Re: Natasha R. Seemingly Innocuous Appearing Circumstances Can And Do Have Tragic Consequences!

[DaLittle Kitty]

by DaLittle Kitty
I can picture the Bunny Hill incident... Considerable force can be generated if the skis went out from under Ms Richardson generating rotational force as she fell back something like the forces involved in a golf swing only with the end result she strikes the back of her head.

To my understanding she was not knocked unconscious. The problem is there are many times delays in an injury "declaring" itself... That is why we have a trauma system... but even still she was not being observed or questioned by professionals... so the delays mounted all the while the pressures were building in the closed compartment of her skull... Whomever Blocked the EMS From Questioning Her!!! :think:

By the time she reached the hospital she apparently was not taken to a hospital w/ neuro-surgical capabilities and therefore was not in a place where the pressure could be relieved and her brain function saved. This can happen anywhere... that is why we have trauma centers so that we minimize the potential for patients w/ injuries requiring specialized care do not end up going to the WRONG hospital with the subsequent loss of precious time that can and will result in negative outcomes.

Head injuries from such circumstances should initially be directed as a matter of mandatory policy to hospitals w/ neuro-surgical capability and helmets should be worn by participants!

:nuke: To the MORONS that would say that this is the stinking socialist Canadian system... In this respect the Canadian and U.S. health care systems are identical. The exact same thing can and does happen here... It is the decision as to which hospital the patient is taken to and how much time elapses from the incident and presentation to a tertiary care center with the appropriate spectrum of medical services... Neuro-Surgery in this case!

Trauma helicopters obviously are a big time saver... Ask the family of Princess Diana? Diana VERY likely would have survived the same accident in America due to the ATLS Protocal and EMS use of air transport.

The availability of Air Transport saves lives and is consistent with delivering critical patients from accidents, strokes and heart attacks to the critical services that these patients require in the MOST TIMELY fashion. There are specific criteria that are standard for employing air transport. EMS evaluates the patient on scene obtains history of the accident evaluates the patient and CALLS THE TRAUMA ALERT if the patient meets criteria. Patients coding on the scene ARE NOT transported.

Natasha's initial presentation as reported thus far in the press does not point out details that indicate at least initially after her accident the parameters being met for air transport even if it was available? She refused EVALUATION) Celebrity should not exempt people from being assessed... (QUESTIONED BY EMS)... No matter who YOU are!

Precious time was lost, patients left to their own devices make ill advised decisions...but that is often the nature of these injuries/situations... Patients may refuse treatment initially but once a patient becomes UNCONSCIOUS the situation IS out of their control and the objective reasoning of the EMS Team takes over.

These are just some of the reasons why there are tragic outcomes such as that of Ms Richardson. After the fact, all we can do is try and LEARN from the consequences of errors made by anyone and everyone and try and prevent in the first place accidents from occurring (helmets), and work to improve systems, timeliness and efficacy of response when accidents occur. :think:

[BrklynLiberal]

1. It was a tragedy, made all the more so due to its avoidability.

As you said, I hope the lessons will be learned and lives saved in the future.
Only 43% of US skiers and boarders wear helmets. But ironically, most of the really GOOD,
serious skiers and boarders wear helmets. Most of the double-diamond (expert) skiers wear them.

[Hippo_Tron]

121. It's kinda like riding a bike

If I'm riding around campus on the sidewalks at a 5-10pm, I probably should wear a helmet but chances are that I won't see it as life threatening if I don't.

If I'm biking on the streets or at any serious pace then under no circumstances will I go without a helmet. I've seen people take falls and know it could be a lot worse with no helmet.

[pnwmom]

2. She also refused to see the medics in the 2nd ambulance -- but they examined

her anyway and took her to the hospital in spite of her refusal.

How could they do this? Because there's an exception to the patient-may-refuse rule, in the case of a head injury.

The medics in the first ambulance shouldn't have been turned away by the hotel employee. If they had had the chance to see her then, they might have observed signs of head injury that were not obvious to the university student/ski instructor who was trying to care for her. And they MIGHT have overruled her refusal of care, just as they did the second time around.

Unfortunately, we'll never know.

[DaLittle Kitty]

3. PRECISELY! Head Injury IS A DIFFERENT ANIMAL As You Point Out!

:think:

[LisaL]

4. And how do you know that she refused the second

ambulance? What's been reported is that she refused the first one.
In that case, right after the accident, if she was lucid, there'd be no reason to suspect head trauma was affecting her thinking.

[DaLittle Kitty]

8. Hotel Workers Turned Away the FIRSt Ambulance w/o Seeing Natasha Is What I Read!

No questions asked by EMS of Natasha from which evaluation of head injury need for treatment might well have been made in a timely enough fashion to get patient to hospital for CT and flight to tertiary care center w/ Neuro Surgical capability !

[pnwmom]

11. Not being lucid isn't the only sign of a head injury.

She was still lucid when the general manager saw her around 3 pm, and still refusing treatment, but they called for the ambulance to "come and get her" anyway. The question is, if the medics had been allowed to see her the first time -- instead of being turned back by hotel employees -- would they have detected subtle signs of a head injury that the university student with her didn't recognize? Wouldn't you think trained medics would have been more likely to persuade Ms. Richardson to go to the hospital than a college student? And if she still said no, they might have even overruled her, if they had seen something of concern, because head injuries are an exception to the refusal-of-treatment rules.

http://www.people.com/people/package/article/0,,20266545_20267163,00.html

"The instructor called the general manager and said Richardson had a headache and she was not feeling well. The GM went to see her and said she was going to call an ambulance. Richardson said she didn’t need an ambulance or a doctor – and the GM insisted that an ambulance come and get her."

Another call was placed from the hotel to the paramedics at about 3 p.m. and an ambulance arrived nine minutes later, according to Yves Coderre. He says Richardson was still lucid and coherent when she spoke to paramedics, but her condition had worsened and there were signs she might be in danger.

" saw something that wasn’t right," says Coderre. "He saw some signs indicating her condition was destabilizing. He called ahead to the hospital to let them know of her condition and he put the siren on." Coderre declined to specify what the exact signs were.

__________________________

The following relates to a hospital discharge against medical advice, but a similar exception for head injuries exists for refusal of care in the field.

http://209.85.173.132/search?q=cache:WgzYMi3_1wEJ:www.moh.gov.om/nursing/1%25202%2520Discharge%2520AMA.pdf+%22against+medical+advice%22+form+%22informed+consent%22+%22head+injury%22&cd=1&hl=en&ct=clnk&gl=us


The following must be present to allow refusal of care. Patient is an adult (refer to definition) or represented by a legallyappointed representative or parent (if a minor child).a. Relatives cannot consent to the refusal of care for their relative unless he is a legally designated representative.b.Patient is competent: Health care workers should determine the competency of the patient based on reason and carefulness,utilizing the following guidelines:

c.The patient’s presentation, physical assessment and vital signs are consistent with a person presenting in a physical condition that would support cognitive capacity. Some conditions that might diminish cognitive capacity include: • Unstable vital signs that could affect cerebral circulation or oxygenation. • Evidence of alcohol or drug intoxication.• Evidence of head injury.

[DaLittle Kitty]

12. Not Feeling Well i.e., NAUSEA and Headache ARE S/S of CONCUSSION or Worse!

Pretty standard and may have been illuminated if the FIRST GD EMS crew was permitted to see her... Maybe not but clearly she departed from the bunny-hill so it must NOT have been an ordinary fall... Read my possible description of HOW the fall took place... As a hockey player I have fallen the same way WITH a helmet on and were I not wearing a helmet likely as not would have suffered a head injury of some severity. So no helmet on packed snow... No helmet... Beginners if anyone wears a helmet beginners should... Helmets should be part of the package IMHO!

[pnwmom]

16. Yes, and dizziness, and skin changes, and pupil changes, and

sensitivity to sound and light, etc. All things that the university student with her wasn't trained to look for.

I feel for that student, too. What a terrible position she was put in.

[DaLittle Kitty]

22. Quite Right!

[DaLittle Kitty]

30. Dilated Pupils Would Be LATE Change in An Intercranial Bleed, Which IS What Natasha Had

It's the SUBTLE STUFF confusion, thinking AND judgment as well as headache nausea... that count as well as the description of the force of the injury itself... Read my discussion of likely how injury occurred... for those who have skiied or ice skated they should understand ... for those who have not you might have to imagine what I am describing...?

[pnwmom]

55. Which post are you referring to, DaLittle Kitty? I'm not sure I saw your

discussion of how you think the injury occurred.

[DaLittle Kitty]

102. Read The Main Post here that Began the Thread! Go To Top of Page MY OP!

:)

[MiniMe]

56. The hospital discharge rules apply after somebody has seen a doctor

She probably was perfectly lucid when they brought her off the slope. If she didn't want to go, there was nothing the ambulance crew could have done about it. The whole situation is tragic, but even if the ambulance crew had seen her, she probably wouldn't have shown any outward signs. She probably would have needed an MRI, or an x-ray at the minimum to be able to tell. The problem with a slow leak in the brain is that it is slow, and the symptoms don't usually appear at first. By the time the symptoms do show up, it is usually too late without a helicopter or being in a hospital that has neurosurgery capabilities already. Even if Liam Neesan has been with her, he may have gone along with her statement that she was OK. We have all learned a lot from this incident, and hopefully Quebec will get a helicopter system now. But sometimes, accidents are just that, accidents, and sometimes you die in an accident. The only reason we are hearing so much about this is because NR was Liam Neesen's wife.

[pnwmom]

60. How do you know the ambulance crew wouldn't have been more likely

than the university student to be able to persuade her of the seriousness of the situation and to convince her to get checked out at a hospital?

We can't know, but I think it was a serious mistake to send the ambulance away without allowing the medics to speak with her. She also refused the second ambulance, but they overruled her then, even though she was still lucid. They should have overruled her the first time and insisted she speak to the medics.

[uppityperson]

96. "They should have overruled her the first time and insisted she speak to the medics."

WTF? Taking away someone's rights is ok with you? Forcing health care on a legal adult is fine with you?

This incident ended tragically, but are you seriously saying that an adult should not be able to refuse care?

[pnwmom]

154. That's exactly what they did the second time. She was lucid and yet

they called for the ambulance to come and get her.

I'm not saying that an adult can't refuse care, but that the rules allow a competent adult to refuse care ONLY in the context of having received medical advice from a qualified professional. This she did not receive. The resort people shouldn't have turned the medics away. They should have allowed the medics to approach her, and let HER tell them "no" herself. The medics could have then explained directly to her the risk she was taking and if she still refused treatment, had her sign an AMA form.

http://209.85.173.132/search?q=cache:WgzYMi3_1wEJ:www.moh.gov.om/nursing/1%25202%2520Discharge%2520AMA.pdf+%22against+medical+advice%22+form+%22informed+consent%22+%22head+injury%22&cd=1&hl=en&ct=clnk&gl=us

All adult persons presumed competent to make decisions affecting their medical care will be allowed to make such decisions.

The following must be present to allow refusal of care:

Patient is an adult (refer to definition) or represented by a legallyappointed representative or parent (if a minor child).
a. Relatives cannot consent to the refusal of care for their relative unless he is a legally designated representative.
b.Patient is competent: Health care workers should determine the competency of the patient based on reason and carefulness,utilizing the following guidelines:
c.The patient’s presentation, physical assessment and vital signs are consistent with a person presenting in a physical condition that would support cognitive capacity.

Some conditions that might diminish cognitive capacity include: • Unstable vital signs that could affect cerebral circulation or oxygenation. • Evidence of alcohol or drug intoxication.• Evidence of head injury.

___________________________________

Note that even relatives cannot consent to refusal of care unless the relative is a legally designated representative. A hotel employee cannot consent to refusal of care either.

[cleo4cole]

176. insist she speak to medics

what makes you think an adult can be overruled in their decision for healthcare,please don't make opinions that you have no idea what you are talking about.you are scary

[uppityperson]

183. You are making the same argument I am.

You can't overrule an adult in their decisions for medical care. That is what I said.

Until she showed symptoms to overcome that, legally you cannot overrule an adult in their decisions for medical care.

You agree with me, yet call me scary. Odd.

[pnwmom]

302. At 3:00 the general manager DID overrule her and called for the

ambulance to come and get her. She still didn't want to see a doctor and she was still lucid, according to the general manager.

The law about "against medical advice" has an exception for head injuries. In order for a person to be able to decline care, the person must be informed of the care needed and be competent. There are several conditions that put competence into question. Two examples are intoxication and a head injury.

When the first ambulance arrived, however, she might still have appeared competent. In that case, the medics -- if they had not been stopped by the hotel employees -- could have spoken to her, advised her that it would be wise to seek help, and gotten her to sign an "against medical advice" form. Or they might have succeeded, as the resort employees did not, in persuading her that the potential risk warranted a trip to the hospital.

http://209.85.173.132/search?q=cache:WgzYMi3_1wEJ:www.moh.gov.om/nursing/1%25202%2520Discharge%2520AMA.pdf+%22against+medical+advice%22+form+%22informed+consent%22+%22head+injury%22&cd=1&hl=en&ct=clnk&gl=us

Discharge against Medical Advice

All adult persons presumed competent to make decisions affecting theirmedical care will be allowed to make such decisions.

The following must be present to allow refusal of care: Patient is an adult (refer to definition) or represented by a legallyappointed representative or parent (if a minor child).
a. Relatives cannot consent to the refusal of care for their relative unless he is a legally designated representative.
b.Patient is competent: Health care workers should determine the competency of the patient based on reason and carefulness,utilizing the following guidelines:
c.The patient’s presentation, physical assessment and vital signs are consistent with a person presenting in a physical condition that would support cognitive capacity. Some conditions that might diminish cognitive capacity include: • Unstable vital signs that could affect cerebral circulation or oxygenation. • Evidence of alcohol or drug intoxication.• Evidence of head injury.

[DaLittle Kitty]

107. Clinical Presentation W/ CT Is What Is Required W/ History of the Incident

Plain CT shows Bleed Plain Xray is not useful. read the other posts.. subtle changes in mental status are discernable and she obviously did not feel well S?S CONCUSSION Not a stay at home w/ college student situation!

[Garbo 2004]

6. Reportedly 2nd ambulance was called because she was then exhibiting overt symptoms.

Don't recall reading a report that she refused treatment the second time ambulance was called.

[DaLittle Kitty]

9. The Point iS If The #1 Ambulance Crew Saw Her They May Have Observed Subtle Symptoms

Which may have allowed the all important sequence of FULL Eval and Treatment choices to commence in a timely enough fashion to have a shot at a more favorable outcome.

[pnwmom]

15. Exactly. And she would have been more likely to listen to trained medics

telling her she needed treatment than to the poor university student who was trying to "babysit" her.

[nadinbrzezinski]

44. LOL trained medic here, yuo know how many times I was

told to go fuck myself?

What happened to her, is actually quite typical, unfortunately

[DaLittle Kitty]

50. Yes I see Lots Of Idiots Too... You Try To Work Around It and Maybe Increase Success

in getting people evaluated.

[nadinbrzezinski]

68. You know I wish it was easier but it isn't

that is the point

[pnwmom]

151. Do you realize these "first responders" have only a $100 first aid course

before they go into the field? They're not qualified to offer medical advice, as an ambulance medic would be. They are trained to load the patient onto a toboggan, get her down the hill, and call for an ambulance. They're not qualified to sign an AMA form.

Training for the Canadian Ski Patrol:

https://www.canskipatrol.com/join-us.php?PHPSESSID=dbeb ...

Training Courses: First Aid classes are held two (2) nights per week from 7:00 pm to 10:00 pm. Select from the training section the centre or course you would like to attend. You must indicate a second choice if the class at the centre you have requested is full. You will not be permitted to attend a course you have not previously registered for in advance. All courses are on a first come first serve basis. In the event you are not able to attend the course requested it is your responsibility to inform your Chief Instructor or the office to make alternate arrangements. A maximum of five (5) classes missed is allowed.


Rewrites of Written and Practical Exams:
One rewrite is allowed at the discretion of the Chief Instructor/Examiner of your training centre. It will not be done within 24 hours of the original attempt. A minimum of 70% is necessary in order to be considered for rewrites, written or practical, to be an option.

Area Orientation/Walk the Hill Day: Your Patrol Leader will contact you to confirm the date and time for this event. Please remember to dress appropriately for the weather.

On-hill /Trail Training: On-hill/Trail training is a portion of the patroller's training, which addresses the activities, skills, and procedures necessary to develop a person trained in first aid to become a competent ski patroller. As a condition of membership in the Canadian Ski Patrol, each member will be trained for the following:
Each patroller will be certified as able to complete all runs/trails of his/her area. Ski ability should be at an intermediate level or better.
Each patroller, after training, must competently handle an empty toboggan used to evacuate an injured person safely from the hill/trail. You will learn to transport a toboggan up hill on lifts and learn to carry a backboard properly down the hill. As part of toboggan training you will learn how to place people in and out of the toboggan. In case of Nordic resorts, several transportation and evacuation techniques are examined, as well as emergency shelters and other survival skills.
Accident Site Management is also part of this training. This is the procedure on how to manage an accident site at the ski area.
Each patroller will be instructed in, and prove a competent understanding of all patrol systems and procedures at the ski area where he/she is assigned.


Fees: Registration fees for the 2008/2009 season are as follows:

New Member Registration Fee $210 (includes First Aid & CPR course, CSP manual (CD-Rom), and First Aid kit.)
First Aid Course Only $100

[nadinbrzezinski]

218. And my first EMT course was 65 dollars and your point ?

They WERE the first responders

[pnwmom]

62. Don't you think it would have been better if the first medics had been allowed

to at least try to speak to her?

[nadinbrzezinski]

70. She said no, hands are tied

the sky patrol ARE the first responders... see how that works

Medics are SECONDARY responders

In an ideal world every patient that EMS comes across, regarless of level of training, would be transported to the hospital, with no fuss and no muss

But if patient says no... and they're alert and oriented... guess what? you can't

That is the truth

Now on the bright side... this may lead to the necessary choppers in Quebec... knowing how the funding game works

[bottomtheweaver]

71. Were you there?

Because there's no evidence for any of the claims you keep making, at least the ones I can decipher.

[nadinbrzezinski]

93. ten years EMS experinece as in actually havng to deal with this

how about you?

My claims are actually based on not only national standards of implied and informed consent, but they apply in North America

that includes the US, Canada and Mexico

How about yuo?

what is your knoweldge on this?

After all people who have dealt with this, for real, are trying to educate you

I am willing to bet that this will end nowhere near a court...

[pnwmom]

165. I think Intrawest will settle out of court and we'll never hear about it. n/t

[nadinbrzezinski]

197. It will not even get to that stage

willing to bet here. mostly based on that pesky experience with the actual laws of implied, informed consent and how the hell EMS works

And I have to ask, are you waiting for a lawsuit?

I think you are

This is a tragedy... but unfortunately, as you are discussing this applying yuor biases to her, I am willing to bet that in North America, in the last week or so, since this happened, there are at least ten more cases

And they will read very similar

chew on that

As an adult you are allowed to tell EMS to buzz off...

People do, and people die

This is where using HIGH PROFILE cases like this to EDUCATE people comes in

And where the system may finally gets its helo

Chew on that... this is how life, real life, works

[pnwmom]

206. She did not tell EMS to buzz off. The ski patrol is not EMS qualified.

The most she could have done is sign a "refusal of care" for for the ski patrol. But that wouldn't extend to the ambulance service. And, actually, she didn't sign a refusal of care for the ski patrol because they DID load her up on the toboggan and take her down the mountain.

What she did was verbally tell someone that she didn't need to see a doctor, and apparently she signed some liability waiver -- but she didn't sign an AMA for the ambulance because she never spoke to or saw those medics.

Unless this gets to the courts, we'll never know whether there was a settlement. Often a potential defendant will offer a settlement before a single legal document is officially filed.

That is how real life works.

[nadinbrzezinski]

217. Yes they are... they are the first responders

no matter how you try to twist this

By the way, Canada is FAR LESS sue happy... chew on that... it will go nowhere

Hell I still remember an AMERICAN trying that game down where I worked. We had the AMA... judge threw them out of the court... after making them pay for all court costs

I can see a similar outcome if it gets that far

Funny, they were American... really...

