What Happened toNatasha Richardson?
Natasha Richardson, Epidural Hemorrhage and Canadian Health Care
in remote resort areas in the United States, small community hospitals would likely lack neurosurgical coverage. In fact, because of the huge malpractice risk associated with the field, even if there was a neurosurgeon available, whether he or she would take emergency call at a community hospital would be in question.
Mont Tremblant is one of the most recognized and popular ski resorts in the world. It is famous for celebrity sitings, and the rich and famous frequently take up seasonal residence there.
As of 2005, Mont Tremblant had been recognized by Ski Magazine as the #1 ski resort in Eastern North America for 8 consecutive years.
Given the popularity of the area and the nature of skiing and snowboarding, Natasha Richardson may be the most famous person that’s ever come down from Tremblant’s slopes needing emergency neurosurgery, but I doubt that she is the first.
According to JAMA :
Head injuries constitute only 5% to 15% of all injuries from ski and snowboard accidents, yet are the primary cause of serious disabling injuries and death. There are approximately 10 fatalities per year in Colorado from accidents on the ski slopes, and among the fatally injured in one study, head injury was the cause of death in 87.5%;
Another report lists the incidence of ski head injury incidence at 0.77 per 100 000 ski visits
And a mega-study estimated rate of one death per 1.5 million skier-days.
Comparable ski areas in the U.S. – say Vail and Park City – both list neurosurgeons in their cities. Vail, Colorado has a population of 4,589 and is home to 1 practicing neurosurgeon. Park City, Utah population 7,371 also lists 1 practising neurosurgeon.
Availability of Neurosurgeons
Kevin, M.D. rightly states that a neurosurgeon is probably just as unlikely to be available in a U.S. ski town, as in Canada, and that may be so but the reasons are diametrically the opposite.
The last good data I could find listed only 174 neurosurgeons in the entire country. In the U.S. we have 3,500. A study on the need of neurosurgeons listed the density of neurosurgeons in the U.S. to be about 1/55,000 people which means that an analogous number of neurosurgeons needed in Canada would be about 604.
It is true that neurosurgeons eschew emergency room coverage in the United States, but it is for completely different reasons than in Canada. Here, our ED’s don’t want to pay what it takes to hire a neurosurgeon for coverage; in Canada, no one wants to even be a neurosurgeon.
But as we go towards a single-payer system, we can all expect that when we need it most, the system will not be there for us, as it was not there for Natasha Richardson.