Mon commentaire suite à cet éditiorial : Charles GL writes : To Forrest G - it took 8 minutes to get Natasha Richardson to Ste.-Agathe, and 40 minutes to Sacre-Coeur. A helicopter would not have been quicker. ***************** Yes; but the real killer numbers are : 50 min scene time for the second ambulance and AND 1:50 min at the Centre Laurentien Factor this by the actual beneficial interventions : Ambulance - Basic EMT = Oxygen (that's it) Local Hospital - IV access, Artificial coma & intubation, perhaps hypertonic saline) and AND a CAT-Scan Note Diagnostic (CAT-Scan) Is useless if does not result in a treatment (Cranial decompression/drainage)(Not available in the small hospital) It serves only to orient and support the Trauma referral ... But We knew this patient needed a Trauma center upon the arrival of the second ambulance ... clinically (Did not need a Scan... she needed specialised care) In Trauma; TRANSPORT is 80% of the care Transport to a Medical Center with the appropriate level of care (Avoiding the deadly “Pitt Stop” of limited medical value on Patient outcome The Helicopter is a mere tool (one of many) of a Trauma SYSTEM It is one (very technological) way to bond all the medical elements and have the medical actors work and think on the same level : The best survival of the prehospital patients A SYSTEM is best placed to evaluate, direct and attribute resources. Then come back, RE-evaluate, do Quality Assurance and tweak the system accordingly Years of that guarantees best care and base care in relation to available resources (Human AND Monetary) At this time the Quebec Trauma system follows a pretty loose and hope base system. As for the American health system (which I know intimately) It's failures Does not justify our own failures i.e. We save so many... we can allow to lets SOME die in prehospital with the minimum of effectual intervention or concerns on our part American can DEFINITELY learn from us (and they are) We, on the other hand can learn from all It's when we do that that WE improve We... Being more important than Americans, You will agree Charles
________________________________ From: Charles Brault <[email protected]> To: [email protected] Sent: Tuesday, March 31, 2009 12:12:48 PM Subject: URG-L: Prevetable death? from a Qc MD Aux dernières nouvelles : Mz Richardson aurai elle-même canceller son rendez-vous de suivie à la clinique locale ! Don't blame Canada: doctor U.S. media finger 'socialized medicine' in actress's death By MAX HARROLD, The Gazette Some Montreal doctors added a dose of caution yesterday to the fierce debate south of the border that asked if Canada's "socialized medicine" killed actress Natasha Richardson after she hit her head skiing on Mont Tremblant March 16. "Canadacare may have killed Natasha," screamed a headline in the New York Post. "Was Canada's health care the problem?"asked another in the Chicago Tribune. The implication "is totally unjustified," said Paul Saba, an emergency room doctor at Lachine Hospital and co-president of the Coalition of Physicians for Social Justice. He flatly rejected the notion that a lack of funding for overall public health care contributes to fatalities from head injuries like the one that claimed the life of Richardson, the wife of actor Liam Neeson and the daughter of actress Vanessa Redgrave. Saba stressed he was not commenting specifically about Richardson, but "any patient's refusal of treatment is crucial" to the outcome. So is not wearing a ski helmet, he added. Richardson, 45, wasn't wearing a ski helmet when she fell about noon and was walking and talking afterward. She also refused an ambulance that came for her about 45 minutes later. Another ambulance was called at about 3 p.m. and she arrived at the Centre Hospitalier Laurentien in Ste. Agathe, 42 kilometres away, nearly four hours after her fall. Two hours later, she was transferred by ambulance to the trauma centre at Montreal's Hôpital du Sacré-Coeur, 83 kilometres southeast of Ste. Agathe. An article in U.S. newspapers by Cory Franklin, a physician who lives in Wilmette, Ill., took sharp aim at the lack of CT brain scanners in some Quebec hospitals and the lack of helicopter ambulances. "With prompt diagnosis by CT scan, and surgery to drain the blood, most patients survive," Franklin wrote. "Could Richardson have received this care? Where it happened in Canada, no. In many American resorts, yes." But a simple telephone call yesterday by The Gazette to the radiology department at the Centre Hospitalier Laurentien revealed that the hospital is in fact equipped with a CT scanner. It was not known, however, whether the device, which can cost $1 million, was used on Richardson. As for the need for a medical helicopter, Saba said that while it would be helpful in longer-range cases, it might not have saved the actress. Mont Tremblant is relatively close by road to Montreal's trauma hospitals, he noted. "You have to do a cost-benefit analysis," Saba said. "It takes time to get the helicopter's medical team assembled, get the helicopter to the location of the patient, pack in the patient and fly the helicopter to Montreal." But Michel Garner, head of the emergency department at Sacré-Coeur, said Mont Tremblant is a two to 21/2 hour drive from Montreal. Ste. Agathe can be an hour's drive away, he noted. "I'm certain some patients would benefit" from a helicopter system, he said. André Lizotte, Quebec's chief co-ordinator of air ambulance services for the Ministry of Health, said March 20 that "a serious analysis is under way" regarding implementing a provincial helicopter ambulance service. Lizotte said Quebec is served by two airplane ambulance services - a government-run service in eastern Quebec, and a private-contract service in the western part of the province. But these airplanes need airport landing strips and can't land right beside hospitals, like helicopters can. Paul Brunet, president of the Council for the Protection of Patients, said the question of whether a helicopter ambulance would have made a difference was moot. "If she had worn a helmet and accepted to see a doctor, would there be any talk of this need for a helicopter? "And with all due to respect to the Americans, we don't need any lessons from them about health care," Brunet added. Canada doesn't "have 50 million people without health care like they do." [email protected] © Copyright (c) The Montreal Gazette http://www.montrealgazette.com/opinion/need+helicopter+ambulances/1446231/story.html We need helicopter ambulances The GazetteMarch 31, 2009 Re: "Don't blame Canada: doctors" (Gazette, March 29). This article, based on the opinion of one physician who is not an expert in trauma care, jeopardizes an attempt to address a critical problem in our region that seriously affects public safety - the lack of a proper helicopter ambulance service. The claim that such a service would have had no impact on the outcome of the Natasha Richardson tragedy contradicts the opinion of most experts in the field. All agree that time is critical. In light of the details described in Saturday's Globe and Mail, it is clear that using helicopter transport would have saved precious hours. Yes, people should seek help when it is recommended; yes, a helmet is recommended; and yes, a helicopter would have saved time and possibly her life no matter when a decision to transport was made. Our failure to ensure public safety to a minimum standard is indeed shameful, but it is not a failure of Canadian health care, as this service exists in most of Canada. Rather, it is a failure of Quebec health care. Since Richardson's tragic death we have received several unfortunate victims of trauma at our centre who have had consequences due to a lack of helicopter transport. I'd be very interested to know what Dr. Paul Saba would choose if a member of his family were found unconscious at Mont Tremblant or Mont Sutton - a 3 1/2-hour transit to a trauma centre or a 25-minute flight to the roof of a trauma centre? What do you want? I know what I want. It's also what most Canadians want and get, except here. And that demands an immediate explanation and solutions, not excuses. Tarek Razek Chief of trauma McGill University Health Centre © Copyright (c) The Montreal Gazette