[pnwmom]

267. Then why is the Health Minister refusing to discuss this case

for the stated reason that it may be the subject of a lawsuit?

[nadinbrzezinski]

273. For the same reason we shut our mouths

when we took care of a couple VIPs... that's why... standard, not shocked

[DaLittle Kitty]

225. THIS WILL Go to Litigation! GUARANTEED!

[nadinbrzezinski]

231. If this was the US, sure.. this is CANADA

I can already hear the judge.... buzz off....

Just more politely

[pnwmom]

286. A quiet settlement could occur before any legal papers were ever filed.

A judge wouldn't be involved in that case at all.

[nadinbrzezinski]

291. It will not even get to that stage

it is Canada

By the way, one of our patients, they tried that shit... we insisted on the judge

It was a thing of beauty when the judge threw them out of his court...

[pnwmom]

293. It is the real world.

Do you think Intrawest would want the publicity?

If her family wanted to pursue this, no paper would ever have to be filed for a settlement to occur.

[nadinbrzezinski]

298. In the real word it will go nowhere

and if I were intrawest, I'd insist on it

After all, would be a lesson for others about consent. Once again you have the right to say no

What you think we had that much money for that shit?

But we knew the legal system... and in the real world, outside the US... if there is nothing criminal and forms were signed and no obvious malpractice, it will go nowhere.

Only in the US shit like this goes to the courts

[pnwmom]

306. "Only in the US shit like this goes to the courts." I never said it would go to the courts.

But you keep arguing that straw man.

[nadinbrzezinski]

311. Because it will not even get to a settlement

outside the US... this will not go there

I happen to know that...

here you go

http://www.chsrf.ca/mythbusters/html/myth21_e.php

http://www.thestar.com/News/article/193502

Now for comparison, shall we?

http://en.wikipedia.org/wiki/Medical_malpractice

medical lawsuits in the united states

The culture is not there.

Get it now?

Oh and if they made a mistake, they will own to it, part of the national policy of openness. lovely, ain't it?

So strawman, my ass

[pnwmom]

316. LOL. You might want to try reading your own citation.

According to your own first source, the numbers in Canada and the U.S. are similar. I'm not going to bother looking at the others, because none of these statistics could tell you anything about this particular case. There is no way that Intrawest or its insurance company wants to deal with the bad publicity involved with a potential case with Richardson's family.

From the first article in your post:

"People might think the number of lawsuits is going up because the amounts awarded in court decisions and settlements continue to increase. In 1995, the protective association paid an average of $181,281 per case for lawsuits that were successful or were settled out of court. Payments peaked in 2001, when the average was $371,300 (mostly due to a single large class-action suit). For 2004, the last year for which data are available, the association paid an average $300,692 per case — a 66-percent increase over 1995. ii

The international experience
The United States is the country most often thought of as the “land of litigation.” Even there, though, the numbers aren’t skyrocketing as much as people think. The National Practitioner Data Bank reports that from 1992 to 2004, the number of successful malpractice suits against physicians went from 14,826 to 14,396 — a three-percent decrease. As in Canada, however, the average amounts paid out have increased, from $214,332 in 1997 to $298,460 in 2004 — a 39-percent increase. vi

[uppityperson]

98. Thank you nadin. This has been, hopefully, a learning experience for

people who don't know how it works.

[Name removed]

110. Deleted message

Message removed by moderator. Click here to review the message board rules.

[DaLittle Kitty]

111. EMS Are The People That CALL THE HELICOPTERS!

Ski are responders NEED MORE TRAINING!! And Confidence! Confidence comes w/ training!

[uppityperson]

112. you are replying to yourself with CAPITAL LETTERS?

[DaLittle Kitty]

114. So Ski Patrol Is ATLS or ACLS?

They do not know all the subtle symptoms how to test verbally etc for them and since they do not routinely exercise the required judgment that is standard in the emergency department, then they erred on the side of intimidation by celebrity as did a number of people involved in this case potentially to the detriment of the patient!

It's called patient advocacy!

[uppityperson]

116. Were you there or are you assuming all that?

[DaLittle Kitty]

156. Uppity Please Provide Your Interpretation of the acronyms ATLS and ACLS?

Thank you

[uppityperson]

179. Please answer my question. Were you there or are you assuming all that?

"They do not know all the subtle symptoms how to test verbally etc for them and since they do not routinely exercise the required judgment that is standard in the emergency department, then they erred on the side of intimidation by celebrity as did a number of people involved in this case potentially to the detriment of the patient!

It's called patient advocacy! "

[DaLittle Kitty]

227. It IS Called Professional Judgment! What Percent Of Arriving At A Diagnosis Does

History of Present Illness Play Uppity? Please provide your common sense wisdom if not professional?

[uppityperson]

233. So you were assuming. Just like you assume there are no Level 3 trauma centers

[DaLittle Kitty]

343. No One Discusses This In Florida ... Level 1 or 2.. Others Are Stabilization Points

For flight out for Trauma Care... Order of priority goes waaayyyy out there if you want to get long winded... In a major diaster each little rinky dink hospital has its designation and priority of receiving patients in a disaster plan... But that IS NOT what we are discussing here...

Again please answer some of those clinical questions that ANYONE even a nurse assistant would know if they worked in ER or Neuro areas...

??????

[nadinbrzezinski]

199. My god, yuo are assuming that only an ALS trained person

can tell there is a head injury? (Clue more training, but mostly you can use the Cardiac drugs... )

Many a fine FIRST RESPONDERS have alerted many a fine Paramedics about the presence of subtle signs during patient transfer

You really are clueless how EMS works... you really are

So are you the kind that would sue the first chance you get?

[DaLittle Kitty]

346. Many A Paramedic Might Have Things Right And Then Again They Might Not...

As I described before... A paramedic IS NOT an MD, DO, ARNP or PA EMT/Paramedic Is rough cut eval in the field and get the patient to appropriate level of care... as quickly as possible... As w/ ALL lines of work some are better than others and of course more or less experienced...

I have learned NEVER to just take the word of the EMS crew because their assessment may NOT be correct and send you down the WRONG path diagnostically speaking... When patient arrives you MUST do a focused assessment yourself get history and proceed... This may be done very quickly and in conjunction w/ EMS who are still w/ pt.

When speaking of ALS in context of accident ...head doink... I am speaking of ATLS which is whole different pathway than A C LS...

You SHOULD understand the difference and be able to define each of these protocols IF you are WHO you say you are... and have the experience that you've been touting throughout this discussion... RIGHT?

So Nadine... define the protocols ATLS and ACLS SINCE UPPITY IS CLUELESS AND FOS! You do know what the acronym FOS means ... Right?

:think: :)

[Dorian Gray]

185. If she said NO to them

then what could they have done? Realistically?

[nadinbrzezinski]

200. Legally if she is alert and oriented, and functioning, nothing

I have used the ONLY patient that would have died that I transported by force already once

My reason, when a family member said, he's acting weird... that was my weapon to transit since he had no externma signs and symptoms. When the docs managed to convince him to get scanned, that's when they found the b;eed

Later the lawyers didn't read us the riot act, but told us how close we were to the knives edge, and legally it was a good thing the pt had a bleed... or the lawsuit would have been fun... what some of our posters are missing by a mile

[DaLittle Kitty]

348. Hotel Klowns NEVER Gave Her The Chance to Say NO... To EMS!

That IS the point! :think:

[defendandprotect]

100. I bet that won't be happening any more . . .!!! This story is kinda getting the story out -- !!!

The only good thing about it -- but I hope that helmets will prevent all of

these injuries!

[DaLittle Kitty]

109. CORRECTOMUNDO!

:nuke:

[uppityperson]

19. The point is that she was showing signs when the 2nd one came, not with the 1st

When the first one came, she was not showing signs so could refuse to let them talk with her. She started showing signs of having issues so the 2nd ambulance was called and the could see her BECAUSE she was showing signs.

With a head bleed like she had, there were most likely NO signs for a while since the pressure hadn't built up within her skull yet. When enough time passed, there was enough pressure within her skull to show signs.

[DaLittle Kitty]

25. BALOGNEY~ She Was NOT Evaluated By A Professional Trained To Question Properly To Discern

The types of subtleties that would indicate the presence of Concussion minimally... which of course would NECESSITATE monitored observation and of course CT SCAN OF HEAD which is STANDARD PROCEDURE FOR A HEAD INJURY... :nuke:

[uppityperson]

29. Wrong. CAT scan is not standard procedure for all head injuries

I've been on the provider and the patient side. What caused her death was a slow bleed inside her skull. This would not have shown up initially, only when the pressure built up enough to impact the brain.

You can use all the little exploding icons you want, but you are wrong.

[pnwmom]

67. You didn't address the fact that no qualified person evaluated her in the first

hour after her injury.

So there is no way to know whether she would have had signs of a head injury when the first ambulance arrived.

[uppityperson]

99. Ski patrol did. Are you saying that they are not qualified to assess injuries?

They why the hell are they employed to do so?

edited for typo

[pnwmom]

129. The ski patrol member is qualified to offer basic first aid and to call for an ambulance

when an injury occurs.

And she did that. But this volunteer doesn't have the training or the skills of an ambulance medic.

The mistake occurred when someone -- we don't know who, but it wasn't Richardson herself -- told the ambulance to go away.

[nadinbrzezinski]

201. How many times from here to sunday do you have to even ben shown links

it was her

And the sky patrol ARE FIRST RESPONDERS no matter how you try to ignore that fact

You would sue, wouldn't you?

[DaLittle Kitty]

113. WRONG! She Had Signs of Concussion Even Minimal Obviously H/A Reported Requiring CT

Patient can refuse CT but the standard of care for suspected concussion is for anyone who has worked in an ER... IS a CT w/o of Head!

[uppityperson]

119. Yes Dr Frist.

[cali]

187. Why anyone is taking da little kitty's addled bullshit seriously

is a mystery.

[Name removed]

224. Deleted message

Message removed by moderator. Click here to review the message board rules.

[DaLittle Kitty]

332. Because Da Little Kitty Knows What He Is Talking About!

:) Professional Experience... Trauma Level 1 Experience!

[DaLittle Kitty]

228. The ER MD Echoed My Opinion On LarryKing Last Night... It's Called Professional Judgment!

:)

[DaLittle Kitty]

26. watch larry king now Neuro Surgeon and ER MD Explaining EXACTLY WHAT I AM SAYING!

Using props and visuals!

[uppityperson]

33. I don't need props and visuals, thank you very much.

Having the medical education and experience I've had, I bet I could show you lots of props and visuals myself.

[nadinbrzezinski]

45. Amazing, ain't it?

[DaLittle Kitty]

115. Both Of You Folks Should Watch CNN & The NS & ER MD Discuss Head Injury and CT as Std of Care!

:) Yes and NOT every head doink requires CT but if a concussion is suspected as in this case, CT is std of care!

[uppityperson]

118. No thank you. I will go with my training and yrs experience in neuro and er care

and what my neurologist doc tells me.

And no, they don't do CAT scans of every concussion.

[DaLittle Kitty]

123. Symptoms Get The CT w/o... What did she get in the end? A CT w/o!

Yes not every head injury or suspected concussion w/o symptoms gets the CT... But if you got symptoms and they are increasing in severity and multiplying in number you are getting the CT... Any neurologist worth his/her salt would order the CT... Otherwise you are taking a chance. In the age of the litigious society it is a medico/legal CYA requirement as much as a diagnostic tool... FYI!

[uppityperson]

127. You are not making sense. "symptoms get the ct without..." wtf?

try again with complete sentences.
First you say every concussion gets a CAT scan. I say no. Now you agree.

Once her symptoms increased in severity, her right to refuse treatment disappeared, and they were able to see her.

Doing a CAT scan on every head injury or concussion is not a medico/legal CYA requirement, except for possibly some institutions that have that as their policy.

[DaLittle Kitty]

159. You clearly demonstrate your COMPLETE IGNORANCE Of Current Medical Practice

CT w/o means A Catt Scan WITHOUT CONTRAST You see you are doing the CT scan to see if there is ANY BLEEDING in the skull which will show up quite clearly on the CT scan... So w/ ALL of your Neuro and ER experience I am surprised that you are unaware of such a fundamental diagnostic tool...

This fyi is the first order diagnostic exam in a stroke otherwise known as a CVA to determine embolic or hemorhagic stroke... For one you can use clot buster drugs to dissolve the clot and reverse the sequelae of the stroke by restoring blood flow to the affected area of the brain.

Now quick quiz.. For which type of stroke would you not want to use clot buster drugs?

[pnwmom]

167. I know, I know!

A hemorrhagic stroke.

Alas, I wish I wasn't so well versed in that particular area.

[DaLittle Kitty]

172. But I Wanted Uppity To Answer The Question SmartyPants!

:)

[pnwmom]

173. Ooops!

Sorry.


:P

[cleo4cole]

177. ct scan

sorry but i think you are wasting your time responding to this evidently ignorrant person as to medical ethics

[uppityperson]

181. oooooo, welcome back!

[nadinbrzezinski]

241. And I should watch CSI to learn the actual procedures for crime investigation?

okie dokie

This is the CSI or medical show syndrome... seen it... in fact, we are seeing it right now

[DaLittle Kitty]

345. RIGHT! Then Answer some Clinical Questions DOCTOR! HAAA

Uppity... Another clinical question for you... What would your choice of drug be to control Natasha's blood pressure actually there are two very likely choices... Lets hear it from you... w/ ALL of your medical experience... Good Grief I'm sure that you can help us w/ that hmmm?

[uppityperson]

368. wtf is your problem?

By the way, good luck controlling Natasha's bp. She doesn't have blood pressure since she is dead. Welcome to my short ignore list, up to 2 now.

[pnwmom]

64. The fact is we don't know whether she was showing signs at first, because no

qualified person was allowed to see her.

[uppityperson]

101. Ski patrol did. eom

[DaLittle Kitty]

117. Hx Post Accident Is Very Suggestive of Concussion and Not Feeling well H/A

are pretty impressive for concussion even anecdotally!

[pnwmom]

13. Here's a link. The general manager overruled her even though she was lucid

and called for a second ambulance to "come and get her" even though she refused to see a doctor.

http://www.people.com/people/package/article/0,,2026654...

"The instructor called the general manager and said Richardson had a headache and she was not feeling well. The GM went to see her and said she was going to call an ambulance. Richardson said she didn’t need an ambulance or a doctor – and the GM insisted that an ambulance come and get her."

Another call was placed from the hotel to the paramedics at about 3 p.m. and an ambulance arrived nine minutes later, according to Yves Coderre. He says Richardson was still lucid and coherent when she spoke to paramedics, but her condition had worsened and there were signs she might be in danger.

" saw something that wasn’t right," says Coderre. "He saw some signs indicating her condition was destabilizing. He called ahead to the hospital to let them know of her condition and he put the siren on." Coderre declined to specify what the exact signs were.

[DaLittle Kitty]

14. NAUSEA and Headache ARE S/S of CONCUSSION or Worse!

Not Feeling Well i.e.,

Pretty standard and may have been illuminated if the FIRST GD EMS crew was permitted to see her... Maybe not but clearly she departed from the bunny-hill so it must NOT have been an ordinary fall... Read my possible description of HOW the fall took place... As a hockey player I have fallen the same way WITH a helmet on and were I not wearing a helmet likely as not would have suffered a head injury of some severity. So no helmet on packed snow... No helmet... Beginners if anyone wears a helmet beginners should... Helmets should be part of the package IMHO!

[pnwmom]

17. She probably said something like: "I'm fine, I just need to lie down."

Which could have been a red flag to a trained medic -- but obviously wasn't to the hotel employees.

[uppityperson]

21. Oh bullshit. saying you are fine is not a sign of any sort of trauma.

Good grief. Signs include things like pupils being unequal, nausea, severe headache. With a inner cranial bleed, those do NOT show up UNTIL there is enough bleeding to cause ENOUGH pressure on the brain. What she had would NOT have shown up immediately. Like you said elsewhere, you don't have experience with this, yet refuse to listen to those of us who do.

"I'm fine"=red flag. Good grief.

[pnwmom]

28. Saying "I need to lie down" could mean many things.

Like -- I'm feeling weak, I'm feeling dizzy, I want to go to sleep -- all signs of a possible concussion.

The medics, if they had been allowed to speak with her, could have followed up with appropriate questions.

[uppityperson]

35. I agree. It is really too bad she refused to let them assess her.

If she'd allowed it, and went to hospital, they would have had her really close when signs and symptoms showed up. It is a shame.

[pnwmom]

49. She refused a doctor or an ambulance the second time, too -- but the

general manager called for the ambulance anyway, as was his right. And, even though she was still lucid, they took her to the hospital.

It's too bad the hotel people didn't overrule her the first time and insist that she see the medics who were already there. The outcome might have been different.


http://www.people.com/people/package/article/0,,2026654 ...

"The instructor called the general manager and said Richardson had a headache and she was not feeling well. The GM went to see her and said she was going to call an ambulance. Richardson said she didn’t need an ambulance or a doctor – and the GM insisted that an ambulance come and get her."

Another call was placed from the hotel to the paramedics at about 3 p.m. and an ambulance arrived nine minutes later, according to Yves Coderre. He says Richardson was still lucid and coherent when she spoke to paramedics, but her condition had worsened and there were signs she might be in danger.

" saw something that wasn’t right," says Coderre. "He saw some signs indicating her condition was destabilizing. He called ahead to the hospital to let them know of her condition and he put the siren on." Coderre declined to specify what the exact signs were.

[DaLittle Kitty]

51. Being Sleepy IS A Symptom of Head Injury!

:think:

[pnwmom]

53. I know. My children have had little bumps, and that's always been something

I was supposed to watch for.

Speaking of children, I keep thinking about the son or sons who were with her. How terrible a thing for them to have lived through.

[uppityperson]

103. Being sleepy is a symptom of being awake too long

:think:

[DaLittle Kitty]

120. Not When You've Had A Head Injury In The Middle Of The Afternoon... Google Concussion

signs and symptoms...

[uppityperson]

122. Am I wrong in assuming that you know that not everyone who gets a concussion dies from

bleeding in their skull?

[DaLittle Kitty]

128. YES NO ONE THAT I'VE EVER HEARD OF DIES FROM AN "inner cranial bleed" Dufus!

WATCH CNN!

[uppityperson]

133. Thank you for verifying I was wrong in assuming you knew that.

good grief, my not using jargon makes you post in caps. Bleeding inside the skull is different from bleeding outside the skull. Outside, the blood can just drip. Inside, it collects and puts pressure on the brain. People can die from either, but ex-sanguination is different from neurological damage from increased pressure inside your skull.

Now you know.

[DaLittle Kitty]

162. I Guess Judging From Your Descriptive Adjectives That You Have Authored New

Medical Terminology All your own... Hmm It is Intra-Cranial NOT INNER Cranial Unbelievable!

[uppityperson]

178. omg like wtf? It is called interpreting for the layman.

Jargon is meant to make one sound wise by being confusing.

[DaLittle Kitty]

229. It's The Language Of Medicine!

:)

[uppityperson]

234. You lost your credibility with this post...which I notice you haven't addressed yet

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=5310285&mesg_id=5313100

[DaLittle Kitty]

344. It's Addressed and Is NOT Material To The Discussion... Read below

[pnwmom]

131. Are you saying that you don't know that that can be a sign of a head injury?

Come on, get real.

[uppityperson]

137. I am pointing out in a satirical way that being sleepy can have other causes also.

Like, for instance, doing some sort of exercise for a while, like, say, skiing.

[pnwmom]

158. Which is why these assessments for head injury shouldn't be left in the hands

of people whose only medical qualification is a $100 first aid course.

[DaLittle Kitty]

164. DITTO!

UPPITY IS UNBELIEVABLE

[nadinbrzezinski]

242. Don't call an ambulance in north america

outside of large cities you will most likely get people who only took a 65 dollar course....

That lasted 120 hours, by state mandate

[DaLittle Kitty]

124. BS You ClearlY Have NO Frigging Clue WHAT You Are Talking About...

Pupils are a late sign... You're so smart what would you think about a negative corneal reflex? Hmmm C'mon tell me? And it is not an INNer Cranial bleed it is and INTRA-CRANIAL BLEED! What would be the first symptoms you might see in a head injury... blown pupils?

