into words. My regular doctor put it best when he compared the brain to computer.
"If you drop your computer on the floor", he said, "and then plug it back in....it might work. It might work somewhat, but not correctly. Or..it might not work at all."
He then looked me square in the eye and said: "You f**ked up your computer".
It's still the best explanation that anyone in medicine has been able to offer. Fact is, there's still an incredible amount that medicine simply doesn't understand about head-injuries.

My prayers and sympathies to the family, and I hope that they ultimately get a better explanation of what caused Natasha's death than I was ever able to get.

[prostock69]

Ouch! I am so sorry this happened to you. My husband suffers from Migraines (at least one a week) from a prior head injury. It's not fun.

[OYea]

You might want to do some research on neurofeedback. There is a growing body of research that suggests that it is highly effective for reversing symptoms of mTBI... including migraines and seizures that often accompany them.

[jalyn]

This tragedy scares me to think back of how we skiied without helmets as teenagers, and we never thought or worried about head injury, as I used to wipe out a lot, and just worried about breaking a leg. Am certain this will bring to light new focus on stricter safety regulations at ski resorts.

[ZellaBee]

Don't know what happened in the accident, but just want to comment about falling. I taught myself how to fall early on as a skier, after a few, not so pleasant, falls as a beginner. I found the past of least resistance would prevent me from serious injury.Whenever I could identify I was no longer in control of my speed and/or skis,
I would do a controlled fall, then pick myself up and start again. This is what stunt people do and I wonder if anyone teaches this in ski school?

[toypiano]

Yes, at least some do. At my first lesson, the ski instructor taught various strategies for falling and had me practice all of them. I think I was better at falling than skiing.

[FZliveson]

The "past of least resistance" ?
What is that selective memory?

[FZliveson]

Head injuries are strange things. Eric Medlin, nitro funny car driver died when his tires shook his car violently. There are tens of thousands of tiny blood vessels in the head. Doesn't take much to cause damage for some people. Every day is a gift. The one we take for granted could be the final one.
Hold your loved ones close. Mend your fences and tell the truth. Most grieving at funerals has something to do with undelivered communications. My heart goes out to the family.

[Anthro]

I was certainly taught how to fall when I learned to ski and I still use this when I x-country ski. Even so, I wonder if I should get a helmet? Is the bike helmet okay?

[TXfemmom]

Safety gear is just that, for safety. My grandchildren become quite annoyed at nanna for saying get your helmet every time they get on a bicycle, but I do it just the same. It is my way of saying I love you.

[tamarabamara]

God this just freaks me out. As a person who spent their childhood skiing, I think back to all the times I took spills, and my friends and family members did the same. In later years, I remember taking snowboard lessons and falling HARD several times. I remember seeing several other people in my lesson group do the same. We all got up and started laughing, feeling silly and vulnerable for a moment. Anyway, I know I've hit my head on the hard pack snow a number of times, and watched others do the same.... and yet we all walked away just fine.

As somebody posted somewhere else on the web today... life is neither promised nor permanent.

Makes you decide to cherish the day a little more than you might otherwise.

My thoughts and prayers go out to Natasha's family. How difficult to deal with such a shock.

[jalyn]

Amen. Nicely said.

[taste-the-rainbow]

This is so sad about Natasha Richardson. I do and now will forever wear a helmet. My prayers are with her family.

[viewfromuphere]

while there is nothing inherently wrong with this article...isn't it a little questionable to be posting basically a ...really skiiing is a safe sport item right now...while, according to reports ....this lady's family basically watching as she takes her last breath.

there's plenty of time for the helmut pro/con debate. And you know, we may never know exactly what might or might not have prevented what. Was it an aneuyrism, was it "talk and die" ...the syndrome caused by increased intercranial pressure and swelling of the brain...because that's confidential medical information and her family doesn't have to reveal a darn thing if they choose not to. So even the medical experts are at best, making educated guesses.

This isn't about skiing...( or as Jon Stewart said to Cramer...it isn't about "you")...it's about a family possibly loosing their wife, mother, daughter, sister in horrible circumstances one wouldn't wish on their worst enemy.

with all due respect...that's the important thing at this particular moment..

[Goliadkin]

I think this is a very informative article that answers many of the questions people will have pursuant to Ms. Richardson's tragic death. I welcome it. There are appropriate obits and eulogies elsewhere on the site.

[RoseBlue]

Well said and I agree. But with our electonic age, the second people get tragic news, they post the what they know and how they feel. This is the age we live in, and it can sometimes be crass.
But please stop shooting the messanger. We are in an instant age where people want to respond immediately to a horrific incident, often as soon as it has knocked them over. Please don't dictate what an acceptable waiting period is.

[Balloonman]

I guess about everybody got stories, could run down stories falling on their head hard a time or two. Ski. Bike, Motorcycle, car. Jumping, leaping, running, tripping. Slipping. Hanging upside down and the limb snaps. Collapsing. Hit hard in this sport or that. Boom! But it is the heart here. Natasha Richardson is gone. Bright light out. This mesmerizing actor. Like her Mother. Vanessa Redgrave. What is it about actors like them? Take your breath away. A story can be a drudge but as soon as they appear on 'stage' magic begins. What is it? Aside royal respect for the tradition, the bag of tricks picked up growing up noble in such an extraordinary theatre family. Fathers, Mothers, Sisters, Husbands, Wives. Everybody theatre. Constant working the craft with the best, the learned disipline. A gift? The super power focus on each scene's moment of essence. I think I know this charisma, what it is. It is special to the blood and is after all soul. Cliche I know. Such soul tempered and honed, watch out! Slight-of-hand suspends belief and reality before our eye. Let the 'play' begin! Be amazed, maybe t transformed. Soul. If you don't know what soul is, like Louis Armstrong said about what is Jazz, paraphrased, "If you have to ask Honey you won't know". Anyway, I had no idea I was so taken with Natasha Richardson until now. It hurts to think about her during the day.

[ramblingjohnny]

My uncle died that way but he was not skiing. He slipped on some ice and got up fine 48 hours later Jean-Claude was brain dead. Sometime you just buy the wrong ticket in life.

[luziannagirl]

A large dog running across the room knocked the legs out of a man's chair. The man fell, hitting his head on a heavy coffee table He scolded the dog, lectured the dog's owner on the need for better training, put some ice on the bump, and got on with enjoying the family gathering. The next day he woke up with a bad headache. By the time he and his family associated the headache with the previous day's fall, and decided to go to the hospital, the bleeding on his brain had rendered him unconscious. He nearly died, went into a deep coma for weeks, and three years later, is still slowly recovering.

Even seemingly slight head injuries can be serious. They should always be taken seriously.

What a tragedy for Ms.Richardson's family.

[1088]

I could recall that Sharon Stone bled in her brain too, and died and came back. I wonder why the same method wasn't done for her too? I think they used coils in her neck to stop the bleeding.

[marignymitch]

You're confusing her with the Bride of Frankenstein. An easy mistake.

[Goliadkin]

I'm very embarrassed to be laughing out loud here. You snarky devil.