The initial paramedic assessment, travel time to the hospital and time she spent there was nearly two hours -- the crucial interval in this case. Survival rates for patients with epidural hematomas, conscious on arrival to a hospital, are good.
Richardson's evaluation required an immediate CT scan for diagnosis -- followed by either a complete removal of accumulated blood by a neurosurgeon or a procedure by a trauma surgeon or emergency physician to relieve the pressure and allow her to be transported.
But Sainte-Agathe-des-Monts is a town of 9,000 people. Its hospital doesn't have specialized neurology or trauma services. It hasn't been reported whether the hospital has a CT scanner, but CT scanners are less common in Canada.
Compounding the problem, Quebec has no helicopter services to trauma centers in Montreal. Richardson was transferred by ambulance to Hospital du Sacre-Coeur, a trauma center 50 miles away in Montreal -- a further delay of over an hour.
Because she didn't arrive at a facility capable of treatment (with the diagnosis perhaps still unknown) until six hours after the injury, in all likelihood by that time the pressure buildup was fatal. The Montreal hospital could not have saved her life.
Her initial refusal of medical care accounted for only part of the delay. She was still conscious when seen at a hospital and her death might have been prevented if the hospital either had the resources to diagnose and institute temporizing therapy, or air transport had taken her quickly to Montreal.
What would have happened at a US ski resort? It obviously depends on the location and facts, but according to a colleague who has worked at two major Colorado ski resorts, the same distance from Denver as Mt. Tremblant is from Montreal, things would likely have proceeded differently.
Assuming Richardson initially declined medical care here as well, once she did present to caregivers that she was suffering from a possible head trauma, she would've been immediately transported by air, weather permitting, and arrived in Denver in less than an hour.
If this weren't possible, in both resorts she would've been seen within 15 minutes at a local facility with CT scanning and someone who could perform temporary drainage until transfer to a neurosurgeon was possible.
If she were conscious at 4 p.m., she'd most likely have been diagnosed and treated about that time, receiving care unavailable in the local Canadian hospital. She might've still died or suffered brain damage but her chances of surviving would have been much greater in the United States.
American medicine is often criticized for being too specialty-oriented, with hospitals "duplicating" too many services like CT scanners. This argument has merit, but those criticisms ignore cases where it is better to have resources and not need them than to need resources and not have them.
A trainer, center, helps Buffalo Bills' Kevin Everett after he was injured during a football game on Sunday, Sept. 9, 2007. Comments (0)Doctors are following the playbook in treating Buffalo Bills football player Kevin Everett's severe spinal cord injury except in one notable regard: pumping icy cold saline into his veins to try to prevent further damage.
Although the treatment is experimental, it is more science than science fiction, and also is being tried on stroke and brain injury patients.
"There are compelling reasons why one might want to try it" in a case like this, said Dr. Gary Steinberg, chairman of neurosurgery at Stanford University. He had no role in Everett's case but has tested the body cooling treatment.
Everett's prognosis remains uncertain. His doctors were encouraged by signs on Tuesday that he could move his legs and arms - a day after saying he stood little chance of making a full recovery. They also have said that his spinal cord was intact rather than severed - a very good sign.
Doctors say that it is far too soon to know whether he will be left with any paralysis or its extent.
"Walking out of this hospital is not a realistic goal, but walking may be," Dr. Andrew Cappuccino, the team's orthopedic surgeon, said at a news conference in Buffalo on Wednesday.
That does not mean a return of his career, though, said Dr. Joseph Maroon, team neurosurgeon for the Pittsburgh Steelers and a University of Pittsburgh Medical Center specialist who was consulted on Everett's case.
"If he ever does regain function, no neurosurgeon would ever permit him to play football," Maroon said.
Everett suffered a fracture and dislocation of his spinal cord in the neck area during a game Sunday night against the Denver Broncos. Watching it on television from home was Dr. W. Dalton Dietrich, scientific director for the Miami Project, a spinal cord program affiliated with the University of Miami Miller School of Medicine.
The program is among several in the United States that has led research into moderate hypothermia, or cooling the body a few degrees to try to limit swelling, inflammation and the cascade of events and chemicals that cause further damage after an initial neurological injury.
Dietrich sent an urgent e-mail to fellow neurosurgeon Dr. Barth Green, who knows Buffalo Bills owner Ralph Wilson.
Who did what next is unclear, but doctors say Everett received the experimental cooling therapy in the ambulance, even before X-rays and other tests could show the extent of his injury and the treatment he would need.