[DaLittle Kitty]

125. CNN Repeat on NOW 1200 Midnight.. WATCH IT!

[uppityperson]

136. but it isn't midnight here.

OK, now you get to use caps to tell me that it really is midnight

[uppityperson]

130. bwahahahaha. You tell me I have no friggin clue, then you agree with me.

saying you are fine is not a sign of any sort of trauma.

ps inner cranial vs outer cranial. Inside the skull vs outside the skull. I am sorry if my dislike of jargon makes you post in caps.

[DaLittle Kitty]

166. Point Is YOU Have No Medical Background Whatsoever .. And It SHOWS!

Well as the EMS person says I have dealt w/ lots of idiots...

[uppityperson]

180. bwahahahaha. You say I have no friggin clue, then you argee with me.

:rofl:

You do know what ass-ume means, right?

[Name removed]

337. Deleted message

Message removed by moderator. Click here to review the message board rules.

[merh]

20. The first ambulance was not turned away by the hotel employee

they were ignored by ski patrol who brought Richardson down the hill and then they were called back by dispatch.

Coderre, who has reviewed 911 dispatch records, tells PEOPLE a member of the ski patrol summoned the first ambulance to the scene at 12:43 p.m. on Monday, not long after her fall toward the bottom of the run. The ambulance arrived just after 1 p.m. and waited near the bottom of the mountain while a ski patrol member followed protocol by placing Richardson in a toboggan to transport her down the hill.

Coderre, who has been a paramedic for 28 years and a member of a local ski patrol for eight years, said the paramedics in the ambulance saw Richardson whisk by on the sled without stopping. Minutes later, their dispatcher called them and said they were free to go because the actress had refused treatment.

http://www.people.com/people/package/article/0,,20266545_20267163,00.html

Ski patrol/the hotel should have taken her to the ambulance on scene.

[uppityperson]

24. If she refused, as reported, taking her there was legally wrong.

[DaLittle Kitty]

27. Not So W/ A Head Injury IF EMS Was Permitted To Evaluate Her!

Asking HER The Questions... Hotel blocking access by EMS was the wrong move!

[uppityperson]

31. But she refused to let them evaluate her. At that point, she was legally allowed to.

I am sorry that you do not understand the difference between right to refuse medical care and assault.

[DaLittle Kitty]

39. Assessment By Asking Questions IS NOT Assault Sir/Madam!

I am trying to provide context as a health professional who has had first hand experience and training in this sort of thing... Clearly you do not have benefit of the same experience... You do NOT have to get within TEN feet to assess w/ a few simple questions in oder to make some determination as well as asking the ski instructor who was w/ Natasha what happened... GETTIT?

[uppityperson]

41. I am trying to provide context as a health professional who has had firsthand experience also

Forcing yourself on someone who does not want to see you, is capable and legally competent, is either assault or harrasment.

Get it?

[nadinbrzezinski]

46. Medic here, If I transport a patient by force

who is A&O x 4, even after bump in head, and I don't have any secondary witness reporting subtle signs of personality changes, for example, or vomiting and there is no other Sign and Symptom... that is false detainment, and quite possibly assault

Frustrating as hell for medics

Been there, done that... had a PT sign an AMA and transported same an hour later with an intra cranial bleed, he died that evening, by the by... on first contact we even had medical control try to talk him into it, by the by

This is why this is called the lucid \dead syndrome

I transported only one patient who could play the game of 20 questions, who REFUSED care, only once, after family said... "he's acting weird."

We knew we were on the edge legally.

Patient had a subudral though... but our only reason to transport and use IMPLIED consent, was the fact that relatives reported a change in personality

Get it now?

[pnwmom]

57. Right -- IF, as you say, there are no other signs and symptoms of

a head injury, which you -- as a medic -- are qualified to recognize. Hotel employees are not.

The difference in this case is that the medics in the first ambulance didn't obtain an "against medical advice" from her, because they never spoke to her -- they never assessed her condition or gave her any advice at all.

The only assessments done were by unqualified resort employees, who legally cannot stand in for a injured person on the issue of consent. In other words, they should have allowed her to speak directly with the medics, not turned the medics away.

[nadinbrzezinski]

63. There is an AMA, from the facility

and that is the point

She did sign one... uppity person linked to it (news story)

And my first patient I mentioned HAD NO SYMPTOMS on first contract

See... that's the point

He made an adult decision

She made an adult decision

I don't blame her, just as I don't blame that patient

but this is very common... regardless of WHERE in the world

[bottomtheweaver]

66. No, Corderre was simply speculating that she signed a waiver.

No one has linked to such a doc.

[nadinbrzezinski]

73. Once again, not that you will get this

due to privacy concerns, NOBODY can link to that document from DU or anywhere else

No matter how much you insist that you want to see it

His speculation, translate it as it exists until it is proven otherwise... that would be my dear, in a court of law... and somehow I suspect this will die a quiet death with absolutely no lawsuits...

The system I worked on... you'd need a warrant from law enforcement, got it now? Hell, after I turned them in I had no access to them

[bottomtheweaver]

74. The claim that anyone linked to such a doc is false.

That means it isn't true. Can I make that any clearer for you?

[nadinbrzezinski]

82. You are lawyer? No you are not

you are medic, no you're not

You have been trying to blame people and have no clue

Want to bet there is no lawsuit coming?

Wanna bet they're doing an investigation (VIP medicine is a bitch) and then quietly dies?

Want a bet that if we are lucky Quebec gets it's choppers (good thing) and everybody, well except you, will stop making a big fuss out of this?

Look I know how it works.

Been there, done that.

Hell, it is frustrating as hell

But that is the way it works

You want to force medics to transport every patient to the hospital, change the law where any head injury, no matter how light it seems, is treated by implied consent. Until you do that... this is a very public example of something that happens too often, it even has a name, lucid dead syndrome

[bottomtheweaver]

87. I'm not a lunatic either. n/t

[nadinbrzezinski]

89. Yuo mean someobdy with experience, as in real world experience?

I see

[bottomtheweaver]

95. I'm sorry, but I find none of your claims remotely credible. n/t

[pnwmom]

160. How can you know for sure that if you had been at the site,

with your training as a medic, you wouldn't have observed subtle signs of head injury and you wouldn't have been able to persuade Richardson to go to a hospital for a CT scan? The point is that none of us knows!

What we do know is that the only "responder" who observed her for the first two and a half hours was someone whose only qualification was a $100 first aid class. And that they turned away an ambulance with qualified medics who had already driven all the way out there to see her.

What a tragic waste.

[nadinbrzezinski]

202. My EMT course, ran 65 US at a local community college

wow... that make me really unqualified... after all it is about the same as 100 Canadian back in the day... these days, they paid more.

And my kids down in TJ it ran them the cost of their uniform , safety gear and notebooks

(We made the textbooks none existed in Spanish at the time)

WOW

did I mention out of the over 1000 people I trained only 20 had even a smidgen of college education? The rest never went to college, nor had the intention of going to college? They were average for EMS crews in North America.

WOW... that's bullshit if I ever read some

As to your friend that you were responding to... you two would sue at the drop of the hat

This is clear....

Let me repeat this... there will be no lawsuit...

And while you continue to argue about her... I am willing to bet twenty more cases across North America, that read very similar, have already occurred... chew on that.

[pnwmom]

209. I'm glad the paramedics in my state have far more training than you did.

All the paramedic programs here require a year of college level classes.

What state are you in? Remind me to stay out of it.

http://www.doh.wa.gov/hsqa/emstrauma/pmtrnprg.htm

CENTRAL WASHINGTON UNIVERSITY
Emergency Medical Technician - Paramedic Program
Department of Health, Human Performance and Recreation
400 E. 8th Avenue Ellensburg WA 98926-7572
Program Director: Carolyn Booth , RN, MPH
Telephone: [phone] [e-mail]
Medical Director: Jackson Horsley, MD
Class Capacity: 21. Begins: September Length: 12 months
Tuition: Resident-$4,023 per year, Non-Resident: $11,799 per year (2003-2004 academic year)
Award: Diploma, Certificate, BS
COLLEGE OF EMERGENCY SERVICES WASHINGTON
Emergency Medical Technician-Paramedic Program
P.O. Box 707
Woodland, Washington 98674
Program Director: Carl T. Miller, MS, NREMTP
Telephone: [phone], e-mail: [e-mail]
Medical Director: Greg Lorts, MD
Class Capacity: 24. Begins: May and September Length: 1year
Tuition: $ 8,000.00 per course, plus books (includes Anatomy and Physiology)
Award: Certificate
COLUMBIA BASIN COMMUNITY COLLEGE
Emergency Medical Technician-Paramedic Program
2600 North 20th Avenue
Pasco, Washington 99301
Program Director: Eric Nilson, EMT-P
Telephone: [phone] ext. 4007, e-mail: [e-mail]
Medical Director: J.L. Loera, MD
Class Capacity: 24. Begins: September Length: 18 months
Award: Certificate
HARBORVIEW MEDICAL CENTER-UNIVERSITY OF WASHINGTON
Emergency Medical Technician - Paramedic Program
325 Ninth Avenue, Mail Stop: 359727
Seattle, Washington 98104
Program Director: Roy Waugh, EMT-P
Telephone: [phone]
Medical Director: Michael K. Copass, MD
Class Capacity: 16. Begins: October Length: 10 months
Tuition: Sponsorship by Regional EMS Employers ONLY
Award: Certificate
NORTHWEST REGIONAL TRAINING CENTER
Emergency Medical Technician-Paramedic Program
11606 NE 66th Suite 103
Vancouver, Washington 98662
Program Director: David Anderson
Telephone: [phone], e-mail [e-mail]
Medical Director: Lynn Wittwer, MD
Class Capacity: 24 Begins: September and March, Length: 12 months
Tuition: Approximately 7,250
Award: AAS in paramedicine in conjunction with Clark College
SPOKANE COMMUNITY COLLEGE
Emergency Medical Technician-Paramedic Program
N. 1810 Greene Street
Spokane, Washington 99217
Program Director: R. Mark Zandhuisen, EMT-P
Telephone: [phone], e-mail: [e-mail]
Toll Free: 1-800-248-5644, ext. 8129 FAX: [phone]
Medical Director: Tim Chestnut, MD
Class Capacity: Approx. 30. Begins: Fall Quarter Length: 12 months
Tuition: $2500 per course (subject to change), including books
Award: Certificate, AAS offered
Web site: http://www.scc.spokane.edu/?emtp
TACOMA COMMUNITY COLLEGE
Emergency Medical Technician-Paramedic Program
5900 South 12th Street
Tacoma, Washington 98465
Program Director: Mike Smith, NREMT-P
Telephone: [phone], e-mail: [e-mail]
Medical Director: Joe Hoffman, MD
Class Capacity: 24. Begins: September Length: 9 months, 18 months
Tuition: Resident-Approximately $4500, Non-Resident-Approximately $8,300
Award: Certificate, ATA
TACOMA FIRE DEPARTMENT
Emergency Medical Technician-Paramedic Program
2124 Marshall Ave
Tacoma, Washington 98421
Program Director: Lisa Breitinger
Telephone: [phone]
Medical Director: James Billingsley, MD
Class Capacity: 16. Begins: fall Length: 9 months
Tuition: 3,500 per year
Award: Certificate
Pre-requisites: Must be paid EMT/Firefighter with full support of sponsoring agency.
BELLINGHAM TECHNICAL COLLEGE
Emergency Medical Technician-Paramedic Program
3028 Lindbergh Ave.
Bellingham, Washington 98225
Program Directors: Therese Williams/Gerald O’Connor
Telephone: (360) [phone]
Medical Director: Marvin Wayne, MD
Class Capacity: 20 – Begins: Fall Length: 15 months
Tuition: Approximately $17,000
Award: AAS Degree in Paramedicine
NOTE: Primarily a Washington State, North Region training program for sponsored students from trauma verified, publicly-funded ALS agencies, or approved by county MPD. Students from outside the North Region will be considered on a space available basis.

Pre-Requisites: college transferable level math, English and psychology (numbered 100 or higher)

[nadinbrzezinski]

215. NAEMT qualifications in the US are by hours of training

the average paramedic (at an advanced level, which is what I was), have on average 1200 hours of training, aka your college year

I had 2500 hours of advanced training, including PALS, ATLS, ACLS, pharmacology, basic rescue et al

Chew on that

Most of my practicums were done at many a unit in hospital, chew on that

You assume much and know little of how any EMS system works... and around the world even the RED CROSS runs ambulance services staffed by EMT and Paramedic crews

By the way, we used Seattle's protocols, which at the time were considered the most advanced protocols in the United States

Oh and there is much more, for the six years we ran the training school... our medics (advanced that is, not the basic crews), had more training than their counterparts in the United States, which lead to many a transport IN THE US, since the medics could not touch that patient, due to what was done in the field. And our BASIC crews also had more advanced training than their counterparts across the border

You chew on that

You know little how this works, and assume much

But the average EMT- Basic course in NORTH AMERICA... these are Emergency Medical Technicians, are 120 hours long, we made ours 150 since we included some skills basic EMTs in the US cannot do, such as IVs, and two drugs. (Oxygen and Narcan) fer the bloody record EMT-B use Oxygen and can only transport a STABLE patient with an IV, under TKO, that is to keep vein open... we gave them Narcan, due to the overdoses, way too common

You chew on that.

By the way I find it of interest that you have yet to answer what I told you... 20 people across North America (that is the US, Mexico and Canada, a population of about 600 million round numbers) have already died over the course of the week under similar circumstances. Hit on head, alert and oriented times four, refused to see medical provider... You are outraged over a VIP, but this happens... more often than you care to believe

Oh and to the court. This happened in Canada... they are FAR LESS SUE HAPPY than in the US... this will go nowhere in the courts...

at this point this is faux outrage on your part

[pnwmom]

77. Who gave her the medical advice that she supposedly rejected?

The medics in the first ambulance never saw her, and there was no doctor in the clinic.

So who gave her the medical advice? A hotel employee isn't a qualified person to give medical advice. All a hotel employee could do was have her sign a liability release or waiver -- which is NOT the same as an AMA form.

[nadinbrzezinski]

84. SKY PATROL traeted her, they are TRAINED FIRST RESONDERS

they called 9.11 you try now to figure this out...

[uppityperson]

106. Ski patrol. Those people trained to rescue and assess ski injuries.

[pnwmom]

132. Yeah, right. Volunteer college students. n/t

[uppityperson]

138. Huh, I know EMTs who never went to college. You have an issue with college students?

[pnwmom]

141. I have an issue with people who think training in basic first aid is

anything comparable to the training that ambulance medics undergo.

[uppityperson]

142. You keep changing the goal posts.ow do you know these are volunteers taught basic first aid?

proof please

[pnwmom]

146. This is how I know.

Training for the Canadian Ski Patrol:

https://www.canskipatrol.com/join-us.php?PHPSESSID=dbeb...

Training Courses: First Aid classes are held two (2) nights per week from 7:00 pm to 10:00 pm. Select from the training section the centre or course you would like to attend. You must indicate a second choice if the class at the centre you have requested is full. You will not be permitted to attend a course you have not previously registered for in advance. All courses are on a first come first serve basis. In the event you are not able to attend the course requested it is your responsibility to inform your Chief Instructor or the office to make alternate arrangements. A maximum of five (5) classes missed is allowed.


Rewrites of Written and Practical Exams:
One rewrite is allowed at the discretion of the Chief Instructor/Examiner of your training centre. It will not be done within 24 hours of the original attempt. A minimum of 70% is necessary in order to be considered for rewrites, written or practical, to be an option.

Area Orientation/Walk the Hill Day: Your Patrol Leader will contact you to confirm the date and time for this event. Please remember to dress appropriately for the weather.

On-hill /Trail Training: On-hill/Trail training is a portion of the patroller's training, which addresses the activities, skills, and procedures necessary to develop a person trained in first aid to become a competent ski patroller. As a condition of membership in the Canadian Ski Patrol, each member will be trained for the following:
Each patroller will be certified as able to complete all runs/trails of his/her area. Ski ability should be at an intermediate level or better.
Each patroller, after training, must competently handle an empty toboggan used to evacuate an injured person safely from the hill/trail. You will learn to transport a toboggan up hill on lifts and learn to carry a backboard properly down the hill. As part of toboggan training you will learn how to place people in and out of the toboggan. In case of Nordic resorts, several transportation and evacuation techniques are examined, as well as emergency shelters and other survival skills.
Accident Site Management is also part of this training. This is the procedure on how to manage an accident site at the ski area.
Each patroller will be instructed in, and prove a competent understanding of all patrol systems and procedures at the ski area where he/she is assigned.


Fees: Registration fees for the 2008/2009 season are as follows:

New Member Registration Fee $210 (includes First Aid & CPR course, CSP manual (CD-Rom), and First Aid kit.)
First Aid Course Only $100

[Dorian Gray]

188. She probably

felt fine.

It's totally tragic, but I don't see what the point is of blaming anyone. It's tragic. People made mistakes, including Natasha Richardson. Hopefully this will serve to educate people to seek medical advice after such a fall... or, more importantly, to wear a helmet while skiing, no matter how difficult the slopes are.

[nadinbrzezinski]

243. Not the patient, patients are stubborn, it will educate the family to push for them

to agree to go to the hospital

:-)

And for Quebec to get their helos...

Some good can come out of it

[pnwmom]

76. It wasn't an AMA, it was a liability waiver.

And they couldn't have obtained an AMA. Why? Because there was no one at the resort to give her medical advice -- no doctor, nurse, or other trained medical personnel. She couldn't go against medical advice unless there was someone there to give her medical advice -- including an assessment of her status, the risks of not accepting treatment, etc.

Now, if the medics in the first ambulance HAD been allowed to see her -- as you've seen people as a medic -- then THEY could have gotten her to sign an AMA. But a hotel employee could not have.

[nadinbrzezinski]

79. Wht do yuo think a liabity waver is in that case

god people are dense

[pnwmom]

91. A liability waiver is not the same as an AMA form.

A liability waiver releases the resort from liability. It is not in itself an AMA and thus would not have prevented the first medics from speaking with her.

Your background is as a medic, I realize that. But mine is in informed consent issues -- or, in this case, informed "dissent." She couldn't have refused medical advice because no qualified medical person assessed her condition and informed her of the risk of declining treatment.

[nadinbrzezinski]

94. Ok, so if you are right, this will end up in courts

I am willing to bet that this will not

As far as I can tell, they followed procedures

And she said no... once again... if she was alert and oriented times four... nobody can do a damn thing

Now if she was alert and oriented times four, and somebody who knows her said, she's acting weird, then by all means, transport... kicking and screaming... and at that point, if there is nothing wrong, god help the crew

See not that simple

[pnwmom]

126. I expect this will be settled out of court

without any publicity at all. An attorney for Richardson's estate would only have to give a copy of the potential lawsuit to Intrawest Corp. -- it wouldn't actually have to be filed for negotiations to commence.

But we'll see.

[uppityperson]

104. I betcha ski patrol is trained to do assesments.

Or are you saying they employ untrained personnel for ski patrol, rescuing injured people?

[pnwmom]

135. These are volunteers taught basic first aid. Their qualifications don't

even come close to those of ambulance medics.

[uppityperson]

140. How do you know these are volunteers taught basic first aid?

Proof please.

[pnwmom]

144. They take a $100 first aid course. Is this the kind of training you think would

qualify someone to assess your family member for a head injury -- and to turn a waiting ambulance with trained medics away?


Training for the Canadian Ski Patrol:

https://www.canskipatrol.com/join-us.php?PHPSESSID=dbeb903e22bbba19d77c9b0e61db78c9

Training Courses: First Aid classes are held two (2) nights per week from 7:00 pm to 10:00 pm. Select from the training section the centre or course you would like to attend. You must indicate a second choice if the class at the centre you have requested is full. You will not be permitted to attend a course you have not previously registered for in advance. All courses are on a first come first serve basis. In the event you are not able to attend the course requested it is your responsibility to inform your Chief Instructor or the office to make alternate arrangements. A maximum of five (5) classes missed is allowed.


