According to The Globe and Mail, a Canadian news organization, recordings of radio traffic between the ambulances, the dispatch center and the hospitals show how Natasha Richardson steadily deterioriated as her epidural hematoma progressed.
The timeline as reported by The Globe and Mail:
- 12:43 pm First ambulance dispatched. The Medical Priority Dispatch Code used is 17-B-1. 17 refers to a fall. B-1 refers to a dangerous body area. Since there have been multiple reports that Richardson had no obvious injuries, the dangerous body area designation suggests someome was concerned about her head. If they didn't have an idea what was injured, the code would've been 17-B-3.
- 1:00 pm Ambulance on scene without a victim.
- 1:11 pm Ambulance cancelled by the ski patrol. Paramedics never got to evaluate Richardson. We know from previous reports that Richardson refused ambulance transport, saying she was fine.
- 2:59 pm Second ambulance dispatched to Richardson's hotel room. The dispatch code this time is 17-D-1, which tells us the call-taker (911 operator) was told the condition is related to a fall (17) and now the questions the call-taker asks has led him or her to prioritize it D-1. With a few exceptions, like cardiac arrest or choking, the highest response level is D (pronounced on the radio as Delta). Call-takers arrive at this code by asking a series of questions about the victim. Whether or not Richardson is able to breathe adequately would be one reason to prioritize it as a Delta response, so would confusion.
- 3:55 pm Ambulance report to the first hospital. The medic mentions Richardson's Glasgow Coma Scale (GCS) as 12. Somebody with no injury would get a GCS score of 15. The medic mentions she is "verbal" and that knocks a point off her score. He also mentions she's confused, which knocks another point off. If she's only at 12, what else is wrong? Either she wasn't making any sense at all when she spoke to the medic or she couldn't follow simple commands, either one knocks another point off her score. I'm a little surprised that her blood pressure isn't higher, but overall her signs and symptoms are very alarming. Any accredited trauma system in the US would triage her to a level I or II trauma center and bypass the smaller hospital.
- 6:38 pm Richardson arrives at Sacré-Coeur in Montreal, a larger hospital able to handle her injury. To their credit, the ambulance crew made really good time. There are some, me included, who think using a helicopter to get Richardson to Sacré-Coeur, a trip of about 30 minutes according to The Globe and Mail, might have made a difference.
In a previous post I asked if you thought Canada's, or more specifically Quebec's, EMS system had any affect on the outcome of Richardson's case. There's been a lively discussion in the comments section. I also have a poll on the question, which I've moved here.
The people of Canada and most certainly Quebec have a right to know if their system isn't as good as it could be. If this is simply a unique outcome based on totally unforeseen circumstances, well then it is just a random tragedy that is more indicative of our fragile existence than of any mistakes.
If, on the other hand, this could have been different, don't we owe it to the next victim to ask tough questions? It's pretty clear from the information just in this timeline that Richardson didn't go from talking and joking to coma. There were signs that she was deterioriating, signs the paramedic correctly identified. The question is, was there a lack of planning or too few resources available in the EMS system responsible for her care?
Isn't it important to find out?
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My mother-in-law died of a subdural hematoma from falling down her carpeted stairs. She managed to get back up and go to bed before my father-in-law asked her why she wasn’t at work at she was unable to answer coherantly. They were three hours away from a trauma 1 and by the time they got there their was nothing they could do. The incidence was so bizarre that the police launched an investigation unable to believe that she died from falling down a flight of stairs covered by soft carpet. Ironically about a year ago one of the nurses my husband works with had her mother dye the same way. Subdural, epidural whatever these brain injuries seem to be difficult to diagnose and treat in a timely manner.