The goal of the treatment is "to cool the tissue a few degrees to reduce its need for oxygen and to reduce its metabolic rate" and limit secondary damage from chemicals the body releases after the initial injury, said Dr. Elad Levy, a University of Buffalo neurosurgeon who treated Everett.
On Monday, as Everett's temperature began to rise, doctors decided to try cooling his body again, using a slightly different system. This time, a hollow tube called a catheter was inserted into the femoral vein in the leg near the groin. Cold saline was circulated inside the catheter, indirectly cooling the blood as it flowed through the vein.
"We did this here at the University of Pittsburgh in the 70s," but with a different method of threading a catheter directly over the spinal cord, Maroon said. The treatment had to be done within three hours of injury to have any benefit and was extremely cumbersome, he said. For that and other reasons, it was largely abandoned until recently, when doctors have resumed testing it through different cooling methods for stroke and brain injury patients.
"Not a lot is known about it for spinal cord injury," said Steinberg at Stanford, where it mostly is done in some stroke and head injury cases under an experimental protocol.
Other aspects of Everett's care are more routine.
He received large intravenous doses of methylprednisolone, a steroid to limit inflammation and swelling, and had decompression surgery to relieve pressure on his spinal cord.
Doctors initially operated from the front of his neck, removing the injured disk and bone impinging on the spinal cord, and realigned it. They filled the space where the disk had been with a bone graft - whether from a cadaver or his hip isn't known - and put in a titanium plate to stabilize the neck area.
Surgeons then turned him over and operated from the back of his neck, fusing the vertebrae above and below the fracture, and putting in four screws and two small rods.
Long-term results from such operations can vary widely, said Maroon, the Steelers' surgeon who published a paper in the April issue of Journal of Neurosurgery on this topic. He has operated on about 30 athletes.
On Wednesday, Everett was successfully removed from the respirator though doctors say it could be a struggle to keep him breathing on his own. A stroke and blood clots in his legs are other possible complications they are trying to prevent.
He showed more ability to move his legs and a little more in his arms, but has no movement or function at all of his hands. He is getting nourishment from a feeding tube, and his mother is at his side.
"She understands that this is a life-changing event," and that "the story will change over months to years," said Dr. Kevin Gibbons, another University of Buffalo neurosurgeon who has been treating Everett.
Cuba? Mexico? Canada?? If you want good health care there are better choices... Australia Germany Netherlands New Zealand England... you'd probably get the same or better treatment than in the USA... And if you are an uninsured American, you'd definitely get better health care there.
The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness. John Kenneth Galbraith
Where does the USA stand in keeping our infants alive in the first year of life??? We should be first, don't you agree. Top medical facilities, programs like WIC and welfare for those with out money to support an infant... Take a guess??? First? Second??? Surely with our great health care and welfare for any baby that needs it... we should be no lower than THIRD???
According to the CIA World Factbook... The Untied states ranks 44th in the world at keeping our babies alive for their first year of life. 44TH! Behind: Northern Mariana Islands Cuba European Union Italy . Isle of Man
Taiwan Greece
Canada
Ireland
New Zealand San Marino United Kingdom Wallis and Futuna Portugal Australia Jersey Netherlands Luxembourg Belgium Austria Guernsey Denmark Korea, South Slovenia Liechtenstein Israel Spain Switzerland Germany Andorra Czech Republic Malta Norway Anguilla Finland France Iceland Macau Hong Kong Japan Sweden Bermuda Singapore Monaco
The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness. John Kenneth Galbraith
Even with a higher-risk population, the alleged differences in infant mortality are negligible. We’re talking about seven infant deaths per 1,000 live births in the U.S. compared to 5 deaths per 1,000 for Britain and Canada. This is a rounding error — perhaps literally when you consider that the U.S. tabulates every birth, even in poor, small and remote areas, while other countries are not always so meticulous.
But the international comparisons in “infant mortality” rates aren’t comparing the same thing, anyway. We also count every baby who shows any sign of life, irrespective of size or weight at birth.
By contrast, in much of Europe, babies born before 26 weeks’ gestation are not considered “live births.” Switzerland only counts babies who are at least 30 centimeters long (11.8 inches) as being born alive. In Canada, Austria and Germany, only babies weighing at least a pound are considered live births.
And of course, in Milan it’s not considered living if the baby isn’t born within driving distance of the Côte d’Azur.
By excluding the little guys, these countries have simply redefined about one-third of what we call “infant deaths” in America as “miscarriages.”