Rewrites of Written and Practical Exams:
One rewrite is allowed at the discretion of the Chief Instructor/Examiner of your training centre. It will not be done within 24 hours of the original attempt. A minimum of 70% is necessary in order to be considered for rewrites, written or practical, to be an option.

Area Orientation/Walk the Hill Day: Your Patrol Leader will contact you to confirm the date and time for this event. Please remember to dress appropriately for the weather.

On-hill /Trail Training: On-hill/Trail training is a portion of the patroller's training, which addresses the activities, skills, and procedures necessary to develop a person trained in first aid to become a competent ski patroller. As a condition of membership in the Canadian Ski Patrol, each member will be trained for the following:
Each patroller will be certified as able to complete all runs/trails of his/her area. Ski ability should be at an intermediate level or better.
Each patroller, after training, must competently handle an empty toboggan used to evacuate an injured person safely from the hill/trail. You will learn to transport a toboggan up hill on lifts and learn to carry a backboard properly down the hill. As part of toboggan training you will learn how to place people in and out of the toboggan. In case of Nordic resorts, several transportation and evacuation techniques are examined, as well as emergency shelters and other survival skills.
Accident Site Management is also part of this training. This is the procedure on how to manage an accident site at the ski area.
Each patroller will be instructed in, and prove a competent understanding of all patrol systems and procedures at the ski area where he/she is assigned.


Fees: Registration fees for the 2008/2009 season are as follows:

New Member Registration Fee $210 (includes First Aid & CPR course, CSP manual (CD-Rom), and First Aid kit.)
First Aid Course Only $100

[nadinbrzezinski]

219. Once again the first EMT course I took was 65 bucks

lasted by state mandate 120 hours

Your point?

They are trained as FIRST RESPONDERS...

[uppityperson]

221. Did you see the one

below where the buddy spews over "disinformation" like existence of a level 3 trauma center? I'm done with these guys. Thanks for trying also.

[nadinbrzezinski]

223. THey are the kind that all medical providers fear

they will sue over an ingrown nail

Thankfully in Canada, if it was them... the judge would tell them to buzz off... just more politely

[DaLittle Kitty]

61. I think I GOTTIT.. No one From EMS Actually Spoke To The Patient! That's The KEY!

No questions asked... No assessment done! This was more than a bump on head it was acceleration deceleration injury w/ likely concussion...


So you and I have seen recalcitrant patients and should understand how to be a patient advocate and work through resistance to assessment and/or treatment... WHEN you are speaking to the patient face to face... RIGHT?

Since the ski instructor was w/ her a savvy EMS person would have been able to "sell" assessment and since she was under obs of the ski instructor /college student could have obtained implied consent from her if they were assertive enough to go that route explaining potential negative consequences of NOT getting evaluated... hmm?


Speaking to the ski instructor to determine the forces involved such as for example in an MVA how much intrusion, unrestrained etc ejected... condition IMMEDIATELY following accident... yada yada and getting the details and documenting them or perhaps CALLING HER HUSBAND WHO I am sure has a cell and would have been able to give the go signal you require... would be more than enough to CYA...

Natasha was no uninsured street guy... I am sure that her husband could have been contacted if anyone had the sense to do it...


Celebrity getting the better of the EMS guys intimidated by upscale resort mgt., and not having the balls to uphold their need to speak to the patient herself and not some intermediary when you are talking HEAD DOINK... Is A problem... So ya GOTTITT NOW?

[nadinbrzezinski]

65. Sorry the sky patrol did an assstment

she COULD and DID refuse further treatment

Sky patrol are trained as FIRST RESPONDERS not just chopped liver

[merh]

75. Then why did ski patrol take her to the clinic and not let her return

to ski again?

Why were they with her for so long, why was she monitored?

That doesn't happen if it was simple spill, you know it and I know it.

She did not tell the ambulance to go away, it was ignored by the ski patrol and the ski instuctor - they were then called back by dispatch.

[nadinbrzezinski]

86. I wasn't there, but I can bet somebody had a gut feeling

why they insisted on keeping an eye on her

but they are the first responders

That is how this works ok

And this is so common, it is sad

Happens all the time

Lucid dead syndrome here you go

----------------------------------------

'Talk and die syndrome' made actress's death difficult to prevent
Condition masks severity of brain injury, prompting victims, such as Natasha Richardson, to refuse medical treatment, experts say
Article Comments (21) JESSICA LEEDER

From Friday's Globe and Mail

March 20, 2009 at 3:29 AM EDT

Natasha Richardson's fatal descent began when she suffered a rare bout of "talk and die syndrome" after falling on a Quebec ski hill with limited access to head-trauma specialists.

Brain-injury experts say victims of the infrequent syndrome, which masks head injuries, are often conscious after hitting their heads and lucid enough to deem themselves unhurt, as Ms. Richardson did this week, laughing off her tumble on a beginners hill at Mont Tremblant and declining an ambulance. Victims can appear healthy even though they require medical attention and, in some cases, are on the brink of death.

"You can't drag them screaming to the hospital," said Charles Tator, a University of Toronto neurosurgeon who emphasized that talk and die syndrome is an infrequent occurrence in brain-injury cases. Still, he said: "Every health-care professional, paramedic and ski patroller knows about this phenomenon. That's why you never allow a head-injured person to be alone."

http://www.theglobeandmail.com/servlet/story/RTGAM.20090320.wrichardson20/BNStory/National/home?cid=al_gam_mostview

Educate yourselves

[merh]

105. I don't need you to educate me

and your rude ending was unnecessary.

The ambulance was there, if the ski patrol had a "gut feeling" and were not able to convince her to go get checked out at the hospital - by real doctors, then they should have taken her to the ambulance and let them take the time to try to convince her. It wasn't a simple spill if they brought her down in a sled and stayed with her all that time, it was more or they wouldn't have had that "gut feeling". Everyone in this industry knows that the more that try to convince her to seek care, the better as the odds are she will realize it can't hurt, if only to shut up all the concerned voices.

[DaLittle Kitty]

143. Finally, Someone W/ Some COMMON SENSE! This IS Why We HAve ATLS Protocal and Why

We "backboard seemingly unhurt patients in traffic accidents because there are "occult injuries" UNSEEN, not obvious injuries..

We used to have car accidents people would be walking around after the accident, turn their head and fall down paralyzed! That's the reason for the cervical collars...

The EMS weak ass unassertive EMS BS is disgusting... I have seen and heard plenty of these stories... The mechanism of injury the immediate aftermath and how the patient feels momentarily after the accident... +LOC H/A, nausea... People have to be coaxed to go to the ER... The EMS'ers who just show up and asks once or twice and bails out is doing the patient and the community a DIS-SERVICE!

More assertive EMS personnel in this circumstance might have been the difference. Sadly they were not...

[pnwmom]

168. Another voice of reason. n/t

[pnwmom]

80. The ski patrol person wasn't a medic, and wasn't qualified to

sign an AMA form.

[nadinbrzezinski]

88. FIRST RESPONDER... more than just firrst aid

it is an actual EMS certificate, google it up

[DaLittle Kitty]

145. But W/ Infrequent and Minimal Experience In Evaluating Head Injuries...

They teach skiing... Mostly and people fall down... And the Bunny Hill location was a curve ball too... How could ANYONE hurt themselves on the Bunny Hill? BTW the Emergency Room Doc and The Neuro Doc have substantiated my remarks here... Problem no assessment by professionals w/ experience evaluating head injury on a frequent basis. Story will come out... autopsy done today...

[pnwmom]

169. And the ski patrol person's only qualification was a first aid class,

not EMS training.

[pnwmom]

163. A ski patrol member in Canada only has to have a $100 class in basic first

aid, plus CPR training.

By your definition then, a ski patrol member is NOT a first responder.

(Why did you think they were first responders?)

Training for the Canadian Ski Patrol:

https://www.canskipatrol.com/join-us.php?PHPSESSID=dbeb...

Training Courses: First Aid classes are held two (2) nights per week from 7:00 pm to 10:00 pm. Select from the training section the centre or course you would like to attend. You must indicate a second choice if the class at the centre you have requested is full. You will not be permitted to attend a course you have not previously registered for in advance. All courses are on a first come first serve basis. In the event you are not able to attend the course requested it is your responsibility to inform your Chief Instructor or the office to make alternate arrangements. A maximum of five (5) classes missed is allowed.


Rewrites of Written and Practical Exams:
One rewrite is allowed at the discretion of the Chief Instructor/Examiner of your training centre. It will not be done within 24 hours of the original attempt. A minimum of 70% is necessary in order to be considered for rewrites, written or practical, to be an option.

Area Orientation/Walk the Hill Day: Your Patrol Leader will contact you to confirm the date and time for this event. Please remember to dress appropriately for the weather.

On-hill /Trail Training: On-hill/Trail training is a portion of the patroller's training, which addresses the activities, skills, and procedures necessary to develop a person trained in first aid to become a competent ski patroller. As a condition of membership in the Canadian Ski Patrol, each member will be trained for the following:
Each patroller will be certified as able to complete all runs/trails of his/her area. Ski ability should be at an intermediate level or better.
Each patroller, after training, must competently handle an empty toboggan used to evacuate an injured person safely from the hill/trail. You will learn to transport a toboggan up hill on lifts and learn to carry a backboard properly down the hill. As part of toboggan training you will learn how to place people in and out of the toboggan. In case of Nordic resorts, several transportation and evacuation techniques are examined, as well as emergency shelters and other survival skills.
Accident Site Management is also part of this training. This is the procedure on how to manage an accident site at the ski area.
Each patroller will be instructed in, and prove a competent understanding of all patrol systems and procedures at the ski area where he/she is assigned.


Fees: Registration fees for the 2008/2009 season are as follows:

New Member Registration Fee $210 (includes First Aid & CPR course, CSP manual (CD-Rom), and First Aid kit.)
First Aid Course Only $100

[uppityperson]

108. How do you know that? Prove it.

[DaLittle Kitty]

150. Why Just Last Year I Saw A Patient W/ A Ventriqulostomy On The Slopes!

That's how I know!

[uppityperson]

182. No answer, just insults.

How does that saying go? Never argue with drunks or fools? I probably have that wrong also. Oh well. Tata

[pnwmom]

170. Here's the proof, again.

Training for the Canadian Ski Patrol:

https://www.canskipatrol.com/join-us.php?PHPSESSID=dbeb...

Training Courses: First Aid classes are held two (2) nights per week from 7:00 pm to 10:00 pm. Select from the training section the centre or course you would like to attend. You must indicate a second choice if the class at the centre you have requested is full. You will not be permitted to attend a course you have not previously registered for in advance. All courses are on a first come first serve basis. In the event you are not able to attend the course requested it is your responsibility to inform your Chief Instructor or the office to make alternate arrangements. A maximum of five (5) classes missed is allowed.


Rewrites of Written and Practical Exams:
One rewrite is allowed at the discretion of the Chief Instructor/Examiner of your training centre. It will not be done within 24 hours of the original attempt. A minimum of 70% is necessary in order to be considered for rewrites, written or practical, to be an option.

Area Orientation/Walk the Hill Day: Your Patrol Leader will contact you to confirm the date and time for this event. Please remember to dress appropriately for the weather.

On-hill /Trail Training: On-hill/Trail training is a portion of the patroller's training, which addresses the activities, skills, and procedures necessary to develop a person trained in first aid to become a competent ski patroller. As a condition of membership in the Canadian Ski Patrol, each member will be trained for the following:
Each patroller will be certified as able to complete all runs/trails of his/her area. Ski ability should be at an intermediate level or better.
Each patroller, after training, must competently handle an empty toboggan used to evacuate an injured person safely from the hill/trail. You will learn to transport a toboggan up hill on lifts and learn to carry a backboard properly down the hill. As part of toboggan training you will learn how to place people in and out of the toboggan. In case of Nordic resorts, several transportation and evacuation techniques are examined, as well as emergency shelters and other survival skills.
Accident Site Management is also part of this training. This is the procedure on how to manage an accident site at the ski area.
Each patroller will be instructed in, and prove a competent understanding of all patrol systems and procedures at the ski area where he/she is assigned.


Fees: Registration fees for the 2008/2009 season are as follows:

New Member Registration Fee $210 (includes First Aid & CPR course, CSP manual (CD-Rom), and First Aid kit.)
First Aid Course Only $100

[DaLittle Kitty]

83. So Is Putting A College Student To Watch Her The Same As An ER?

Why Did She QUit Skiing then if she was OK? Falling is something that is part and parcel to skiing... So having the college girl stay w/ her is equivalent to observation ooops not withstanding concussion w/ standard eval being CT of Head? So are they trained evaluators of concussion ?

Can the ski patrol if they were to suspect even mild concussion which if one assumes that they did given the college student obs business then we return to what is the proper eval for a concussion...

In the 21st century that is a CT of Head and if the patient is to refuse CT does so w/ full explanation from an emergency room physician who describes potential consequences if the concussion is NOT just a concussion.

How do we triage (reason for doing CT Head Injury) (reason for ECG/Cardiac Enzymes w/ Chest pain) It IS to RULE OUT the MOST SERIOUS potential problems FIRST then we move to the least harmful potential diagnosis... NOT THE REVERSE!

So the ski patrol/Instructor rather than being assertive and sticking to his/her training and knowing what's appropriate... wilted under the movie star celebrity BS! Perhaps you have not met celebrities... The ONLY difference between them and us when it comes to health care is that THEY ARE ON TV... Pants go on the same way, bathroom activities are the same... They DIE just like we do! etc! GETTIT?

[nadinbrzezinski]

90. No he didn't wilt at her BS

she was alert and oriented times four

read about it

http://www.theglobeandmail.com/servlet/story/RTGAM.20090320.wrichardson20/BNStory/National/home?cid=al_gam_mostview

try to comprehend this happens

[DaLittle Kitty]

149. But Not Feeling Well And W/ A Headache!

Go to www.CNN.com

[pnwmom]

171. According to whom? According to a person whose only qualification

was a $100 first aid course.

[nadinbrzezinski]

257. I paid 65 for my EMT B? WOW

this is quite amazing

[pnwmom]

289. Did you work part-time on a volunteer basis?

I'm surprised that you would want to denigrate your professional skills by comparing them to those of a part-time volunteer.

[nadinbrzezinski]

294. I was an EMT-P, I wrote the courses for my kids

and I worked part time as a REd Cross volunteer

I helped develop a full EMS system... wow imagine that? Together with Doctors who's regular practice was separate as well... imagine that

By the way my coursework included 200 yours of international law

Unlike you, I don't denigrate volunteers

And volunteers make most of EMS in North America... what you think you get a full time crew when you call EMS in some places in the US outside of major cities? That delusional aren't we?

Do me a favor, never, ever call an ambulance, please

But the first EMT course I took was at a junior college

[pnwmom]

72. Legally, you can't refuse medical care that you haven't been offered.

She never spoke with a medic who could have offered her care. So she didn't legally refuse care.

The resort acted on her behalf. And legally they do not have that right. That was a mistake.

[nadinbrzezinski]

78. Read tis carefully... she spoke with the sky patrol

they were the first responders... if she told them no... and she is alert and oriented times four, with no other symptoms, and those will not appear for a while... they acted properly

She has the right to refuse care from FIRST RESPONDERS or any other higher trained responder

The Sky Patrol is the first responder

Got it now? Or do you need more information on how this works?

What she needed, with many other patients that have a bump in the head, and refuse care, and later die, is an advocate that KNOWS them well and can tell the medics, first responders, et al... that they notice something different

See about the patient I transported AFTER the family said, he was acting weird? UNTIL they gave me that weapon, legally I could not transport, no matter how many knotts from here to sunday I tie myself into.

In an ideal world, medics could have been told no thank you ... they would not be able to transport either... By the way my assumption that she was fully functional and capable of saying no early on comes from similar contacts. GET IT?

The symptoms don't appear immediately, why I'd love to transport every suspected head injury. The reality is... that doesn't happen

[pnwmom]

85. Actually, the qualifications of ski patrol members vary. There is no

national standard in the U.S. and I haven't heard of one in Canada either. That is yet another problem with safety at ski resorts.

But here's an example. Are you going to claim that these volunteers have medical training equivalent to a ambulance medic? There is no way these volunteers are qualified to sign an AMA form.

http://www.northstarattahoe.com/info/ski/employment/volunteer.asp

Below are the minimum qualifications to become a Mountain Safety Volunteer Guide:
Each individual must become a member of the National Ski Patrol Host organization. To sign up please visit www.nsnsp.org.
Commit to volunteering for at least four-teen days during the season on the designated weekends/holidays. Designated days include all Friday, Saturday, & Sunday starting on December 13th until April 15th. The peak holiday periods include all days starting Sunday, December 21, 2008 through Sunday, January 4, 2008.
Must possess current credentials, or attend provided training to attain the proper credentials. Minimum certification include: NSP's Outdoor First Care or equivalent. Examples of equivalent certifications include American Red Cross Basic First Aid, Cross First Aid, Standard First Aid, or First Aid Basics, American Safety and Health Institute Basic First Ail, National Safety Council First Aid or Standard First Aid or a credentialed Responder.
Must be an intermediate or above skier or rider.
Must have great communication skills and enjoy working with the public in an outdoor environment.

[nadinbrzezinski]

92. First responder, next

by the way, this is what they were dealing with

http://www.theglobeandmail.com/servlet/story/RTGAM.20090320.wrichardson20/BNStory/National/home?cid=al_gam_mostview

[DaLittle Kitty]

97. Who Called EMS #! That Came After The Paramedics On The Ski Slope?

So The People who called the EMS were your party of reference... Again, mechanism of injury witnessed by ski patrol who first evaluated her... Did or were EMS #1 given a report from the ski patrol? You either give a rats ass about getting the details BEFORE you book... Or you don't! If these EMS 'ers had some cahunas they might well be heroes?

Even if someone tells you I'm OK you still get to ask THEM the questions RIGHT? But NOT in this case... Where the verbal assessment would have likely shown results... Is she going to lie to the EMS guys? Listen I have gotten plenty of TOTALLY wrong reports from EMS in ER! I have learned NEVER to take w/o a grain of salt the report from EMS... It can lead you down the wrong diagnostic path!

Can you say my stomach hurts and then point to your chest? I understand, believe me! EMS is a very tough arena... I sympathize but you cannot get so routine that you bail out at the first opportunity...

So getting the story in a detailed fashion first of all from ski patrol who called EMS for WHAT reason????? Then actually questioning the patient herself... would allow assessment for subtle cues...

If she needed the trip down the hill on a sled likely as not she HAD a concussion... Again which goes back to the critical pathway of Differential Diagnosis... Signs of concussion... momentary LOC? Woozy, confused... You are back to CT again!

This BTW was NOT a suspected head injury... It WAS a head injury the degree of which needed to be ascertained...In a TIMELY fashion! She clearly had symptoms otherwise WHY call EMS?

WHY transport back on a sled? and...

WHY have the college girl stay w/ her?

WHY? Because she HAD a head injury w/ symptoms that no one got to ASK HER about who had any diagnostic ability... Until it was too late!

[merh]

48. Not with head injuries

laughing and giddy can be a sign - like a punch drunk - goffy

it was up to her to tell the medics she didn't want to go to the hospital, she didn't want to talk with them.

She had no medical care for hours, even when taken to the clinic.

I've seen ski patrols take folks down the slopes in a sled, they don't do it if it was a simple tumble or fall, if they did they would be plenty busy all day.

[DaLittle Kitty]

69. ABSOLUTELY, Why I do not ski Anymore! Skiing IS Dangerous If You

#1 Do not do it very often #2 Are not very athletic or out of shape #3 You are older and do not ski much. In skiing you use muscles that you never knew you had... Ice hockey or golf... I do those enough to not hurt myself... and I wear a helmet! For hockey!

[pnwmom]

58. She also refused the second time, but they called for the ambulance

to come and get her anyway.

Was that wrong, too?

