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Why Natasha Richardson Ended Up Dead: A Neurologist Explains
How can it be possible for a healthy 45 year-old woman to take a spill on a "bunny hill" and end up brain dead within the day?
That's the question that I posed to neurologist Dr. Dexter Sun, who practices at New York Presbyterian Hospital/Cornell in New York City. First of all, rest assured he said: this is a highly unusual case. Normally, a tragedy like this occurs only after a very heavy impact accident, says Dr. Sun.
With that said, Dr. Sun explained that there are three particular possibilities that could account for Natasha Richardson's state:
1. "She may have a fairly rare underlying hematology condition called hypocoagulation, in which she lacks a blood clotting factor," says Dr.Sun. This could be a genetic factor which had gone unnoticed throughout her life until now. When the clotting factor is missing, a minor bleed can become a hemorrhage.
2. It's possible that Natasha could have been taking a blood thinner like coumadine, for another medical condition, that would have made it much more likely for her to bleed after any head injury, according to Dr. Sun.
3. Finally, and most likely, she did have a harder spill than what has been reported. Sometimes when this happens "you can have a high level cervical spine fracture or a fracture at the base of the skull," says Dr.Sun. When this occurs, and the injured person continues to move around as Natasha did -- not realizing that she was seriously hurt -- the spine can touch the brain stem and cause a severe brain injury.
A high impact fall on the head can also cause three different types of bleeding within the brain: 1) an intracranial hemorrhage, which begins as a microscopic rupture of a blood vessel deep within the brain, 2) a subdural hematoma, which is a bleed that occurs in the dura, which is the outer layer of the brain, or 3) an epidural hematoma, which is a hemorrhage, that takes place between the outer skull and the dura.*
As for why Natasha initially seemed perfectly fine after her spill, apparently the hemorrhage can begin in one small spot in the brain and then grow in intensity.
All of these types of bleeding and the cervical spine fracture, result in dramatic swelling of the brain and pressure in the skull, which also pushes down dangerously on the brain stem, which is the center of life, according to Dr. Sun.
Big question: Was there ever a chance to save Natasha Richardson's life? If she hadn't insisted that she was fine and walked back to her room, could prompt medical treatment have made a difference?
Since initially there was no indication that Natasha's life was in danger, it's unlikely that she could have been saved. She would have needed to be rushed into the hospital and into a CT scan in a matter of minutes, according to Dr. Sun.
"If she had gone to the hospital and a CT scan indicated that there was bleeding, her skull would have been opened to relieve pressure, and she would have been given medication to relieve the pressure in her brain," he says.
Only then, would there have been a chance that she could pull through.
Tragic.
*The autopsy confirms that Richardson died from an epidural hematoma.
For more on Natasha Richardson follow Bonnie Fuller at twitter.com/ bonniefuller.
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Lawsuit or not, all skiers should be interested to know more about the fall and the resort's accident/injury protocol. From the very beginning of this tragedy, the resort has said or implied that the fall was a little tumble on a bunny slope. But, the ski instructor called the ski patrol who took Ms. Richardson down the mountain on the sled and called an ambulance. Any skier knows this is not a normal reaction to a simple fall. Given that the instructor and ski patrol thought these precautions were warranted and given the contents of the recently released emergency calls, you have to ask who - exactly - declined additional care and was he/she the right person to make that decision? We know it wasn't the first ambulance attendants - they didn't talk with Ms. Richardson. Given that she had been in a fall that resulted in her being carried off the mountain, did the resort leave it to her to decide whether she needed more help? Did anyone even remotely qualified to assess injuries weigh in on that? I hope that if I ever fall hard enough to cause someone to summon the ski patrol and they wrap me up, put me on a sled and bring me down, I'm at a resort that will take me on to a hospital or a least a doctor, a paramedic, an EMT, a nurse... someone who knows more about head injuries than the person who has just fallen on her head.
I'm a thrill seeker and have never worn helmet on a bike, slope, rarely on motorcycle, or anywhere. But this has me thinking, especially with kids, the thrill and fresh air isn't worth the loss. Sad for all, but how do people stand to have every detail scrutinized, from the grief to accident details, to who didn't do enough or do the right thing to save her?
Helmet it is, though. But what a mutty blend, safety and thrill.
http://muttslikeme.wordpress.com
Wear a helmet -its the least you can do.
To all those who have advocated suing the resort....first of all, you ski at your own risk. The ski patrol is trained in basic care...they DID summon an ambulance...however.....if the patient refuses care, even if a paramedic feels they should go..that paramedic cannot force the patient to do anything...they can't even TOUCH the patient without the patient's consent or risk being charged with ASSAULT!!! This was a tragic accident but the resort acted correctly.
See Ed and Deb Shapiro's Profile
I am an avid skier and live in Ski Country USA- I have skied over 30 years and have skied 40 days a year. As an expert who has skied even glaciers. Most of my ski years I didn't wear a helmet i have only worn a helmet for the last 2 years -
there is a wonderful quote: BETTER SAFE THAN SORRY
I highly recommend : WEAR A HELMET - the best of skiers can wipe out- all it takes is one moment of mindlessness- a second of distraction or some out of control skier crashing into you.
