April 8th, 2009
12:34 PM ET

Calculating the risks of skiing in Quebec

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

I just returned from Mont Tremblant, Quebec. It is one of the more beautiful ski resorts in eastern  Canada, and it is also the place where actress Natasha Richardson fell and suffered a fatal brain injury. What caused her death is now well known, but there were some other details that struck me while I was there. Let me try and work through this with you.

[cnn-photo-caption image=http://i2.cdn.turner.com/cnn/2009/images/04/08/gupta.mont.tremblant.jpg caption="Dr. Sanjay Gupta on assignment in Mont Tremblant, Quebec."]What no one knew at the time was that she had hit her head hard enough to cause a fracture in her skull. Just underneath that fracture is a small blood vessel that runs just on top of the brain, and it was that blood vessel that started to bleed. By many reports, Richardson got up after her fall and felt well enough to go back to her room and wave off paramedics who had been called. In neurosurgery, we refer to this as a lucid interval. She may have lost consciousness briefly, but now felt fine. The problem for Natasha or anyone with an epidural hematoma is that the pressure continues to build up in the brain. (See what an epidural hematoma looks like).

A little while later, now in her room, Natasha started to feel sick. The most likely symptoms were headache, nausea, disorientation and lethargy. 911 was called again, and now the clock was definitely ticking. If you ask a dozen neurosurgeons, how much time someone has after starting to develop the symptoms Natasha had, you will get varied answers. Anywhere from a few minutes to 90 minutes, but the message is the same: Speed matters. The problem for Natasha was she was nearly two hours away from a trauma hospital by ambulance, and there was no helicopter available to take her more quickly.

By the time she got to the hospital, too much pressure had built up on her brain and we know she died 24 hours later. The medical care in Canada is world class and the neurosurgeons there could have performed a lifesaving operation, if only she had arrived sooner.

There are doctors in Canada who have been calling for more air ambulances, long before we learned about Natasha Richardson. Others argue that the cost-benefit analysis comes down on the side of not having them. (Read more here) Based on our research, helicopters typically cost around $6,000 per hour to operate, not including other associated costs. So, here is something to ponder: Should ski resorts have access to helicopter services at all times or is there a certain amount of risk you accept if you ski in a remote location? Is it worth the cost to have this benefit?

Watch my full report Thursday on AC 360 at 10 p.m. ET.

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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.