The fact is that there is an exception to the refusal-of-treatment rules that covers head injuries.

http://209.85.173.132/search?q=cache:WgzYMi3_1wEJ:www.moh.gov.om/nursing/1%25202%2520Discharge%2520AMA.pdf+%22against+medical+advice%22+form+%22informed+consent%22+%22head+injury%22&cd=1&hl=en&ct=clnk&gl=us

The following must be present to allow refusal of care: Patient is an adult (refer to definition) or represented by a legallyappointed representative or parent (if a minor child).a. Relatives cannot consent to the refusal of care for their relative unless he is a legally designated representative.b.Patient is competent: Health care workers should determine the competency of the patient based on reason and carefulness,utilizing the following guidelines:

c.The patient’s presentation, physical assessment and vital signs are consistent with a person presenting in a physical condition that would support cognitive capacity. Some conditions that might diminish cognitive capacity include: • Unstable vital signs that could affect cerebral circulation or oxygenation. • Evidence of alcohol or drug intoxication.• Evidence of head injury.

[pnwmom]

36. I agree that the ski patrol should have taken her to the ambulance. n/t

[DaLittle Kitty]

52. So Who Called The Dispatcher? Need More Info Than That!

:think:

[bottomtheweaver]

54. Bingo.

Been wondering that too. Funny Corderre doesn't explain that and it was supposedly his company.

[merh]

81. read this article

it has the info from the ambulance service that shows their time line doesn't coincide with the hotel's

http://www.people.com/people/package/article/0,,20266545_20267163,00.html

[DaLittle Kitty]

153. Key Point From Your Article... Lot's of DillyDallying and F***Ups In This! UnTrained Observers!!!!

(Coderre’s timeline conflicts with a press release issued by the ski resort Tuesday stating that medics were called to Richardson’s hotel room about an hour after her fall. The resort did not respond to an email seeking further comment on the sequence of events.)

[pnwmom]

174. There does seem to be some sort of a cover-up. Why did they say she was

taken to the hospital an hour after the fall? Unless they knew there would be a problem that they waited for 2.5 hours to call the second time.

[Justice]

191. taken down hill in a toboggan - suggests fall was more significant

[merh]

196. I know - I'm surprised that others haven't picked up on that.

if it is "protocol" to toboggan everyone down the hill after a fall then the ski patrol would be very busy and the slopes would be filled with toboggans and not skiers.

[DaLittle Kitty]

339. That IS The Same Conclusion That ER Doc On Larry King Had... The klowns here

are afflicted w/ Cognitive Dissonance afraid of facts... That's why they would not watch the docs who described pertinent material!

[nadinbrzezinski]

43. Not quite, if patient is alert and oriented times four

there is nothing the medics can do....

Been there, done that, so many times it is not even funny

The ONLY time I transpored against a PT wishes was when family said, he was acting "weird"

We were legally on the knives edge

[DaLittle Kitty]

194. #191 Is Correct As Were The MD's On Larry King Last Night. EMT IS Rough Cut

The Subtle stuff is for the ER Physician and for crying out loud even the RNs in the ER... As I said previously, there were plenty of avenues to circumvent Natasha's recalcitrance if the EMTs were bright enough and assertive enough to pursue them... Just taking orders w/o questioning is pitiful practice!

[nadinbrzezinski]

236. The ONLY patient hit on the nogging we transported AGAINST his will

who was Alert and oriented times four with no overt sign and symptom that something was wrong was the one relatives said, he's acting weird... no way any of us could know that...

That gave us the LEGAL tool... until we were told that... he signed an AMA,have a good day.


You have never worked in the streets, have you?

By the way, those relatives saved his life and did the PATIENT ADVOCACY two of us have been talking about all this time

The one you REFUSE to even admit exists

Oh and the lawyer was clear... if he had no bleed, the lawsuit would have been lots of fun... suffice it to say, kidnapping would have meant ten months in the slammer, at least.

Yes, we were that close to the edge of the legal knife

[tonysam]

5. It's Debatable Diana Would Have Survived Her Injuries

She was very, very seriously injured in the crash.

[DaLittle Kitty]

7. At The Time There Was Great Discussion Among Surgeons et al re:Diana...

They wasted more than an hour working on Diana IN THE CAR by an MD from the ambulance then drove right by a properly equipped trauma center. Where she would have had immediate surgical treatment. Diana BLED to death over a course of OVER two hours! I have seen a similar death w/ my own eyes where a patient lingered in an ER w/o being properly evaluated went to OR opened him up by then therer was NO blood pressure left due to lost circulating volume... JUST a pond of blood in his abdomen... Patient coded and died!

Surgeons FIX BLEEDERS! Timely presentation is key to finding and fixing the LEAKS before the BP is ZERO!

[nadinbrzezinski]

47. Yuo forget that MedSans, the French System

has different protocols

The MD on board is standard and medics are not as common

her death though brought a revision in standsards

[DaLittle Kitty]

10. Anyone who survives two hours Plus of dillydallying Could likely have had a Good Chance W/

w/ Proper surgical/Trauma Care!

[pnwmom]

18. If they had had a medical helicopter get her, the flight to Montreal would have

been 15 minutes.

[uppityperson]

23. Wrong. Having a slow cranial bleed can often be fatal, even with care

I have a friend who died from this, was 55. She got care, prompt care, and died. It happens.

[DaLittle Kitty]

34. Time to Diagnosis and Appropriate Treatment IS Key... Sorry about your friend!

[uppityperson]

38. and sometimes people die. We all will.

It is a shame MsRichardson didn't put herself in the medics hands or gone directly to a hospital as she would have been closer when she started developing problems. But, as evidenced by my doctor friend's wife, even prompt appropriate treatment doesn't always work.

[DaLittle Kitty]

40. I CERTAINLY AGREE, HOWEVER It Is Indeed Better To Give Life A Chance Agree?

[uppityperson]

42. Good grief. No, I think we should kill everyone who has an owie

[DaLittle Kitty]

32. I am Speaking About Princess Diana NOT Natasha.. Intraabdominal bleed is different animal

than intracranial bleed... abdomen is a pliant space...

[uppityperson]

37. ah, that it is. eom

[MiniMe]

59. I also thought there was some delay in being able to extract her from the crash

It was almost 12 years ago, so I'm not sure if I am remember correctly, but I thought there was a problem getting the people out of the car.

[DaLittle Kitty]

147. Poor System... Our System IS Scoop And Run To Trauma Center Developed During Vietnam War

This was the genesis of our modern day trauma system using air transport. France system relies on treatment at the scene by MD on ambulance then they screwed up and drove right by the best hospital to treat her... She was conscious in the car... and bled to death from repairable injuries!

[tonysam]

203. No, There is Considerable Controversy About Diana

She suffered far more serious injuries than it appeared.

[nadinbrzezinski]

226. Yes there was... one that is usually left out of the discussion

that was an armored car

Cut points in armored cars are not published...

From personal experience, we got one... I broke three jaws of life on one.

And that does not go into the protocols that the French system had at the time

I expect the usual suspects to also call bullshit on this

After all, they have overall so far

[defendandprotect]

134. Besides helmets and getting this story out - which is obviously happening . . .

I think the ski resorts and maybe even the hotels have to explain IN ADVANCE the dangers

of an accident like this so that if it happens, the victim is prepared and understands

the true dangers. AND, the family does, as well. Probably a pamphlet in the room --

or something that comes along with the HELMET.

[pnwmom]

139. Right. And one of the things people should be told

is how available trauma care will or won't be, in the event it is needed. Many resorts -- which can be the size of a small city -- are in isolated locations. If they aren't prepared to helicopter injured people out to trauma centers, they should at least inform people what their options will be if an accident occurs.

[DaLittle Kitty]

148. Reasonable Point.. Fore-armed is Fore-Warned!

[merh]

152. I have to disagree with you

It is the responsibility of the traveler, the sport enthusiast, to find out and to know what medical facilities are available.

Like I said, I used to scuba. I always made sure my dive master and the dive boat captain and crew had arrangements should an accident happen - I always made sure a decompression chamber/hyperbaric chamber was within a reasonable distance and that they knew how to get me to it in time.

I tried snow skiing but to me it was too much effort for too little fun, I don't like being cold or falling down a lot (which happens when you are a beginner or when you don't ski often.)

[DaLittle Kitty]

155. As I Noted In An Earlier Post and Yes Buyer Beware! Know the Risks.. Why You Choose NOT

to ski... and scuba which is one of the most dangerous activities as well... Good to know the decision tree and the options you want taken in the event of a problem...

[pnwmom]

157. How are they to find out if the resort won't tell them? The way to find out

is for the resorts to make their protocols available to anyone who asks for them.

[merh]

161. Well, yes, if asked the resorts should make the information

available. It is up to the traveler to ask.

[TorchTheWitch]

186. snow in your pants is not fun

I tried skiing once and once was enough. Being cold, falling down and the damn snow in my pants swore me off it. And to think I actually paid money to endure that, too. Ugh.

As far as I'm concerned winter is for hibernation. Wake me when it's at least the middle of April.

[merh]

192. exactly

and those boots!

You know the ski boots that are designed so that you are "poised for the slopes". They are clunky and uncomfortable to walk in and ugly.

The ski lodge by the fire with a hot cup of kahlua coffee is the only place to be when at a ski resort.

[TorchTheWitch]

214. the ONLY place to be!

In front of the fire with refreshments and footwear that one can negotiate moving from Point A to Point B in without being a physical hazard to one's self and anyone else in the immediate vacinity. Staking a claim in front of the fire was exactly what I did for 90% of my one day stay seeing as it didn't take long at all to come to the conclusion that skiing was not for me.

And now I shall return to my seasonal coma as I see that the middle of April has not yet arrived. ;)

[cleo4cole]

175. response

i am sorry but you must be pretty ignorant as to refusal of care ,no one can be forced to have care!!! and why even speculate on that she thought she was fine and refused care in the beginning. i also read a comment that standards of care come into play, um guess what,not at a ski resort. all this discussion is so regardless,how about thinking of the family ,they are greiving,why add to it with stupidity. the only thing i can say is a four or five star ski resort should have a level three trauma center very close by. but folks give the family a break let them greive their loss without all the questions

[uppityperson]

184. "no one can be forced to have care!!!" Exactly. Nice to see someone else gets this. eom

[TorchTheWitch]

189. That can't be forced to speak to EMT's either

But some people just don't want to get it. They do get it, they just want someone, anyone, to blame in this case for some reason. They can't be forced to go to those medics to speak to them if they have already refused. The liability waiver indicates that Richardson wouldn't even speak to the EMT's which meant someone from the resort had to tell them she refused and turn them away. Absolutely everything in the news about this case indicates that Richardson refused to see or speak to EMT's at all the first time they were called, yet some people just desperately want to hang someone for her death. It's absurd.

This is immensely common. I've even done it myself. People, for whatever reason, very often refuse ANY intervention by medics (which includes even speaking to them) and sometimes it turns out to be a bad decision. We're allowed to make our own medical decisions even if it turns out to be the wrong decision and kills us... but that's our right, and nobody can do a damn thing about it however much they may want to and see a good reason to. I'll be damned if I'll be happy about that right being taken from me, and it pisses me off to no end that there are people here that think it should be.

[tonysam]

204. And Because She Signed a Waiver,

there is absolutely NOTHING the family can do legally. Not that they would sue, but facts are facts.

[merh]

205. Wrong, those waivers are not legitimate

You cannot sign away your rights in instances like this - with a head trauma, there is no guarantee that the individual understood their rights or the "legal contract" that waiver represented at the time it was signed.

Waivers such as that are used to discourage lawsuits, they don't prevent them.

When the ski patrol brought her down the hill they could have very easily taken her to the ambulance. At that time, if she was not interested in talking with the paramedics on board, she could have told them so. That was not the case, that ambulance was ignored, the paramedics never saw her or had a chance to talk to her. They didn't know if she was alert and talking and laughing, they just received a call from dispatch to return.

[TorchTheWitch]

235. if she already refused to see the medics they couldn't

We don't know exactly what happened and precisely when she refused to see the medics. If she told the ski patrol she didn't want to see the medics they could not have legally physically taken her too them. All they could do in that instance is everything they could to encourage her to. If she said she didn't want to see them they couldn't force her to. It depends on what she said and when she said it. That's why the waiver... the resort didn't want the legal responsibility of turning away the medics she her own self wouldn't speak to even just to tell them her own self to go away. That will stand up in court and historically has... as it should. At the time of her signing the waiver it was not known she had anything more than a little owie. They encouraged her to seek care because they knew what she believed was nothing could be something, but they could not force her speak to the medics if she didn't want to. And the presentation of the liability waiver at that time suggests that she refused to speak to the medics and tell them to go away herself thereby handing off that responsibility to someone at the resort.

As an aside... anyone can sue for any reason they want whether they have a legitimate case or not. Nothing prevents a lawsuit for that reason. Liability waivers are CYA in the event that a lawsuit does result in the future. Liability waivers don't sign away one's legal rights. In this case, she preserved her legal rights by signing one... that legal right being to refuse unwanted medical intervention. What liability waivers do is document who is responsible in the event something happens. She probably also signed a liability waiver before being allowed on the slopes that said something to the effect that although they encouraged helmet use, the individual is free to not wear one if they chose, but in the event that choice results in a head injury that the wearing of a helmet could have prevented, the responsibility for refusing to wear one lies with the individual who chose not to and not with the resort. Signing such waivers does not infringe upon anyone's rights... it documents who is responsible.

That doesn't mean that liability waivers are never overruled. If it can be proven that the individual was informed falsely about what they were signing or that the waiver infringed upon a person's legal rights they may or may not be aware of, then they can be overruled. In this case, I can't see anything like that. Since the resort could not force her to tell the medics to go away herself thereby handing that job off to someone at the resort they rightly covered themselves legally by having her sign the waiver so they couldn't be held legally responsible for the turning away of the medics. The existance and timing of the waiver tells me that she refused to so much as tell the medics herself that she was refusing their intervention and to go away.

There is NOTHING to suggest that she wasn't allowed to speak to medics herself and EVERYTHING to suggest she refused to which nobody could force her to do once that refusal was voiced. I'm guessing that once she got to the bottom of the slope she saw the ambulance and either believed or was told it was for her and refused to even speak with those medics THEN. Perhaps she was embarrassed and believed a big fuss was being made over her for nothing, and it's my guess that's probably what she thought at that time. The resort did the right thing in calling for the ambulance and doing everything they legally could to encourage her to utilize their service, but they could not force her to even speak to them once she said she didn't want to.

[merh]

237. You are mistaken

She was on the sled when the ambulance folks saw her, the ski patrol ignored them and went to the clinic (when one says clinic, one assumes med staff is there, it wasn't). She was never given the chance to tell the ambulance crew ON THE SCENE that she didn't want treatment. There is nothing about taking to the awaiting ambulance that would have been illegal, she already had agreed to the tuboggan ride and the clinic visit.

The hotel appears to be covering ass, their time line is different from the ambulance services time line.

Make up all the "you can't make her" stuff you want, it is just making it up. The ambulance was on the scene, the ski patrol should have taken her to it and at that point, she could have refused the care or transport. As it stands, she never refused it as far as anyone but the hotel staff knows.

[TorchTheWitch]

258. You are entirely missing the point

We don't KNOW at what point she refused ambulance service or to speak to them at all. She was probably told they called an ambulance for her on the way down the hill at which point she probably voiced her refusal to see them, or she saw them herself waiting for her at the bottom of the hill and at that time voiced her refusal to see them. It stands to reason that without her saying she didn't want to see the medics that the ski patrol would have taken her directly to the ambulance that they called for her since that's what they DO UNLESS the person refuses to be seen. What we DO know is that everyone at the resort including the ski patrol did everything they could to encourage her to seek treatment. It defies absolutely all logic that once arriving at the bottom of the hill with the ambulance waiting right there that they would not take her to it unless she had ALREADY refused... THEY were the ones who called the ambulance for her and THEY were the ones that wanted her to seek care! SHE was the one who refused care. Why in the world is it logical to believe that she was deliberately not taken immediately to the ambulance that they called for her to seek treatment they wanted her to receive and we KNOW she did not? The only thing that does make any logical sense is that she refused to see the medics before she could be taken to them. And the liability waiver and the timing of it further bares that out.

[merh]

272. It is you missing the point.

She took a fall that made the ski patrol feel it necessary to take her to the bottom of the hill by toboggan. That means it wasn't a simple spill, it was more than just a slip or a tumble (I wonder if she lost consciousness for a time, before the patrol was called to her.) We know the spill was enough that they continued to monitor down the hill, to the clinic and in her hotel.

The ambulance was there, the ski patrol should have taken her to the ambulance so that the EMS on board could talk to her. That would have served a couple of purposes. One, it would have bolstered their position that she refused care - it would be more than just their word on it - and it would have bolstered their position that they did all they could to ensure she had care. It also would have allowed others to evaluate her to determine if she was capable of making the decision and who knows, maybe one of the EMS crew could have talked her into going to the hospital. The more that can try to convince someone the better.

With a head injury, the person's refusal is not always the final say on it, medical staff can determine that they are not capable to make that call due to the injury.

And all we know is, the hotel says she refused care, no one "not associated" with the hotel has said that. Additionally, the hotel's time line does not coincide with the ambulances time line.

[nadinbrzezinski]

246. Wanna bet this will be thrown out of the CANADIAN court system

if it even gets that far?

[merh]

248. wanna bet that the truth has yet to be made public

that it was known her fall was more than just a simple tumble and that the hotel is covering its ass and not releasing the truth?

You don't even know if she signed a waiver, you are just taking the hotel's position on it "standard procedure is"....

A simple fall on the bunny slope does not warrant a toboggan ride and constant monitoring by staff.

[nadinbrzezinski]

250. I get it, this is a conspiracy. I get it

here is the truth, this is a syndrome

And while you and I have been discussing THIS VIP case, about twenty more people have perished across North America under similar circumstances

That is got hit in nogging, and refused medical care, and later died

That is the truth

So you are going to tell me that we should be outraged over those deaths as well?

By the way NA? That is Mexico, Canada and the US.

THis is called the talk and die syndrome

http://www.theglobeandmail.com/servlet/story/RTGAM.20090320.wrichardson20/BNStory/National/home?cid=al_gam_mostview

'Talk and die syndrome' made actress's death difficult to prevent
Condition masks severity of brain injury, prompting victims, such as Natasha Richardson, to refuse medical treatment, experts say
Article Comments (21)
JESSICA LEEDER
From Friday's Globe and Mail
March 20, 2009 at 3:29 AM EDT
Natasha Richardson's fatal descent began when she suffered a rare bout of "talk and die syndrome" after falling on a Quebec ski hill with limited access to head-trauma specialists.

Brain-injury experts say victims of the infrequent syndrome, which masks head injuries, are often conscious after hitting their heads and lucid enough to deem themselves unhurt, as Ms. Richardson did this week, laughing off her tumble on a beginners hill at Mont Tremblant and declining an ambulance. Victims can appear healthy even though they require medical attention and, in some cases, are on the brink of death.

"You can't drag them screaming to the hospital," said Charles Tator, a University of Toronto neurosurgeon who emphasized that talk and die syndrome is an infrequent occurrence in brain-injury cases. Still, he said: "Every health-care professional, paramedic and ski patroller knows about this phenomenon. That's why you never allow a head-injured person to be alone."

Why they didn't leave her alone, by the by....

So are you going to continue to be this outraged?

reality is some good will come out of it... but this will go nowhere in the Canadian legal system. They are FAR LESS litigious than we are...

On the bright side, this may lead to mandatory helmets at bunny slopes and... helos for Quebec... and hopefully more patient advocacy.

Now where exactly did I leave my tinfoil and thank you god... that my first reports of VIP proved to be false... long story, but VIP medicine sucks for all concerned, mostly due to the Monday Morning quarebacks... and of course the one VIP I took care off... was a pain too.

[merh]

252. it is you and all those who commented on the condition without

examining her and/or speaking to anyone outside the hotel (to include the ambulance dispatch who's time line varies from the hotel's) that are the arm chair quarterback.

I've not diagnosed her as you and those you link to have, I've said that the ski patrol should have taken her to the ambulance that was waiting on her. They screwed up when they didn't, they screwed up because that ambulance crew should have been told by the patient she didn't want care or transport and that crew should have had the chance to evaluate her and to try to convince her to get care.