I had a serious accident last year and luckily was wearing a helmet --the helmet was dented but I was fortunate to survive--if not for the helmet god only knows. This is serious- I am writing this to let people who says that a helmet is not necessary or it wouldn't help in all situations etc is missing the point
Enjoy,
Ed
Are you required to sign a liability release form before being admitted onto a slope?
When you purchase your lift ticket you agree to not hold the resort liable. The terms are printed on the back of the ticket. It is also posted on a very large sign near the ticket window where I usually ski.
Excellent article and great detail. It's refreshing to see one explain things in detail, rather than resort to guesswork or what she "coulda/woulda/shoulda done" mentality that until now, has been permeating throughout this site and story. And you are so right, that if she was on something like blood thinners (something I hadn't even considered myself) that it's likely a contributor. We don't know that, yet I think you are taking a responsible approach of mentioning it as a possible factor. I was getting tired of people simply saying "she died cause she wasn't wearing a helmet". To me that is pure ignorance. While they can prevent serious head injuries, they do not make you immune from harm. Both my parents have been on blood thinners for years and it was only because of being around them that I came to realize that even a minor injury while on blood thinners can turn into a medical emergency.
Obviously, we may never know all of the details about what exactly happened in Natasha's case, or any possible contributing health and medicine factors. But hopefully some good can come out of this, even if it's nothing more than raising awareness about a medical, medicinal or other issue.
Thanks, Bonnie, for this great article. I wish more journalists would use these kinds of tragic situations as "teachable moments." Keep up the good work here and on your Twitter feed!
What occurred to her is beyond comprehension. The sad fact is millions of Americans have accidents all the time, have zero health insurance for one reason or the other, are not privvy to proper medical attention. She had insurance, and assumed she was ok, instead of getting checked out. The irony is no longer funny. Hospitals MUST perform tests on anyone coming into thier ER with Head Trauma, Insurance or NO. That is a basic part of practicing medicine. This crap of we will only see those whom we deem worthy, is crimminal. When you are teaching medicine, you are teaching the art of healing, not supporting the insurance companies that are lining thier pockets. Going back to basics, teaching medicine and expecting your interns to practice, not ride the coat tails of the insurance companies is paramount. Should they do the latter, it should be grounds for expusion from the program. Hositals that choose to play god should not get grants until they choose to help ALL patients, insurance or NO.
While I agree with much of what you say- none of it would have helped Natasha Richardson (which is who the article is about).
See Ed and Deb Shapiro's Profile
doctorwang- I disagree- you can't say that because if the circumstances were different in any way she may have fallen differently. You are judging the fall as it happened without how she would have fallen if she wore a helmet.
Wearing a helmet as I do can give a person a different perspective and skiing is so quick and ones mental and emotional state is part of the whole picture.
So ultimate you can't say how something will be unless the situations is the same. My helmet saved my life. That is a fact!
Peace, Ed
Hypocoagulation is ruled out by the birth of her two sons. It's highly unlikly this condition would've gone undected during childbirth....twice.
(Perhaps she was embarassed after her fall and minimized it? That sounds like something a lot of women might do...me included.)
She was too far from a good head trauma center. Simple as that.
Maybe an arbitrary rule is called for: Hit your head on ski slope (or swimming pool or in any supervised venue), go to hospital, no option. Insurance to cover the expense of the ambulance and ER and CAT scan could be included in the ski ticket price. If the occurance is very rare, it would probably add no more than pocket change.
Yes, most head strikes will not be fatal, but for the ones which potentially are, time is of the essence. The odds are low, but the stakes couldn't be higher.
Four years ago I fell and hit my right brow bone on a tile floor. It split my eyebrow open (I still have the scar where hair stopped growing). I had a CAT scan and medical followup, and they assured me nothing was wrong. I have to say, though, I haven't quite been the same since that fall. I have memory lapses (I'll lose a couple hours in a day when I have NO idea where the time went). I'll blank on words. I lose things more frequently. I have mood swings. It's nothing that completely hampers my life, they're small annoyances, but they're there. My head injury may have felt like "just a bump", but it may have caused some damage. Heady injuries are nothing to take lightly.
I saw some lawyer-putz on CNN last night talking about how Liam Neeson should sue the resort. Frankly, I was repulsed. This was a freak accident, and the resort did everything correctly. If a patient refuses treatment, there's nothing anyone can do. Suing for money is not going to bring her back, especially when they did everything they could to get her help.
Money won't bring her back, but it will teach these places they must have proper medical teams ready for such incidents. She is not such a freak accident as you claim, many are injured and it goes un reported. The only way to send a message to these ski lodges is to get tough, REALLY tough, so they provide proper care for thier patients/ guests. As to her refusal to medical treatment, when someone has had a head trauma, techically they are not mentally fit to make such a choice, and it should be based on the paramedics findings. If its deemed they need care asap, so be it. Someone who looks and acts fine may in fact be in the most danger, so you cannot base anything on that. Head trauma of any magnitude must not go ignored. The kinds of medical problems, crisis that can evolve happen within seconds, minutes, an hour, and long term, cause blindness, mental blocks, neuro issues, Its not a freak matter. SUE LIAM.
