by Jeffrey B. Randall, M.D.

Actress Natasha Richardson’s recent death from a traumatic brain injury (TBI), after falling on a beginner’s ski slope, has left a host of questions about how such tragedies might be avoided in the future.

Although many of those questions may never be fully answered, two facts are clear: wearing helmets saves lives, and patients with life-threatening brain injuries such as Richardson’s have a better chance of surviving if they get immediate treatment at a regional trauma center – a facility that has resources beyond regular hospital emergency departments.

Hospital emergency rooms are set up to handle a spectrum of health problems, ranging from simple lacerations to serious heart and lung conditions, but they do not usually have surgical specialists and an operating team available at a moment’s notice. Trauma centers, by contrast, can quickly tap a full complement of medical professionals to treat severe injuries within the first hour – a time period that can make the difference between life and death. Brain injuries, in particular, demand the specialized care available at a trauma center because changes in a patient’s condition can occur suddenly and must be recognized and acted upon right away.

While most head injuries are not immediately life threatening, even a minor fall like Natasha Richardson’s, can cause bleeding to begin beneath the skull, putting increasing pressure on the brain. The rigidity of the skull leaves no outlet for relieving that pressure – unless surgeons intervene to remove the blood clot and halt any further bleeding. If pressure continues to build, causing further compression of the brain stem, the crucial work of regulating the heart is compromised, and movement and breathing is impaired, leading to coma or death.

In a trauma center, neurosurgeons and trauma surgeons can rapidly distinguish between a blow to the head that can be life threatening and a concussion, which does not require surgery but is a more serious problem than most people think.

Most importantly, the trauma center structure enables these surgeons to be immediately available around the clock and they can use a dedicated operating room to treat patients in the crucial moments after an accident.

Besides the speed of treatment available in trauma centers, advances in neurosurgery are also improving the odds of survival for car accident victims, brain tumor patients and others who are severely injured. Unlike the popular image of brain surgery requiring extensive drilling through the skull of a patient with a shaved head, neurosurgery today often involves much smaller incisions and incorporates CT scans, MRIs and guidance systems, similar to a global positioning system, to pinpoint exact locations for surgery, making procedures safer and speeding recovery.

Neurosurgeons are one part of a trauma center’s team of acute care providers, which include trauma surgeons, anesthesiologists, orthopedic surgeons, critical care physicians, and specially trained nurses, respiratory therapists and radiology technologists .

Providing both rapid transport of patients and rapid treatment, the effectiveness of the trauma center approach cannot be underestimated. For instance, the Trauma Center at Eden Medical Center regularly treats patients who have been diagnosed with an epidural hematoma – the type of traumatic brain injury reported to have taken the life of Natasha Richardson. Over the last 20 years the great majority of those patients treated at Eden have returned to their normal lives.

A recent state survey placed Eden Medical Center at the top of California hospitals for having the lowest mortality from these cranial operations. In an era of ever expanding health care challenges, the regional trauma system provides a great benefit to our community and saves lives.

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Dr. Randall is a brain and spinal surgeon, board certified in neurosurgery and is affiliated with Eden Medical Center. For more information call 1-888-445-8433.