[nadinbrzezinski]

253. She said no, from what we know

she was alert and oriented times four, from the stories... that is the implication

No matter how you try to spin it, she is an adult... she has a right to refuse care... now if she was a child, a minor, rules change

So do you by the way.. so my advise, if you ring your nogging, go get it checked out (not betting you will... but hey, that is the lesson here for most folks)

And until the law is changed where EMS HAS TO TRANSPORT every patient who falls down and hits head no matter what... or how alert they are... the crew could not transport... an alert patient who could play the game of twenty questions. If she could not (second call) or was symptomatic (second call) then we move into the territory of implied consent, read on that, understand it.

Ok....

Time line my ass... she said no....

Now if you care to go play lawyer, I will repeat this... the Canadian system, like most around the world, is far less litigious than the US... this will last all of ten minutes... I am willing to bet

By the way, I am not going to blame anybody here, starting with her, and ending with the resort. It is a tragedy, but one that does happen, more often than folks like you want to even try to understand

Once more... you have the absolute right to tell EMS to buzz off ... to the eternal frustration of many a trained medic around the world. Do you want that right to go away?

[merh]

264. What you accept as the truth, "what you know" is the hotel's version

They say she said no, she didn't tell the ambulance crew "no", they were just told to return via a call from dispatch. They never spoke to her, never saw her in person - they saw her at a distance as the ski patrol brought her down, then on to the clinic.

We know that her spill wasn't a simple spill, folks fall all the time on the slopes and the ski patrol doesn't make them stop skiing and doesn't toboggan them down (no matter how routine the hotel tries to make this out to be). If every skier that fell on the slopes, whether they be on the beginner, intermediate or expert runs, were made to stop skiing and were tobogganed down by ski patrol, ski patrol would be very busy and there would be hardly anyone on the slopes but ski patrol.

You only know what the hotel says, that she refused care. The fist ambulance crew never spoke to her so they will not be able to confirm the "refuse care" version.

Allegedly she refused care later on in the day and despite that alleged refusal, the ambulance came and took her away. So your "refused care" argument is weak and rather useless.

As is your position about the litigious system of Canada and the alleged waiver. Canada affords lawsuits and the waiver is not a absolute deterrent to a lawsuit. Canadian legal precedence has often held that a waiver may not prevent lawsuits but it can add a defence to allegations of breach of duty.

We only know that it is "procedure" for a waiver to be signed if care if refused, we don't know if she signed it - you have simply assumed she did because the first ambulance was called back. Number two, lawsuits still happen in Canada (even though I never said one would occur, I simply pointed out the failings of the ski patrol and your silly assumptions based on very little facts and 1/2 truths as told by someone with a bias or as repeated by a press that had her dead before the fact.

And the time line issue is pretty important, the hotel's time line does not coincide with the ambulance services' time line. Who has something to protect, the hotel or the ambulance carrier?

I've never said that folks didn't have an absolute duty to tell EMS to go away. She never told the first crew to go away. With head injuries, even if I tell them to "go away" they can overrule that and take me if they perceive that my physical health makes me incompetent at the time to make such a decision.

[nadinbrzezinski]

269. I tell you right now this will end nowhere near a court

no matter how many times you try to blame the resort

And yes, you have a right to say no

And there is more, yes people die for saying no

Most of them are not even known... the only reason why you know about this well this tragedy, one of many, happened to a VIP

learn the lessons,

These are

Patient advocacy plays a role

if you get hit in the head, by all means see a doctor

Those are the lessons

You may feel fine... but there may be a bleed underneath

That is the lesson.

Now please continue spinning and trying to find a conspiracy where there is none


:banghead: :banghead: :banghead: :banghead: :banghead:

Oh and I forgot

:tinfoil:

[merh]

274. No one is trying to find a conspiracy or wearing any tinfoil

I am disputing your absolutes because you don't know all the facts, you only know what the hotel has said to be the facts. Those "facts" are lacking - it is not protocol for the ski patrol to take everyone that falls on the slopes down via toboggan. You know that. To ignore that simple truth is to put forth a very weak argument. To believe the "doctored" truths and to ridicule others who question the incident does nothing more than make you out to be a closed minded fool. You'd rather ridicule and snark than discuss the matter. Lord help anyone that disagrees with you.

I never said the matter would end up in court. I have simply disputed the absolutes you and others try to push, the waiver would not be a bar to the litigation. A person with a head injury can be overruled when it comes to medical care. The ski patrol did not do enough. The hotel had inadequate care, a clinic with no medical staff.

[nadinbrzezinski]

275. I don't know their protocols for bringing somebody down who hit their

head, do you?

As to closed minded fool, all I can say is that people are trying to make hash where none exists

And she said NO

That is the simple truth

She is an adult and can say buzz off to the EMS crew

I know this is the part that people are trying to make hash off, and find the resort in the wrong

This will end nowhere near a court

And shockingly NO RESORT I know off has that kind of care, nor will they ever get it... mostly due to the cost and how INFREQUENT these kinds of accidents are

Clear enough?

As to the clinic with no medical staff, many a resorts in NA are staffed by the sky patrol

So don't go to them. I guess that's the other lesson

[merh]

277. You don't know she said "no"

You only know that the hotel claims she said "no" and the hotel has a protected interest in this.

I'm not making hash, I'm pointing out inconsistencies.

No resort can afford to take all skiers down from the slopes via their ski patrol that fall and hit their heads or may have hit their heads (but show no symptoms). It is just not practical. I would bet she lost consciousness for a time, that is how they know she hit her head in the fall.

And all I am doing is discussing matters, I am not insulting hordes of folks the way you are and I am not professing a greater knowledge of the facts than what I have or than what has been made public. It is you that is taking all this so personal and insulting everyone who doesn't bow to your "knowledge". That is truly sad, these are just words on a screen, take a break, chill out - go relax.

[nadinbrzezinski]

278. And you don't know she said yes.. you assume such

every news story implies she said no

Why would the sky patrol prevent EMS from seeing her? At that point you are entering a criminal case, manslaugher comes to mind

So tell me, why would the sky patrol, who called EMS, prevent her from seeing them?

And I am not insulting anybody, just using ten years of EMS and knowing how the system works

Sky patrol are first responders

Now if trying to educate people on how this works is insulting people... then guilty as charge... I guess I have insulted you and everybody else who is trying to find something wrong in what looks like pretty Standard Operating Procedure

Granted, SOPs change when blood spills, but if you find educating you on SOPs insulting, as I said, guilty as charge, and there is more PROUD OF IT

[merh]

285. The hotel has said she said no

the ambulance service said that its people were ignored, not allowed to talk to her, they don't know if she said no.

You haven't educated me on shit, you have proven that you don't know all you claim to know. The duty of care for you is limited.

[nadinbrzezinski]

296. That is why I went into a shoot out to rescue a cop

trust me lead mosquitoes are lead mosquitoes.. and will kill you if they hit you

The hotel, every news story implies she told FIRST RESPONDERS no

Get educated... she had a right to say no

YOU have a right to say no

I have the right to say no

UNTIL we are no longer lucid

Get it?

Until that moment (second ambulance in this case) you have the right to consent, when second rig showed up, they acted on implied consent, even if she said no at that point, they had the right to care for her

[merh]

301. Stop with the GET EDUCATED CRAP

I don't care what you did that involved bullets, that has nothing to do with this discussion and it is pretty pathetic for you to try to use that to prove anything.

You couldn't educate a soul, you are too angry, too certain - if you are an instructor I feel for your students - they are missing the only certainty in any situation -- that is all situations are different and you have to treat each one uniquely, based upon its own facts and the circumstances in that moment.

Funny thing is, you keep going back to news reports that are incomplete or have been proven to have distorted time lines, keep it up, all your screaming and bragging will prove that you can scream and brag, nothing else.

She never said "no" to anyone other than a rep of the hotel, she never told the ambulance staff who were first on the scene as they came down from the hill "no". The protocol for her fall was more extreme than the "just a fall" and you know it.

Keep getting all angry and mad, make this a flame war, show how easy it is to set you off. Doesn't harm me in the least and it doesn't change the facts you continue to ignore.

[nadinbrzezinski]

303. Did you or didn't you say I didn't care for patients?

you did

And you do need to get educated

Sorry

You have NO FUCKING CLUE WHAT YOU ARE TALKING ABOUT and are assuming much, such as the ability of medics to assault, yes that's the correct term, a patient by forcing themselves on them. Or illegally detain them, if they transport against their wishes and they are lucid

Tell me once again, since the resort called EMS? what did they have to gain by telling the medics to buzz off?

Either she refused (this is the case) and was alert and oriented and has a LEGAL RIGHT TO SAY NO

Or there's something that needs the cops to investigate a criminal complaint

GET IT NOW?

So what is the motive for them, who called EMS, to turn them away?

Give me a motive?

One that chiefly makes sense.

Otherwise, you are trying to make points where none exist.

ti was a tragedy... this shit happens all over the world

There is more. I am sure you'd sue for an ingrown nail... so happy I am not doing any medical care no more... people like you scare me

[merh]

309. The only motive I question is your motive

I don't get why this has you all upset and angry - has you insulting folks left and right.

If the thread bugs you, ignore it. You won't change my mind, I know that there are facts that have not been made known and I know that the ski patrol should have gone the extra step to take her to the ambulance so that others could evaluate her and so she could tell them "no" if that is what she wanted.

Or, if you don't want to ignore the thread, just keep screaming and spewing, it makes you so much fun to post with.

[nadinbrzezinski]

315. What is my motive?

Please doctor freud, do enlighten me

[merh]

321. I have no idea what your motive is, that is why I question it.

It is you that profess to know it all.

[nadinbrzezinski]

325. Well ten years doing EMS and

doing rescue actually gives me somewhat of an idea of how this works for ahem, real...

As well as teaching EMS personnel and being on the ground floor of creating a whole EMS system

But know it all... as I told a person in college, I read (or in this case, did the actual job)

I guess guilty as charged.

By the way, don't expect to change your misinformed opinion, but perhaps somebody will read the thread, read about talk and die syndrome, ring their noggin, and go to the hospital and get the care they need... and perhaps avoid all kinds of nasties

Of course, I, or you, will never know... but it is conceivable...

That is the role of some of these threads

Called education

And what these tragedies bring, education

[merh]

327. but you weren't there

and you don't know all the facts

and you have failed to allow your curiosity to lead to ask questions

you and I both know the ski patrol wouldn't have been there unless she were knocked out in the fall

folks fall all the time on the slopes, this was more than just a fall

All the experience in the world does no good if your mind is closed, your's isn't only closed, it is rusted shut.

[nadinbrzezinski]

328. Yeah I had some questions, and sorry to point this out

but EVERY news story that has emerged so far followed EMS protocols to the letter regarding consent... which were some of my questions early on.

What questioned do you want me to ask?

Because the road you are taking leads straight into a criminal complaint

The sky patrol prevented an injured patient from being seen by EMS.. that is what some of you are alleging

That my dear is at the very least obstruction

Why would the sky patrol put themselves in that legal hazard?

by the way, you can go from obstruction easily into manslaughter, as I pointed to another poster... no when it comes to that, laws are not that different.

And that is where the tin foil comes in... once again, why would they do that? I want a reason that makes sense... not just the time lines don't match and they are covering their ass... (free hint, every time you have a VIP things get ahem interesting.. I know... had the joy of having to deal with that, another hat I wore, public information officer) But time lines at times were not the same even when I dispatched my ambulance and the cops dispatched their patrol car... true, it happens

And you are right, I wasn't there. I wasn't there at many calls where we did clinical case reviews.. and all we had to go by where the EMS run reports... some more complete than others... which also lead to many a work ups with crews about the need to have complete records

Again, I will point to experience...

[merh]

330. Your experience means shit when you don't know the facts.

The news reports are one sided, have been the hotel's version and the ambulance company had to clarify the bad information that the hotel gave. The hotel has down played the accident, trying to make it a simple fall when anyone with a wee bit of sense and true experience on the ski slopes knows, the ski patrol doesn't come to the bunny slopes and make the skier stop skiing and then escorts them down the slopes in a toboggan if the fall was minor. The ski patrol thought their call and experience were enought, if they couldn't convince her no one could, they didn't think the EMS could do any better. They let their experience get in the way of his reason and burden of care for the patient. Cops are first responders, some have medical backgrounds, were paramedics and medics, they know that if they cannot convince the "injured" to go to the hospital chances are, the ambulance staff can - it's worth a shot if the person needs care and the ski patrol did believe she needed to be seen by a doctor (that is part of the news reports you rely on) - the ski patrol was so worried about her health they didn't leave her.

It wouldn't have been that hard at all. Since the ambulance was on the scene, ski patrol looks at skier and says "they need you to tell them you won't go to the hospital and they need to make sure you are okay, so they will ask you some questions". Since the ski patrol didn't do that, he screwed up.

What the facts tell me is that the ski patrol should have done what they could legally do, override her choice and state that they didn't believe she was capable of making the decision because of her injury, then they should have put her on the ambulance.

Like I said, you would be so easy to take on the stand, you get far too emotional and think that you have all the answers, you ignore the facts and/or your lack of facts and you get upset if someone dares to challenge you.

[nadinbrzezinski]

331. The ambulance is on the scene, ski patrol looks at skier and says "they need you to tell them you wo

Patient said no and she was lucid, they could not force her to do that... which has been the point

You also have the same right by the by... and so do I

As to news stories one sided... ok...

Perhaps I have more respect for the Canadian media than you do

Even if I know that sometimes happens (lord knows I had the Press scrub a story of VIP hurt, not that it matters who, since he WASN"T hurt) They were going to go LIVE with it, suffice it to say it would have been breaking news all over US News Channels...

Ah we lucky few who share that story and the few chuckles over it


So far, I have no reason to believe any of those news stories is wrong

When we have them, I will revise my opinion accordingly. But so far, I have no reason to do such

For you, it is the media purely... no way I can explain this, nor hope to get a rational explanation as to why the sky patrol would willingly engage in obstruction. Yes, it is that simple... why did they engage in obstruction?

[merh]

342. and the ski patrol tells her, well you need to let them know and

sign the form that says you don't want to be transported.

Like I said, the ski patrol was so concerned for her well being that they transported via toboggan and didn't leave her side. They could have said that her injuries made her incapable of making a reasoned decision and they could have put her on the ambulance. They have that right, they had that duty. Ski patrol is the cops, EMS is the medical providers on the scene. Ski patrol doesn't take her to the hospital on the toboggan, they don't hook her up to IVs or call the hospital for directions on what to do, the way the second ambulance crew did.

Keep showing your ignorance. Keep defending when you don't know all the facts.

It was not obstruction, it was inept care - there is a difference. The obstruction comes from the hotel that continually released half truths and inadequate info. They have a reputation and hotel to protect.

I've relied on more of the facts than you have, you have only relied on half facts and I find it laughable that you try to ridicule me for relying on the news media. That is all you have done.

[nadinbrzezinski]

352. Talk and die syndrome

why they did that

Sorry... I guess it is time to call this over


And I think you are wrong, and you think I'm wrong

Have a good day, or life, or whatever

(and yes, I will wear the know it all monicker proudly)

[merh]

354. What did her pupil's reflect?

Do you know to look at the pupils, to test the extremities for their strength or ability to maintain a grasp - what neurological symptoms to be on the look out for?

It is only being explained away as "talk and die" because that is what happened to her. Epidural hematomas, the type she died from can be treated, the clot removed, a bore hole placed in the skull so the swelling brain can escape and not be too severely damaged. They can detect it, before she gets too bad off, by checking the pupils, performing neurological tests, monitoring the blood pressure. The symptoms are there, if you know what to look for, if you are trained beyond basic CPR/life saving tactics and how to strap someone into a toboggan and bring them down slope. EMS would perform such tests and would be on the phone to the hospital to relay the results to a trained medical doctor (which is what they did on the second trip).

Ski patrol should have taken her to the ambulance and allowed them the chance to talk to her. If she wanted to say "no" ski patrol should have let her say "no" to EMS on the scene and they would have had her sign that AMA. She never signed one because no medical professional saw her.

Wear your monicker all you want, it doesn't matter to me.

[nadinbrzezinski]

355. You do not know what assessment first responders did

unlike you, I have far more respect for them

Free clue

Talk and die, in early stages patients have no delayed pupil response, that is later, when pressure builds

They have no neuro effects in grasps, that is later, when pressure builds

And yes I will wear it proudly

After all you gave it to me

:-)

And you should know one when you meet one

:hi:

[merh]

356. Cops are first responders, firemen are first responders

they may have first aid training but they are not trained EMS or paramedics. You don't know what to look for in the injured person's eyes and you know it all, that tells me the ski patrol had no idea what to look for either.

I have respect for first responders such as the ski patrol but their training is limited. The EMS has more training and they know enough to get in touch with the hospital, to talk to a physician.

Your ego aside, you know there is much more to this tragedy than what has been reported and you know that she did not get timely care due to the failings of those around her, those that did not suffer a head injury.

:hi:

[nadinbrzezinski]

357. I also know that I cannot touch a patient legally

when they are lucid

:-)

As to my ego... we are now entering the ground of personal attacks

Again, you should know a large ego when you see one

:hi:

[merh]

358. It is pure ego that compels you to defend this.

As if those of us that say the ski patrol and the hotel screwed up are attacking you personally. Of course, nothing could be further from the truth, you have just taken this on as your personal crusade. It is you that has been insulting and personally attacking others, your latest being the attack on the OP.

You say she was lucid, you don't know, you weren't there you are only going by what the hotel reported (mind you the ski patrol has not publicly stated what her condition was, the hotel has spoken for them).

Her fall was more than just a simple fall on the bunny slope. If it had been such a simple fall, the ski instructor would not have called the ski patrol. Chances are she was knocked out and that is why they were called. That is why they tobogganed her down and why the ski patrol and the ski instructor stayed with her.

She was refusing treatment when the ambulance was called the second time, EMS and the hotel ignored that and she was transported to a hospital.

Continue making it personal, it doesn't matter to me.

[nadinbrzezinski]

360. Nah it is you making it personal

and my agenda is to educate people on how EMS works, and hopefully for folks to get the obvious two lessons out of this

When involved in any dangerous sport, not only skiing, wear a helmet

if you ring your noggin hard enough and you feel fine... still get checked out... just in case you do have this syndrome... caught early enough it is very treatable, and prepare to be your own damn advocate... see that lack of initial signs and symptoms... that may be a problem in a busy ER

And if you happen to have the money or public health system (canada) to do that, there is absolutely no excuse for you to refuse to go checked out, call 9.11 or however you get to the ER.

That is my agenda

Yours seems to be... well they prevented the care, in other words they interfered in the treatment chain

My dear that is a criminal complaint

:-)

And there is nothing here that seems to indicate this... but you think there is.

So the conspiracy continues... and I love conspiracy theories, by the way... taken notes on yours... useful in a novel or two... hmmm how exactly did that character die? They prevented EMS from treating, for whatever nefarious reason...

By the way at this point, this is just fun, to see how you imagine what does not exist.

[merh]

361. It is not a criminal complaint

Your extremes and absolutes prove nothing more than your judgment and reason is off kilter.

I have not shouted "GO EDUCATE YOURSELF" and called people pretenders or mocked them as you have, that is making it personal and you have taken this whole thing personally.

Folks don't need you to educate them, most on DU are quite smart and they get it. She should have sought care. Folks should wear helmets, most won't they are ugly and uncomfortable. Not much you can do to make them change their minds.

Hell, it is not even pupil response that one would look for in the eyes. Why don't you go read up on epidural hematomas. Maybe you will be the one educated as a result of this thread.

[nadinbrzezinski]

362. sorry but interfering with EMS is a felony

here is a story that may illuminate this for you, even if the doctor was found not guilty

http://publicsafety.com/article/article.jsp?id=4495&siteSection=3

I know I could find more of this... but it is late

http://www.emsnetwork.org/artman/publish/article_24407.shtml

Here you go with one more

Interfering can rise to the level of felony

Sorry...

Now next imagined crime here

And I have not taken this personally

Doctor freud...

Now to obvious lessons, wear your helmets, go to the hospital when hit on noggin

And no, most folks here are not educated on a lot of issues, including how their local EMS works, or patient rights

[DaLittle Kitty]

366. EXACTLY... WELL SAID!

:think: :)

[Gwendolyn]

249. Thou are correct!

To begin with, Canada isn't remotely the kind of litigious country that the US is.