To cruisepuppy7452a,
I couldn't agree with you more. Suing the ski resort is the only way positive change will be made there to ensure this doesn’t happen to anyone else.
Now it's come out (I already guessed it), that it wasn't 1 hour between Ms. Richardson's fall and seeing a doctor, rather it was 4 hours between the accident and Ms. Richardson arriving at the hospital.
Also, as you said, if she did "waive off" the ambulance (which I don't know if I believe), the resort staff should not have allowed that to happen and insisted that the paramedics examine her. That's just common sense and should be routine practice at any ski resort.
Perhaps Ms. Richardson would have died anyway, we will never know; however, by suing the resort, her family can make sure that emergency procedures are not just written on paper or placed on their website but put into practice and enforced.
You're wrong on so many levels its scary. BTW- this is America and if the lady refused medical attention she was well within her rights. The accident itself has raised a huge amount of awareness to the potential head injuries from skiing. A lawsuit would only turn the publicity into another frivolous attack of an innocent resort from an unfortunate accident. How can this be in any was the resorts fault? If she would have broke her leg and the bone severed an artery then died from blood loss, would the resort still be to blame? I'm sure in your opinion its always someones elses fault...
Since this unfortunate occurrence happened To Natasha Richardson I have wondered about what could have caused such damage from a seemingly minor fall. I am grateful for this article which explained a lot about the situation.
Having played sports when I was younger (especially football) i had been knocked in the head many times with no ill effects. (I think) Again I am grateful, this time for having a hard noggen.
Glenn Smith Author of Lotus Petal, A Parable to Help You to Overcome The Fear of Death
http://lotuspetalbook.com
I agree. This article cleared up many of my own questions on how a person could die from falling on a bunny slope.
Very likely she was on coumadin or at least aspirin daily. This was so unfortunate, that she didn't notice or was trying to be brave thinking this will go away. She must have had an incredible bumb on her head. Highly unusual. That is so shocking to all.
I have been an RN for more than 46 years. My only hope is that this tragedy has enough impact to educate people in the necessity of not taking head injuries lightly. The old adage, "It's better to be safe than sorry" definitely applies here, meaning if you are going to over react, do so on the side of safety and get yourself or the other person to a hospital trauma center ASAP and get a CT scan, because as has been reported in the news, these types of injuries require immediate attention to save a life. It is not the time to be "macho" or cavalier.
Hopefully everyone who has heard or read about this will know what to do if they are ever in similar circumstances, and we won't be reading about another life lost that could have been saved.
Although this would not have been an issue for Natasha Richardson, a lot of people are reluctant to err on the side of caution for fear of getting gouged by the hospital or having problems with insurance.
A couple of years ago I suddenly started having chest pain on my left side, so I went to the emergency room. They ran some tests, said they didn't find anything, and released me after about an hour; a few days later the same thing happened, I was still scared so I went to another hospital with the same results. The first hospital charged me $1100 dollars and the second charged double that, for the exact same treatment. I had insurance which paid part of it, but I had about a $1300 bill to pay off while making 12,000 a year and struggling to pay the rent. If I ever have chest pains again, I have to admit that I would be reluctant to go to the emergency room unless I was at death's door.
To mousesoup,
God be with you, and do not hesitate to go to the hospital 10 times if necessary. Don't ever worry about the money. I understand you don't want to be in debt or have a negative credit rating, but you can't pay back the money if you're dead.
Also, I've read that many hospitals agree to take approximately 40% of the bill owed as final payment because receiving something on the bill is better than nothing. You can’t negotiate your hospital bill if you're dead.
So go to the hospital as many times as needed to ensure that your health is not in immediate danger.
I hope people will take your post seriously. My mother was an RN and among the many things she taught us about health, prevention, and so on, was to get checked out after an injury even if we were feeling fine.
Thank you for an excellent post!
Its sad. that she did not realize how hard she had hit her head, having a family or just for ourselves calls for us to be sure about our health. This made me reflect on my child hood, at around 7 or 8, I was out of school feigning illnes no doubt, home alone and outside when I got the great idea of hitching a ride on the back of a mail truck. As it turned to a street nearby to go down hill I decided I better jump off, well my feet went into the air and I landed on the back of my head/skull. I still have the bald spot...the truck kept going, he should hve seen me out of the mirror, I will never know, i picked myself up and got to the side of the road and sit on a cinder block. Ms. Lucy who owned a home store got me into her store and looked at my head and I don't remember what else she did. i think I got a whipping that evening when my grannie came home. When I was about 12 a friend of the family, actually my dads brother in law was swinging me in the air in the kitchen and he slamed me, my head against the wall, my mouth was open as I tried to cry but no sound was coming out..I did not go to the doctors. I was one lucky hard headed kid!
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