Talk and Die: Six Questions (and Answers) About Natasha Richardson's Ski Accident

How can someone seem fine one moment and then quickly deteriorate? In the field of trauma medicine, it's called "talk and die syndrome."
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Natasha Richardson's death is a shock and tragedy for so many reasons. The 45-year-old actress was taking a private lesson on a beginner's run in Mont Tremblant, Canada. When she fell at the bottom of the trail, everything seemed okay. She didn't hit anyone or anything. She wasn't wearing a helmet, but there was no sign of injury or need for a stretcher. She walked to her hotel room but within an hour complained of an extreme headache. Then she was rushed to local hospitals and flown to New York where her family held a vigil.

While every thought and prayer go to her grieving family, the accident and injury raise a number of basic questions:

1. How can someone seem fine one moment and then quickly deteriorate?

In the field of trauma medicine, it's called "talk and die syndrome" -- patients who can speak after some kind of head trauma who then deteriorate rapidly. Researchers have found that some of these patients are potentially "salvageable" -- i.e. lives can be saved -- if the problem is identified in time. But even with early detection, some of these patients simply can't be saved.

2. After her fall, could Richardson -- or anyone for that matter -- have done anything differently?

Richardson reportedly left the slopes and returned to her hotel. Apparently, the ski patrol stayed with her during that time. Until she began complaining of a headache, everything seemed okay.

These cases are quite rare, doctors say. In one 10-year study of head injury deaths in a major Australian trauma center, 2.6 percent of all cases involved "talk and die syndrome."

Still, if you take a fall or bang your head, you should be mindful of the warning signs and seek immediate medical attention if you experience dizziness, drowsiness, headache, slurred speech, loss of consciousness or confusion, nausea, numbness, or weakness in arms and legs.

3. Are Beginners Especially Vulnerable to Injury?

It may seem counterintuitive but experts say the better you are, the greater your risk. Above average male skiers suffer the most serious injuries and deaths, according to the work of ski injury researcher Dr. Jasper Shealy of the Rochester Institute of Technology. Above average skiers move at high rates of speed on intermediate trails. Typically, they're males in their early twenties all the way up to their mid-40s. That's essentially the same demographic group that gets into more car accidents.

4. Could a Helmet Have Saved Richardson?

The answer is maybe, but it's too soon to tell. In general, helmets are helpful, but they aren't perfect. "The sad fact is that we now have 45-50 percent of the snow sports population using helmets," Dr. Shealy explains, "but the fatality rate has not changed." Over all, the rate of head injury has declined 35 to 45 percent, he goes on. That's because helmets are very effective at preventing head lacerations and other less serious head injuries. However, helmets "are less effective for more serious head injuries that typically involve greater kinetic energy and/or speed."

Most fatalities are the result of relatively high speed impact (probably greater than 27 mph) with a fixed object (like a tree), Dr. Shealy notes. "Under those circumstances, it will probably take more than a helmet to save your life," he says.

"I agree with the proposition that everyone should wear a helmet while engaging in a winter snow sport," he concludes. "If you hit a tree at typical maximum skiing speeds, you will still probably die, but if you fell on hard-pack snow (a much more likely scenario) and hit your head on the hard surface, a helmet can likely change what would likely be a serious head injury into a minor, less serious head injury."

In addition, Dr. Shealy's work suggests that helmets may actually encourage riskier behavior among some skiers -- because they feel safer -- and lead to more severe injuries. However, Dr. Shealy says that's not a good reason to skip wearing a helmet. "I encourage everyone to wear a helmet, but ski (or snowboard) as if you were not wearing a helmet. I don't know if realistically anyone can do that, since I suspect that the increased level of risk-taking is sub-conscious."

5. How Often Do People Die or Get Seriously Injured While Skiing?

What happened to Richardson is exceedingly rare, especially for a beginner. Around 15 million Americans are skiers. An average of 39.8 people die each year skiing or snowboarding, according to the National Ski Areas Association, the industry trade group. That means there are .88 fatalities per million days of skiing and snowboarding. On top of these deaths, the NSAA says there are 43.6 serious injuries every year.

In the last 25 years, experts say, the overall injury rate has declined 50 percent. Today, there are 2.5 serious injuries per 1,000 skier visits (i.e. ski days). If you think about the number of days per year that you put on skis -- say, seven -- that means you can ski 61 years on average before really hurting yourself.

6. Is Skiing is More Deadly than Snowboarding?

The death rate for snowboarders is 40 percent lower than for alpine skiers, according to Dr. Shealy's research. When they wipe out, skiers are three to four times more likely to hit something while snowboarders don't slide as far or hit as much. The snowboard acts as a kind of anchor, stopping you before you strike something, according to Dr. Shealy. In terms of over all injury rates, however, snowboarding is twice as risky as skiing, he says.

Natasha Richardson's death is a terrible loss. Like Sonny Bono and Michael Kennedy before her, Richardson's story may serve an important cause: Raising awareness about head injuries and ways to prevent and detect some of them.

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