Further, no helmet law for all will be instituted and Quebec will not be purchasing any helicopters anytime soon. People will continue to refuse treatment, as is their right. The resort will continue to operate as it always has.

In other words, this is a DU discussion and nothing more. The world turns as it did yesterday and will tomorrow.

[nadinbrzezinski]

251. They MAY bet the chopper. The head of the McGill system

is pushing for it now... (they have for about six months) so he will use it as an example (played the funding game myself... so I know how it's played)

As to the bunny slopes, since some resorts in Colorado are starting to mandate them... that's why I suspect you may see them

As to lawsuit...

I remember a family trying that shit with the Mexican courts... the judge not only threw them out of the court, but gave them a bill, for essentially wasting his time

It was a thing of beauty to behold

And I wish our courts started doing that too.

And patients refusing service... every day of the week and twice on sunday... what some people cannot comprehend

[Gwendolyn]

254. Maybe, but it'll be years off and the govt has already said "sorry."

There are so many other issues, such as lack of beds, and life-saving equipment shortages, it would be seen as a "like to have" not a "need to have." It probably doesn't seem practical, since these unfortunate accidents are relatively few and far between, whereas the other issues affect so many.

The kiddies already wear helmets when taking lessons, and that protocol might move to adult lessons as well, but just don't see adult Quebecers, who LOVE their winter sports, going for that kind of law for all. I'll come back here and eat my tuque while posting on DU if I'm wrong. :)

[nadinbrzezinski]

255. The only reason you need the helo is

to transport not only VIPs who fall on the slopes, but trauma pt across the province... and I don't expect them to fly in the winter time, truly, god awful weather you got

I know about the equipment and all that crap as well... let me see, should we get ten suction machines or one heart monitor? Hmmm... or the ... we need a CT scanner, how much are they? Damn... but we need one... hmmm

And the helmets, I see them for the bunny slopes, for them lessons for everybody... after that... well like bike helmets in cali

Kiddies need to wear them... adults, on a purely volunteer basis

I wear mine... but then again, wearing my helmet in an ambulance religiously saved my nogging twice... I killed two helmets in the process

:-)

I still have one... nice and soft where my side of the head would have been hit, and most likely fractured...

[Gwendolyn]

260. Y'ouch! Glad nothing happened to you!

But also goes to show you can bump the head anywhere, any time. I guess an ambulance would be one of the more preferred places though, if you have to take a head lump. :)

The helo thing would be great of course. Maybe it'll happen down the road. There is already an air ambulance service that carts people back and forth from the frozen boonies to civilization, but they need some kind of landing strip, so it's usually from frost land to airport and then ambulance the rest of the way. I guess if you think of Quebec, it's probably more sparsely populated than many areas of the US, with most of the population in a handful of cities. And that's the one teeny downside to Universal healthcare. You really do have to budget for the greater good.

[nadinbrzezinski]

261. Yeah private service, was readying about it, subscriber

One way to get around the cost, and I am sure planners might be looking at it, is a dual mission chopper

Primary use, police, the RCMP... secondary, your RCMP officers are air medics

How one US state got around that one... most of the time they are cops...

For the record, the only time I took a patient to hospital using chopper, we pressed a police chopper into service.

[pnwmom]

208. Waivers are overcome legally every day. Since she received no medical advice

she couldn't have signed an "against medical advice" form. It remains to be seen what kind of waiver or release she did sign.

The government health minister refused to answer questions on this case last week, stating that he wouldn't do so because of the possibility of there being a lawsuit. So he view it as a possibility for some reason.

[TorchTheWitch]

238. I didn't say anything like that

A liability waiver isn't the same thing and you said so many times yourself. The timing of the waiver and the circumstances of her not telling the medics to go away her own self says that she refused to do that, thus the existance of the waiver. Since someone at the resort was going to have to tell the medics she wouldn't talk to them or see them or allow any medical intervention and they couldn't force her to, the waiver was to absolve the resort of the responsibility for turning the medics away. Their hands were legally tied in that they could not force her to tell the medics herself to go away, and everything the resort did shows that they wanted her to receive medical care.

In any tragedy it is wise to assume there may be the possibility of a lawsuit and to keep their mouth shut for that reason. Seeing as this tragedy involved a celebrity there may be more than an average possibility of a lawsuit and a very public one. It isn't for any of us to decide whether or not a lawsuit is warranted or whether one will occur. It would hardly surprise me if one did whether or not it is warranted. I would encourage the family to look into the entire matter and decide for themselves whether or not they want to pursue a case as they are the ones who have to live with her loss and such an examination of what happened will probably go a long way in helping to ease their pain. If they do so and decide that a lawsuit is warranted, fine. If they do so and find that a lawsuit is not warranted, fine.

I have no personal agenda in this matter, and neither do any of us. That's why I can speculate without passing judgment on anyone where I clearly have no legitimate right to do so as all I know about any of this tragedy is the same as what any of us do. For some reason some people feel the need to pass judgment on a matter they can't know enough about and more than likely have been doing so because of some personal reason having nothing to do with the case. That's been about as evident as it can possibly be.

[pnwmom]

259. You're overlooking a third possibility.

They didn't have to speak to the medics for her OR "force" her to speak to them.

All they had to do was nothing -- that is, not contact the medics' dispatcher after the medics arrived, and not tell the dispatcher they weren't needed. They should have allowed the medics to continue on the way to see her, and let her deal with them when they arrived, as the lucid, uninjured person she imagined herself to be.

Instead, they chose to intervene, to act as her spokespeople. That was the mistake.

[TorchTheWitch]

308. Do NOTHING???

ARe you serious???? There was obviously a REASON why they didn't take her directly to the ambulance and why they ended up having to tell the medics to go back. The ONLY reason that would be is if she SAID she would not speak to those medics. SOMEBODY had to tell the medics what was going on! They can't be expected to sit there twiddling their thumbs for ages regardless of her being a celebrity. OBVIOUSLY at some point they had to be told something so they can get back to the business of helping people who want it. Ambulance service is for emergency care and they can't be expected to hang around and wait while the person they were called to assist had already expressed she didn't WANT the assistance.

Get his straight... once a person with no symptoms that warrant overriding their choice to not seek medical intervention says they will not speak to the ambulance personnel that someone called for them and they didn't want they cannot be made to speak to them... that consitutes harrassment and depending on circumstances even assault. You have been informed of this time and time again. Yet you have continually fallen all over yourself claiming she wasn't "allowed" to speak to the medics when you had ZERO basis for such a claim and infinite basis where such an assumption much less a claim completely defies all logic given what is known about the case.

I myself once refused to even speak to EMT's from an ambulance service I didn't want and not ONE FUCKING THING could have been done about it. I knew that at the time and that's exactly why I did it. I was begged and pleaded to change my mind and finally there was nothing left to do but for the person who insisted on calling the ambulance I didn't want to tell them to go away. In my case no injury was involved and I knew no medical service was necessary. Whether a celebrity or not no ambulance service can or should stick around twiddling their thumbs while someone tries to convince the person they should be seen. At SOME point, they have to leave. They have important work to do and can't be farting around waiting forever for something to happen.

[TorchTheWitch]

216. The only thing that family could do

is convince medics that she was not herself thereby giving a reason (though a very slight one) for medics to intervene. Even that can be a legal slippery slope. Of course, one would have to believe that such family members would have encouraged her to seek medical attention to begin with. Often times family members will just take the word of their loved one and back them up in their refusal of care. Sometimes family members can even actively encourage refusal of care when the injured party may have waivered had those family members not intervened. One never knows if family members will be helpful, harmful or neutral. No telling what family or friends may have done in this case.

[nadinbrzezinski]

256. Knives' edge to be specific

I transported a patient who fought me all the way to the ER on those grounds

He's acting weird.

Later we were told by the lawyer, if there was no bleed (there was), the lawsuit would have been fun, and also charges for false detainment... quite possibly jail time

[DaLittle Kitty]

336. EMT's Can Bolt At The First Sign Of Refusal Or They Can Be More Assertive...Or Not!

[DaLittle Kitty]

193. No Such Thing As A Level 3 Trauma Center... Unbelievable the MIS-Info Spewed Here!

:puke:

[uppityperson]

211. BS.There are even level 4 ones, speaking of MIS-info being spewed...

www.aans.org/bulletin/pdfs/win04_trauma_center_designation.pdf

This is the html version of the file http://www.aans.org/bulletin/pdfs/win04_trauma_center_designation.pdf.

College of Surgeons Committee on Trauma to verify that it
meets the criteria for a level 1, level 2, level 3, or level 4
trauma center. “Essential” and “desirable” criteria for each
of the four levels of verification are delineated in Resources
for Optimal Care of the Injured Patient, published by the
ACS. A listing of verified trauma centers is available at
www.facs.org/trauma/verified.html; a brief summary of
criteria for each level follows.
LEVEL 1
At the apex of emergency care is the level 1 trauma center, a
comprehensive regional resource that can provide total care
for every aspect of injury. Key elements include 24-hour in-
house coverage by general surgeons and prompt availability
specialists, including neurosurgeons.
LEVEL 2
The level 2 trauma center can initiate definitive care for all
injured patients. Key elements include 24-hour immediate
coverage by general surgeons and coverage by specialists,
including neurosurgeons.
LEVEL 3
The level 3 trauma center has demonstrated an ability to pro-
vide prompt assessment, resuscitation, stabilization of injured
patients, and emergency operations. Key elements include 24-
hour immediate coverage by emergency medicine physicians,
the prompt availability of general surgeons and anesthesiolo-
gists, and transfer agreements with level 1 and level 2 trauma
centers for patients who require more comprehensive care.
LEVEL 4
The level 4 trauma center has demonstrated an ability to
provide advanced trauma life support prior to transfer of
patients to a trauma center that can provide more
comprehensive care.
Data Source: 2004 AANS/CNS Neurosurgical Emergency and Trauma Services Survey
Trauma Center Levels

Here are a couple Level 3 ones.
http://www.shakopeenews.com/news/general_news/st_francis_named_level_3_trauma_center-6296
http://www.highbeam.com/doc/1G1-164300581.html

[DaLittle Kitty]

333. What You Are Talking About Is Average Hospital That Is An LZ Fot The Helo To Level One

This Is little more than clinic at the 3 and 4 level... No one who works in the business speaks of these hospitals in context of lower level Trauma Centers because they are not in reality. The reality is the patients that have a chance get the helo ride from the scene or a nearby LZ and the ones deemed unlikely to survive go to what you characterize and the academics as the Level 3-4 Trauma Centers.

These are eval and potential p/u points for transport to the Level 1 and 2 BTW Can you UPPITY define the difference between a Level 1 and Level 2 Trauma Center? You still have not defined the acronyms of ATLS and ACLS for the group... Please do so...

[uppityperson]

365. "No such thing as a Level 3 trauma center". Links show you wrong.

The links I posted show that statement was wrong. You post misinformation while claiming it is correct information. Then, when pointed out, you attack and try to expand out to some sort of other stuff, distraction rather than saying "I was wrong, there are Level 3 trauma centers".

Because thhere is such a thing as a Level 3 trauma center.

[nadinbrzezinski]

232. Please review the link provided listing trauma centers

you only have to go down to Delaware to find the first listed as a Level III

http://www.facs.org/trauma/verified.html

Oh hells bells, here you go

Bayhealth Medical Center - Kent General Hospital Dover Level III 11/28/09

[DaLittle Kitty]

338. Nobody talks About Such Trivial Nomenclature Here... Nobody is Flown To Level 3or 4!

1 or 2 that's it ... If pt is very bad and unlikely to survive they are ground transport to local hospital from triage on scene... discussion of Levels other than 1 or 2 where I live... and this is the Blunt Trauma #1 in the U.S.!

[nadinbrzezinski]

364. Please review the definitions of Levels by the American College of Surgeons

You are wrong, this L-1 to L-IV is common amongst medical personnel who DO WORK or have worked in the Prehospital field, as well as Emergency \ Trauma care

For the record, finding out that due to lack of state funding my L-III centers have been downgraded to L-I is all but warm and fuzzy

You have your knowledge, and you are trying to do something here that I find wrong, and quite despicable

You are playing monday morning quareback, never mind that this talk and die is a real syndrome, and instead of bitching over the imagined failings of first responders, you should have stuck to the very obvious lessons

If you are involved in ANY dangerous sport, this includes biking, skiing, mountaineering, as well as ice skating and a few others, WEAR a helmet, may save your life... and this goes without saying if you are involved in some work fields that are also dangerous, such as construction and yes, believe it or not EMS... I am damn glad I wore mine religiously... twice those helmets saved my noggin... I still have one where I was hit on the right parietal area... and no helmet, would have meant a fracture, possibly death. Instead, I got a sourvernir

The second, if you get hit in the noggin hard enough, SEEK medical care, EVEN if you feel fine

Early on you may even have to be your own damn advocate, especially at a busy ER...


By the way... fer the damn record, you and others have accused the sky patrol of interfering with EMS... that my "friend" is a criminal complaint

So if there is evidence of this... given this is a VIP and an investigation is underway, pro-forma... then some people may find themselves on the way to jail

When that happens I will revise my views on this... not a second before

You should also have educated people on the talk and death syndrome, and chiefly not deny that it happens, because most likely this is the actual source of the whole problem... and read this again, it happens...

And yes, you have NEVER worked in the field, and have no idea how many times medics beg patients to go to the hospital, hell I even involved medical control a couple times... when the patient says no and they are lucid, it means no... clear enough?

Once they exhibit symptoms then we enter the realm of... IMPLIED and the rules change as to what you can do with a patient... you KNOW this, assuming you are in the medical field, and all this is a faux outrage... and I have to wonder what is your agenda?

[DaLittle Kitty]

367. Yes EMT I HAve Not Worked "In The Field" My Prep Is A Few DEGREES Beyond That!

What I have more than accurately described is working on the RECEIVING END of the people like yourself bringing the patients... in from the field.

I understand your points but you do NOT understand the points made by others that include quite generally... EMT's NOT just blindly following orders from non-medical people such as hotel staff, demonstrating a little professional awareness of your professional status when called to a scene by actually making certain that YOU as the "professional" KNOWING ALL THAT YOU KNOW, demand to see the patient and let him/her tell you that he/she does not want your services rather than taking the word of an intermediary... in the case of a HEAD INJURY.

Treating celebrities and non-celebrities EXACTLY the same way when it comes to assessment/questioning... In the course of such interview you would have the opportunity to educate the patient as to ALL possible risks... then fully informed the patient if totally a and o x 4 by YOUR assessment still refuses, then you have a case for departure.

Until that point, hotel personnel statements are heresy. Also and perhaps most important as 90% of a diagnosis is THE HISTORY... Taking the initiative to interview the witnesses i.e., in this case the ski instructor who was w/ the pt at the time of her "fall." Especially if the hotel people are shielding the patient from YOUR discerning eye! Not wanting bad publicity perhaps or overly protective of the movie star?

Notwithstanding interviewing the college girl w/ her... Somebody cared about her well being... Neither of us were there. True but neither was the ER Doc on Larry King and the Neuro Surgeon whose sentiments perfectly reflected all that I have said... There was a reason for the tobaggan run and you, many people here, the ER doc on Larry King as well as myself recognize that.

Perhaps you still do not...

No one respects EMS more than I do but I also recognize as you must as well that the job of EMS is to stabilize on scene and transport to facilities w/ the proper resources given the nature of the patients injury where outcomes can be optimized.

If the pt was witnessed +LOC then that patient IS a TRAUMA alert. Hell I had a stockboy in a grocery store fall off a 3 step ladder doink his head +LOC had the store call EMS and walla the kid got a chopper ride... He later thanked me for my intervention when a store full of 200 yuppies on a Saturday afternoon all ran the other way while I kept his cervical alignment and yelled for someone to call EMS!

So if a even remotely similar report was delineated from the ski instructor witness and questions as to behavior, confusion or other s/s elucidated from the witness then the patient is boarded... Goes back to the MVA stuff patients get boarded all the time they go to the ER are evaluated and go home... They don't like it either... The collars and boards and atls save lives... Sometimes persuasion is necessary in these instances...

Health professionals MUSt "sell "their services... How about the guy w/ the MI that "feels fine" after he's had some Nitro and mso4 and is not interested in going to the cath lab? Requires some selling... TEACHING... ASSERTIVENESS! Giving a shit cause you know the guy is going to be fuc*ed! Yep legally those EMS 'ers could ... walk away but the BEST ones will find a way not to!

Remember the walking wounded w/ the cervical spine injuries who transect their spinal cord w/ occult cervical fracture... Pretty much the same principle in play as the talk and death... Conservative protocols are there for a reason... If I was EMS I would have been just a little more ambitious in my pursuit of the truth... Knowing quite a few EMS people some are a little bit more forceful, creative and determined to use their talents to assist the public despite the barriers the public we serve sometimes places before us... than others! I'm done! :)

[DaLittle Kitty]

340. No Such Designation In Florida That Anyone Ordinarily Discusses...

I explained this clearly in other posts!

[nadinbrzezinski]

245. Welcome to DU

:-)

:hi:

[northernlights]

190. another DUer to put on ignore -- yippee!!!!

She didn't land on the back of her head. She hit the left temporal bone, which is on the side of the head, and directly over the superficial temporal artery. That is what caused the artery to spring a leak.

SHE is the person who "BLOCKED" the EMTs from seeing her.

There is no way of knowing whether going directly to a trauma 1 center would have saved her life, or left her alive and severely disabled, or left her in good shape. Any of those 3 outcomes were possible. The sad fact is that dying may have been a more merciful ending.

She had brain activity going into surgery. After the clot was successfully removed, the artery spontaneously tore further, causing a bleedout and massive stroke. That is when her brain died.


A few lessons to take away are:

1. try to enjoy every day because it really may be your last.

2. when you participate in an activity that requires signing a waiver in which you acknowledge you could be seriously harmed or die and release others from liability, take the thing seriously.

3. when you're an absolute beginner at a sport requiring such a waiver, wear a freakin' helmet unless you are prepared to die.

4. when you have an accident and people around you have called an ambulance and strongly recommend you let the EMTs examine you, follow their advice.

Our lives are incredibly precarious. The systems that keep us alive are unbelievably complex, intricate and breakable. It's amazing anyone is alive.

[DaLittle Kitty]

195. Your Analysis Is Completely Off But Your Lessons Are First Rate!

The reason we try is because lives are saved by prompt and effective intervention. I was party for example in savig a patient w/ a torn aorta from a T Bone accident... Normally a 5% chance of survival I had my hands in the chest of this guy as part of the surgical team and this 42 y/o gentlemen eventually WALKED out of the hospital because smart and capable people WERE assertive and took measures into their own hands... ordering tests to rule out aortic transection instead of sending patient to the floor resulted in a trip to surgery and a successful outcome in what WOULD have been another member of the 95% FATALITY Club!

So for all of the klowns w/o any health care experience or for those unwilling to fight for the patients best interests using every avenue to ensure their wellbeing then I say...

Who would you want to be sent to help you in a circumstance identical to Natasha? :think:

[cali]

198. Let me answer your question:

Anyone but you.

[uppityperson]

210. Way. eom

[TorchTheWitch]

240. I wish I could recommend just his post

It is a thing of beauty. I may have it embroidered on a pillow or wall hanging.

:yourock:

[DaLittle Kitty]

349. And Your Profession IS... Pro Blogger!

Yes knowledge is intimidating in a world of ignorance... Clearly your world is such.... www.cnn.com

[pnwmom]

207. You missed a couple of lessons.

When you're a ski resort manager and the ski patrol has called an ambulance for a head injury but the head injury patient says -- "tell them I don't need them." Your answer should be: "they're here now, so I'll let you tell them yourself." (You're not a legal delegate of that person, so don't act as one.)

If you're planning a trip to a ski resort don't assume there will be good medical care in case of an emergency. Find out how long it would take to get to the nearest trauma center in the even that you need to.

[TorchTheWitch]

244. that can only be done if the person hasn't already refused to do so

And everything points to that being the case. Once the person says I don't want to speak to the medics at all, that person cannot be forced to do so. I did that once myself.

[pnwmom]

262. The hotel employee, if s/he had been smart, wouldn't want to speak to the

medics, either, not if it meant turning the medics away from a possibly head-injured person.