Moreover, many industrialized nations, such as France, Hong Kong and Japan — the infant mortality champion — don’t count infant deaths that occur in the 24 hours after birth. Almost half of infant deaths in the U.S. occur in the first day.
But members of Congress, such as Reps. Dennis Kucinich, Jim Moran and John Olver, have all cited the U.S.’s relatively poor ranking in infant mortality among developed nations as proof that our medical care sucks. This is despite the fact that in many countries a baby born the size of Dennis Kucinich would not be considered a live birth.
Apart from the fact that we count — and try to save — all our babies, infant mortality is among the worst measures of a nation’s medical care because so much of it is tied to lifestyle choices, such as the choice to have children out of wedlock, as teenagers or while addicted to crack.
The main causes of infant mortality — aside from major birth defects — are prematurity and low birth-weight. And the main causes of low birth-weight are: smoking, illegitimacy and teenage births. Americans lead most of the developed world in all three categories. .
Although we have a lot more low birth-weight and premature babies for both demographic and lifestyle reasons, at-risk newborns are more likely to survive in America than anywhere else in the world. Japan, Norway and the other countries with better infant mortality rates would see them go through the roof if they had to deal with the same pregnancies that American doctors do.
As Nicholas Eberstadt demonstrates in his book “The Tyranny of Numbers: Mismeasurement and Misrule,” American hospitals do so well with low birth-weight babies that if Japan had our medical care with their low birth-weight babies, another third of their babies would survive, making it even harder for an American kid to get into MIT. But I think it’s terrific that liberals are finally willing to start looking at outcomes to judge a system. I say we start right away with the public schools!
In international comparisons, American 12th-graders rank in the 14th percentile in math and the 29th percentile in science. The U.S. outperformed only Cyprus and South Africa in general math and science knowledge. Worse, Asian countries didn’t participate in the last 12th-grade assessment tests.
Imagine how much worse our public schools would look — assuming that were possible — if we allowed other countries to exclude one-half of their worst performers!
That’s exactly what liberals are doing when they tout America’s rotten infant mortality rate compared to other countries. They look for any category that makes our medical care look worse than the rest of the world — and then neglect to tell us that the rest of the world counts our premature and low birth-weight babies as “miscarriages.”
As long as American liberals are going to keep announcing that they’re embarrassed for their country, how about being embarrassed by our public schools or by our ridiculous trial lawyer culture that other countries find laughable?
The greatest country in the world, with the best health care system in the world... Yet our babies die at a much greater rate than Cuba, Taiwan or Portugal. Our babies die at almost 3 times the rate as Singapore, Sweden or Japan. US babies die at twice the rate as Iceland, France Finland and the Check Republic.
Say it again THE USA IS #1! #1 at blowing things up and invading other countries... but #44 at saving the lives of our infants. I guess it's a matter of priorities!
The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness. John Kenneth Galbraith
Lots of words... lots of dancing... but not too much on facts.
Do you just make this stuff up or does Fox news provide you with a quick feed???
The main causes of infant mortality — aside from major birth defects — are prematurity and low birth-weight. And the main causes of low birth-weight are: smoking, illegitimacy and teenage births. Americans lead most of the developed world in all three categories.
Look at the smoking rate in Europe... those countries have very few smoking laws... they have drug abuse... they have illegitimacy and teen births... but we are twice the rate of Singapore France HongKong Finland and Norway.
Those countries have health care for ALL their citizens... not at an ER when a baby has a fever of 103... but regular health care checkups and prenatal and baby care for ALL their babies...In the US... only for those with health care insurance.
The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness. John Kenneth Galbraith
Chris... My link is the US CIA... a reputable source... Your link sent me to Cuba???
Is that a mistake??? Not exactly in the CIA rank of RELIABILITY!
The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness. John Kenneth Galbraith
The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness. John Kenneth Galbraith
1) you cant take a joke 2) i was surprised that MOVE TO CUBA, was even a website rather than the suggestion that I implied it to be 3) you need to read the entire article.
But the international comparisons in “infant mortality” rates aren’t comparing the same thing, anyway. We also count every baby who shows any sign of life, irrespective of size or weight at birth.
By contrast, in much of Europe, babies born before 26 weeks’ gestation are not considered “live births.” Switzerland only counts babies who are at least 30 centimeters long (11.8 inches) as being born alive. In Canada, Austria and Germany, only babies weighing at least a pound are considered live births.
