As we suspected, InsideSurgery has noted the news reports that Natasha Richardson suffered and died from an epidural hematoma sustained in a seemingly minor skiing accident.
Epidural hematomas result most commonly from a blow to the side of the head in the temporal bone region that cause a tear or rupture in an artery, usually the middle meningeal artery.
The bleeding accumulates in the space just under the skull and has the effect of pushing on the brain. If this pressure is not relieved the brain will herniate or be pushed down the opening of the brain stem or one of the other openings in the skull, causing death.
The only treatment for this injury is emergent surgery to stop the bleeding and remove the clot formed by the bleeding artery. It is not clear from news reports if she received surgery or how timely and professional her medical care was after she sustained the injury.
However, what is not in dispute is the significant possibility that this injury could have been prevented if she had been wearing a protective helmet such as that commonly worn by motorcycle and bicycle riders.
No helmet can completely eliminate the risk of head injury in a severe blow, but these widely available, relatively inexpensive helmets do reduce the risk of injury in low velocity “falls-from-standing-height” type of injuries.
Helmets work in head trauma by absorbing some of the mechanical energy of the blow and preventing it from being transmitted to the skull, thus reducing the likelihood of skull fracture and/or signficant shear forces, in this case in the area of the middle meningeal artery. Injury to this artery is the usual cause of an epidural hematoma and is what killed Ms. Richardson.
The risk of falls and injury in skiing are well-known as witnessed by the existence of paramedics and trained ski patrols at all major resorts. And, falls in any setting invariably involve head trauma.
In fact, the risk of traumatic brain injury in skiing is so significant a group of Canadian emergency room physicians last month called for a rule requiring all skiers to wear helmets while on the slopes.
Despite these risks and tragic accidents just as Richardson’s, helmets on ski slopes are rare, perhaps because of the same reasons that motorcycle riders cite – they diminish the experience of doing the activity and they do not look “cool.”
But, regardless of what the non-helmet wearers may claim – helmets save lives.
What is needed to start to change attitudes about helmets is a high-profile, ski-loving celebrity (Prince Charles and the British royal family?) to be photographed schlossing down the slopes in a perfectly color coordinated, stylishly designed, logo-laden helmet.
Perhas then, as is human nature, skiers will want to join in and emulate the “cool” crowd – and be spared the sad fate of Natasha Richardson.