Even if the person says "I don't want to speak to the medics," no one at the resort had any legal obligation to intervene on her behalf. The best response is "you can tell the medics that" or just silence, and stepping aside. If she was lucid and well, she wouldn't need anyone to act on her behalf. She could have told the medics "thanks but no thanks" herself.

[Xithras]

230. A helmet probably wouldn't have saved her.

Helmets help to dissipate sharp and focused impacts that might otherwise shatter a skull (like hitting a tree) but they don't to much to help against rotational injuries. That brain deceleration is going to occur whether the head is encased in a helmet or not.

Ask any ER doctor about this. 20 years ago an unhelmeted motorcycle rider striking his head on a curb would have died at the scene, his brains smeared down the gutter. Today, the odds are good that he'll instead make it to the hospital, where they'll diagnose massive bleeding in the brain and get the rider into surgery. While the sharp impact (head vs. curb) was blunted by the helmet, the secondary impact (brain vs. skull) still happens.

In Richardsons case, the effect would have been the same either way. She'd have still ended up with a bleed in her skull, and the failure to treat it would have still killed her.

Don't get me wrong, helmets are a good idea in general, but they're not a panacea and probably wouldn't have saved her life.

[chatnoir]

239. So she did have surgery?

That's the first I've read anywhere that they did go thru with surgery -- haven't seen it reported in any of the news I've read.

"She had brain activity going into surgery. After the clot was successfully removed, the artery spontaneously tore further, causing a bleedout and massive stroke. That is when her brain died."

[ddeclue]

212. Unfortunately, everyone is entitled to refuse medical assistance

clearly Ms. Richardson did NOT refuse assistance due to an inability to pay - like many people who fall down she thought she was OK. The problem is NOT "socialized" medicine but people's unwillingness to play it safe and get checked out.

The biggest problem is that we need to train a LOT of otherwise ordinary citizens to be citizen first responders in this country and be able to recognize symptoms requiring immediate medical attention so that even if someone thinks they don't need help from strangers, they will be more likely to listen to someone they know who tells them to seek treatment.

Everyone should get Red Cross training in First Aid, and CPR/AED. Just last year I performed CPR on someone who had a massive heart attack in an early steering committee meeting for Congressional candidate whom I supported. Because I was able to immediately begin CPR I was able to buy him the precious minutes he needed for Fire/Rescue EMT's to arrive on scene and begin more advanced life support and stabilization. They got him to the hospital and he survived and was conscious for a few hours a few days later but then suffered a second heart attack in the hospital from which he died.

I've had to do CPR twice in my life and have been on the scene of two auto accidents where I needed to use First Aid training. Every high school student and college student and member of the military and law enforcement should be required to have this training - everyone should have some training.

I'd like to go through the Advanced training that ARC offers (a 53 hour program that costs $300) but I'm either working and unable to go to classes during the weekday or I'm unemployed and can't afford it.

Doug D.
Orlando, FL

[nadinbrzezinski]

220. Of note, every member of the Armed forces, and law enforcement

is trained to do CPR

In some places Police Cars carry AEDs and at times shock patients well before EMS shows up

I wish I could implement this aspect down in TJ, but that was at the time 2000 dollars\car... just in equipment alone

Unlike most folks I have a very special understanding of how EMS works, since I did help build a system from the ground up

[pnwmom]

263. Did you know that she also refused assistance the second time,

and the general manager overruled her -- despite saying that she still appeared lucid -- and called the ambulance again to "come and get her."

The question in my mind is whether, if the trained paramedics had seen her in the first place, they might have been able to detect subtle signs of head injury and persuade her to accept treatment at that point.

[pipi_k]

213. I won't debate the clinical aspects of it, but I will say...

that the whole thing is just full of irony.

Like Dale Earnhardt Sr.

What looks like a fairly innocuous accident ends up killing him.


Yet in races before, and after, we see cars roll over multiple times, burst into flame, and it looks like nobody could survive, let alone walk away without a scratch, but they do.


I've seen footage on TV where a skier has fallen, tumbling over and over down a massive hill, looking for all the world like a rag doll.

A few broken bones, but alive.


There's just no explaining how arbitrary it all seems sometimes....

[nadinbrzezinski]

222. Of note, Dale Earthart refused to wear the donut

after the crash, and his death that became mandatory in races.

I suspect helmets will start to become mandatory, as resorts will require them

[theNotoriousP.I.G.]

247. Ok Hyacinth Bucket

Cause you reminded me of her with your over the top hysteria. This was an accident nobody could have anticipated and once symptoms began it was too late. Should we all walk around in head guards every day and have EMS staff waiting for us to fall into unconsciousness 24/7? Life happens and tragic outcomes occur.

[pnwmom]

265. How do you know that symptoms began too late? Just because the resort employees

didn't see any?

How do you know there weren't any symptoms that would be recognized by a trained medic -- as opposed to a volunteer member of the ski patrol with a $100 course in first aid?

How do you know that if she had been under the care of medics and/or a hospital during that time, that significant signs of a head injury wouldn't have shown up much earlier than 2.5 hours post injury?

All we do know is that the general manager finally overruled Ms. Richardson -- though she was still supposedly lucid -- and called back the ambulance after 2.5 hours. We cannot know what symptoms a trained medic might have encountered if s/he had been allowed to speak to her when the ambulance first arrived, or whether the medics could have persuaded her to accept their help.

But I wish they had been given a chance by the resort employees -- the same resort employees who eventually overruled her -- to try.

[nadinbrzezinski]

266. Once again, my EMT B course was 65 bucks

hell I think they are still about that

Let me see, three unit course... 20 bucks per unit, that is sixty

Oh and according to the state of california that was all the training I needed to staff an ambulance

Happy now?

You are so ignorant of how this works it is not even funny

You're drooling for the lawsuit, aren't you?

[pnwmom]

268. How long ago was that? n/t

[nadinbrzezinski]

271. The 120 hours are still the standard of training for an EMT -B

Here you go, current offering in california

http://emstainc.com/bls/emt_basic.html?gclid=CNqI-pSWupkCFRwDagodknz55g

Now the course I developed for South of the Border for my EMT-B was 150 hours since it included a couple skills you don't get in the EMT B

Oh and the only thing they changed they added ten hours to the labs now, aka how to put on a backboard and get more practice with it

By the by, EMT B do NOT start IVs, and only med they have access to is O2

Let me add virginia, as another reference for you... 121 hours

http://www.vdh.virginia.gov/OEMS/Training/tprog.htm#EMT%20–%20Basic

[theNotoriousP.I.G.]

270. Because she's dead

and if her symptoms had presented themselves in a timely manner and been detected by medical professionals, she wouldn't be. Accidents happen. I don't understand why this has turned into flame war on DU.

[merh]

276. It isn't a flame war

Just because there is a great deal of discussion about it doesn't make this a flame war. Go post about breast feeding and cigarette smoking, then you will learn what a flame war is all about.

BTW - she didn't receive medical care until anywhere from 4 to 6 hours after the accident. Medical staffs were not given the chance to detect symptoms, she was not afforded the care.

[nadinbrzezinski]

279. what part of she said no to that initial medical care from EMS crews

are you still refusing to see?

No matter how many links are shown to you

You will keep repeating this

By the way SKY PATROL are FIRST RESPONDERS

That is a forty hour course... quite standard for FIRST RESPONDERS in the US as well, by DOT standards

They are part of the MEDICAL DELIVERY SYSTEM

Got it now?

[pnwmom]

283. Why can't you see that no one at the hotel was under any legal obligation

to turn the medics away after they arrived? Why won't you acknowledge that they could have simply stepped aside and waited for Ms. Richardson to speak for herself, which supposedly she was fully capable of doing?

[nadinbrzezinski]

287. First responders, she is able to answer the game of 20 questions

she says no to them and she is alert and oriented times four and exhibits no other sighs, in other words she is perfectly lucid

Medics have no right to intervene... that is the way it is

She has a right to say no, so do you and so do I... and most of the time nobody gets hurt either... it is these few cases when people do get hurt, or simply die

Perhaps since I have been in that situation as a member of a healthcare team, I get it

Now if you want to think anything nefarious here, beyond a civil suit, we enter the realm off.. a criminal complaint

Get it now?

And by the way... this is Canada, there will be no lawsuit, but there is an investigation... there is always one when a VIP buys it

[pnwmom]

307. The medics, having been called, had a perfect right to walk up to her and

ask how she was.

Then she could have blown them off, if she wanted to.

Unfortunately, the resort employee sent them away before they could speak to her. But the resort employee was under no legal obligation to do that. S/he could have simply stood back and let the medics come.

[nadinbrzezinski]

318. no they don't... and that is the point some of us have been trying to splain to you

ALL news stories imply that she was alert and oriented and able to say no

The moment she said no, UNTIL she deteriorated, she had a right to say no

In an ideal world medics would have been allowed BY HER to assess her... but it had to be HER

That is until she lost that ability, aka when symptoms appeared

And unfortunately many of the classic symptoms are late in coming in these cases

Medico-legal ethics are more complex than many folks think

Now out of this tragedy I can foresee, maybe, a helo for Quebec, and mandatory helmets at the bunny slopes

[pnwmom]

324. You're coming at it from your background as an EMT.

But my background happens to be in medical ethics, especially informed consent.

You seem to think this is an open and shut, simple case. I do not. You were right, though, when you said medical/legal ethics are complex. They are.

[nadinbrzezinski]

329. I don't think this is open and shut

in fact, talk and die cases are always very gray... because they end up in ahem death

That said, won't end in any court

Mark my words

If anything it will lead to revisions in EMS protocols... (and I don't count on it either, whatsoever)

But she said no... in the lucid state... from every news story we have been able to obtain, and until I see a story to the contrary, she was in her legal right to do such

That is what eats providers inside, and at times destroys providers, the game of what if... let alone the family

[pnwmom]

335. You should familiarize yourself with exceptions to the refusal-of-consent

rules, if you're still working as an EMS.

http://209.85.173.132/search?q=cache:WgzYMi3_1wEJ:www.moh.gov.om/nursing/1%25202%2520Discharge%2520AMA.pdf+%22against+medical+advice%22+form+%22informed+consent%22+%22head+injury%22&cd=1&hl=en&ct=clnk&gl=us

The following must be present to allow refusal of care: Patient is an adult (refer to definition) or represented by a legally appointed representative or parent (if a minor child).

a. Relatives cannot consent to the refusal of care for their relative unless he is a legally designated representative.
b.Patient is competent: Health care workers should determine the competency of the patient based on reason and carefulness,utilizing the following guidelines:
c.The patient’s presentation, physical assessment and vital signs are consistent with a person presenting in a physical condition that would support cognitive capacity.

Some conditions that might diminish cognitive capacity include: • Unstable vital signs that could affect cerebral circulation or oxygenation. • Evidence of alcohol or drug intoxication.• Evidence of head injury.

[nadinbrzezinski]

341. From news stories she was competent

and she told first responders to have the EMS crew buzz off

That is the problem

And we both can say no as well

You should familiarize yourself with talk and die syndrome

[DaLittle Kitty]

369. Evidence Of Head Injury IS A LOCK! Why Tobaggan Run Talk To Instructor Witness...

Nice Post brings the true medico legal context into play... i.e., The gray area is clearly described and then becomes quite BLACK AND WHITE. The responsibility to pursue the cause as the evidence was plentiful for head injury which could impair judgment even if patient presents as alert and oriented. Orientation cannot be assumed and must be tested as well but the matter of head injury was well beyond dispute.

You just refuted all the walkaway BS at first sign of resistance. As for Glasgow Coma Score you cannot determine the GCS WITHOUT ACTUALLY ASKING THE PATIENT THE NECESSARY QUESTIONS AND OBSERVING THE RESPONSE from the patient herself. But may still be superseded by the presence of head injury and the history of the injury and immediate effect on the patient post injury. Very Good!

[pnwmom]

284. Why can't you see that no one at the hotel was under any legal obligation

to turn the medics away after they arrived? Why won't you acknowledge that they could have simply stepped aside and waited for Ms. Richardson to speak for herself, which supposedly she was fully capable of doing?

[merh]

288. BTW, the ski patrol were not the EMS on the ambulance

What you don't get is you don't know it all - grow up and face it, folks will disagree with you from time to time and that means they don't agree with you. It doesn't mean they are stupid or that you should yell at them or that you are superior, they just don't agree with you.

You'd be easy to rattle in a court of law and it would be easy to show that protocol for you thrumps out individual cases and the duty of care. You have easy buttons to push.

[nadinbrzezinski]

305. THey are the first responders

Definition: There are two meanings for first responder:
The first person to arrive at an emergency scene. Often, first responder is used as a general term for all emergency service personnel who are expected to respond to medical emergencies or large-scale disasters.

A public safety official -- such as a police officer or firefighter -- certified to provide basic life support skills similar to an EMT. When referring to a certified First Responder, the term is capitalized.

[merh]

310. They were not the EMS on the ambulance on scene.

n/t

[nadinbrzezinski]

313. FIRST RESPONDERS... try to learn what that means

no matter how many ways from here to sunday you spin it

They are first responders and part of the medical emergency response system at that resort

[merh]

320. Grow up.

I know what first responders mean. I also know that the EMS on the ambulance were not allowed to see her even though they were on the scene.

[theNotoriousP.I.G.]

280. When does it become a flame war?

Corn flake chicken served at the wake?

It was an accident and why it's turned into a 300 plus thread i.e., woulda, coulda, shoulda to save her is beyond me. It was an unfortunate accident.

[merh]

282. it is because it was an accident that had a horrible outcome

and some believe it could have been handled differently. Differeing opinions do not equal flame wars - again, go post about breast feeding or cigarette smoking and then you will feel the flames. Try circumcisions, that one is known to spark the heat.

[theNotoriousP.I.G.]

292. It wasn't handled differently

and Natasha Richardson is dead. People posting diatribes with exclamation points and angry smilies won't change that.

[merh]

295. Hell, people posting the explanation points and in all caps don't change

a thing, to think that posts on a message board can change things is rather silly. This is simply a place to discuss, if there were power in the posts GWB would have been impeached, ah hell, if there were power in the posts, there would be no war, Gore would have served two terms and life would be better.

If you don't like it, please use "hide a thread" -

And if you want to change the world, push away from your computer and do something like join the peace corps or something.

;)

[theNotoriousP.I.G.]

299. taking your advice merh

hiding thread. It's almost 2 in the morning and I've got disadvantaged kids to teach in the morning.

[merh]

304. Sleep well

:hi:

[DaLittle Kitty]

350. This is An Opportunity For People To Learn and Benefit From The Discussion

Like say persuade a kid or adult to wear a helmet... My experience as a health care professional led me to write this post...

There are some pretenders who like to think that they worked in an ER or on the street and are making up BS that only clouds the more rational discourse. Yeah and I have wasted enough of my time trying to explain to people here how the real world works or could work better... so I believe that of the 3,000 + who have looked at this most will quickly figure out WHO is FOS and WHOO Is Not... Take Care!

[merh]

351. I understand the purpose of your thread and thank you for posting

it. You take care too.

[nadinbrzezinski]

353. Why you have yet to address the existence of L-III trauma centers in the US

by the by, I did learn that the few L-III centers in my state were downgraded to L-1 this year

Not a warm fuzzy

As to pretenders... I think you are one

[DaLittle Kitty]

370. As I Said People who Read The Discussion Will Quickly Figure Out Who Is Real And Who Is not.

Thank you very much! :)

[pnwmom]

281. The resort employees turned the medical professionals away

because a head-injured patient told them to.

That doesn't mean she had no symptoms.

[nadinbrzezinski]

290. Alert and oriented times four

http://jfuson.blogspot.com/2004/10/alert-and-oriented-times-zero.html

glasgow scale of 15




How many ways to Sunday do I have to splain this to you?

she has a right to tell EMS to buzz off....

I know you think she didn't have this right, alas she did, with tragic consequences, but she did

This is also part of the talk and die syndrome, somewhere I put the link to the news story on this, but here is some scientific lit

bur first a definition

http://medical-dictionary.thefreedictionary.com/talk+&+die+syndrome

And here is more

http://www.mdconsult.com/das/article/body/127625845-2/jorg=journal&source=MI&sp=10149163&sid=0/N/103895/1.html?issn=0028-3878

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WHP-4NGBB0D-2&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=f6aa83c6aec4c5e56ada8e8ca1e97d48

Now I will have to ask... since you keep insisting that the resort could not do this, why would the resort, who called EMS turn EMS away? Give me a good reason, that at this point does not involve manslaughter one... because that is what you are implying

From the news coverage, she said no... she has a right to say no... you have a right to say no... sometimes saying no will kill you... most of the time, thankfully, it will not

This is tragic...

There are some lessons...

I guess for some of you, do not go to sky resorts...

[pnwmom]

297. You left out the critical source.

Where was it ever said that she was alert and oriented times four? Where was her score on the Glasgow scale ever reported?

The resort turned the medics away because she told them to. But they weren't her subjects and she wasn't the Queen. They didn't have to carry out her instructions. They could have stepped aside and waited for her to communicate her wishes directly to the medics with the ambulance.

[nadinbrzezinski]

300. Unfortunately I cannot give you access to any specific patient

why?

Heard of privacy? HIPPA in the US...

In Canada other means

In mexico, you need a warrant from law enforcement

Happy hunting trying to LEGALLY obtain that

And she communicated her wishes to first responders, no matter how many ways from here to sunday you try to spin it

[pnwmom]

312. Right. So every time you've said that, you've been making up the facts.

Because that information isn't available to anyone.

[nadinbrzezinski]

314. I am getting to educated conclusions on what the news stories report

so tell me... do you think a crime was committed?

Not allowing the medics to see her is exactly that

Manslaughter one I belief/

Why would the sky patrol risk that?

And that is what you, and everybody else, who insists the medics should have forced themselves on her are implying

So counselor, ball's in your park... ground for manslaughter, for refusal of care?

[pnwmom]

317. No, I think stupidity was committed. And that this has the potential

of being a civil case.

Manslaughter one. What a crock.

[nadinbrzezinski]

319. Refusal of care is a serious charge, it does involve murder

not quite murder one counselor... but manslaughter is there

So why would the sky patrol willfully do that?

That is the implication, that the resort turned them away, after calling them in, for whatever nefarious reason there was...

So was there counselor?

If not, perhaps we are talking about the talk and death syndrome uh? It happens... you know

[pnwmom]

322. The case, if there was one, would be civil.

And the charge would be "wrongful death."

I would have expected in your line of work that you might have heard of that term before.

If not, then, you've learned at least one thing today.

[nadinbrzezinski]

323. There won't be... talk and die syndrome counselor, real medical condition

and she said no...

So unless you can prove counselor that the sky patrol prevented the medics from seeing her, without her refusing them... you have no case

Hate to point this out.

By the way counselor, as we have been arguing this, I'd say by now we are up to 30 people who have died across North America from the same syndrome, counselor should we start filing lawsuits?

If anything this should educate people... you ring your noggin' go to the hospital

[Gwendolyn]

326. What does "turned away" mean?

From the accounts I've read, the EMS were waiting at the foot of the hill when they saw a sled heading past them toward the clinic. At that instant they received instructions from the dispatcher to abort... that they were not needed. Where is all this coming from that the resort physically stopped anyone from seeing the actress, or that they should have "stepped aside?" It sounds like the cancellation was done over the phone, at the behest of Ms. Richardson. And it was her choice.

[DaLittle Kitty]

347. Well Put MOM!

The manager and hotel are in deep doodoo here!

[bottomtheweaver]

363. shout out to you mom and merh

for fighting the good fight. We are looking into the heart of darkness here in all its insane depravity but then maybe I'm just nuts. But I doubt it.

:grouphug:

[likesmountains 52]

334. I was going to stay out of this but really...none of us were there, none of us know all of

the details and timeline..presumably none of us are neuro-trauma experts...none of us are experts on Canadian EMS services..so let's stop the speculation. She's dead, its tragic...but we can't answer the questions from our keyboards in Topeka or wherever.

[tomreedtoon]

359. Prevent such accidents. STOP SKIING.

It's a stupid rich man's hobby anyway, and most recently, a rich man's way to commit suicide. They should send all the AIG idiots on skiing trips; it would be the only useful thing ever done on skis.