And of course, in Milan it’s not considered living if the baby isn’t born within driving distance of the Côte d’Azur.
By excluding the little guys, these countries have simply redefined about one-third of what we call “infant deaths” in America as “miscarriages.”
Moreover, many industrialized nations, such as France, Hong Kong and Japan — the infant mortality champion — don’t count infant deaths that occur in the 24 hours after birth. Almost half of infant deaths in the U.S. occur in the first day.
The infant mortality rate correlates very strongly with and is among the best predictors of state failure.[4] IMR is also a useful indicator of a country's level of health or development, and is a component of the physical quality of life index. But the method of calculating IMR often varies widely between countries based on the way they define a live birth and how many premature infants are born in the country. The World Health Organization (WHO) defines a live birth as any born human being who demonstrates independent signs of life, including breathing, voluntary muscle movement, or heartbeat. Many countries, however, including certain European states and Japan, only count as live births cases where an infant breathes at birth, which makes their reported IMR numbers somewhat lower and raises their rates of perinatal mortality.[5] The exclusion of any high-risk infants from the denominator or numerator in reported IMRs can be problematic for comparisons. Many countries, including the United States, Sweden or Germany, count an infant exhibiting any sign of life as alive, no matter the month of gestation or the size, but according to United States Centers for Disease Control researchers,[6] some other countries differ in these practices. All of the countries named adopted the WHO definitions in the late 1980s or early 1990s,[7] which are used throughout the European Union.[8] However, in 2009, the US CDC issued a report which stated that the American rates of infant mortality were affected by the United States' high rates of premature babies compared to European countries and which outlines the differences in reporting requirements between the United States and Europe, noting that France, the Czech Republic, Ireland, the Netherlands, and Poland do not report all live births of babies under 500 g and/or 22 weeks of gestation.[6][9][10] However, the report also concludes that the differences in reporting are unlikely to be the primary explanation for the United States’ relatively low international ranking.[10] Another well-documented example also illustrates this problem. Historically, until the 1990s Russia and the Soviet Union did not count as a live birth or as an infant death extremely premature infants (less than 1,000 g, less than 28 weeks gestational age, or less than 35 cm in length) that were born alive (breathed, had a heartbeat, or exhibited voluntary muscle movement) but failed to survive for at least seven days.[11] Although such extremely premature infants typically accounted for only about 0.005 of all live-born children, their exclusion from both the numerator and the denominator in the reported IMR led to an estimated 22%-25% lower reported IMR.[12] In some cases, too, perhaps because hospitals or regional health departments were held accountable for lowering the IMR in their catchment area, infant deaths that occurred in the 12th month were "transferred" statistically to the 13th month (i.e., the second year of life), and thus no longer classified as an infant death.[13] UNICEF uses a statistical methodology to account for reporting differences among countries. "UNICEF compiles infant mortality country estimates derived from all sources and methods of estimation obtained either from standard reports, direct estimation from micro data sets, or from UNICEF’s yearly exercise. In order to sort out differences between estimates produced from different sources, with different methods, UNICEF developed, in coordination with WHO, the WB and UNSD, an estimation methodology that minimizes the errors embodied in each estimate and harmonize trends along time. Since the estimates are not necessarily the exact values used as input for the model, they are often not recognized as the official IMR estimates used at the country level. However, as mentioned before, these estimates minimize errors and maximize the consistency of trends along time."[14] Another challenge to comparability is the practice of counting frail or premature infants who die before the normal due date as miscarriages (spontaneous abortions) or those who die during or immediately after childbirth as stillborn. Therefore, the quality of a country's documentation of perinatal mortality can matter greatly to the accuracy of its infant mortality statistics. This point is reinforced by the demographer Ansley Coale, who finds dubiously high ratios of reported stillbirths to infant deaths in Hong Kong and Japan in the first 24 hours after birth, a pattern that is consistent with the high recorded sex ratios at birth in those countries and suggests not only that many female infants who die in the first 24 hours are misreported as stillbirths rather than infant deaths but also that those countries do not follow WHO recommendations for the reporting of live births and infant deaths.[15] Another seemingly paradoxical finding is that when countries with poor medical services introduce new medical centers and services, instead of declining the reported IMRs often increase for a time. The main cause of this is that improvement in access to medical care is often accompanied by improvement in the registration of births and deaths. Deaths that might have occurred in a remote or rural area and not been reported to the government might now be reported by the new medical personnel or facilities. Thus, even if the new health services reduce the actual IMR, the reported IMR may increase.
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