Helmets: Even for Movie Stars

Natasha Richardson, Tony award winner and wife of actor Liam Neeson, is reportedly brain dead from a head injury sustained during a ski lesson at Mont Tremblant, in Canada.  She was not wearing a helmet.  Ms. Richardson had no apparent external injury from her beginner ski lesson, and developed a headache about an hour after the event.  After evaluation and management in Canada, she was flown back to New York, where it is anticipated that she will be taken off of life support. 

Based on the description of the event, Ms. Richardson may have had an epidural hematoma, which is sometimes called "talk and die" syndrome, because patients suffer bleeding next to the brain that becomes apparent only after pressure has built up inside, usually in about an hour.  Patients with epidural hematoma can occasionally be saved if they have already reached a hospital that has staff to perform emergency neurosurgery before the pressure builds to the point of irreversibly damaging the brain.  This irreversible pressure damage is called herniation. 

Because it is reported that Ms. Richardson did not collide with anything when she fell, it is remotely possible that her condition is not related to a specific injury, but rather, she may have suffered an intracranial event that just happened to occur as she was skiing. 

Although not commonly understood, 'brain dead' is dead.  There is no medical or surgical intervention that can bring someone back to life after the brain stops working, even if the heart is still beating.  People who are brain dead frequently have perfectly good working organs and are candidates for organ donation. 

Studying the 2000-2001 and 2001-2002 Colorado ski seasons, Levy et al determined that with public education and helmet loaner programs, skiers were 8 times and 6 times more likely, respectively, to wear a helmet than prior to the implementation of these programs.  They found that only 4% of skiers chose to wear a helmet in ski areas where there were no helmet loaner programs and suggest that helmets ought to be included in ski packages. 

Helmets were found to reduce head injury while skiing by 29% according to Hagel et al and 60% by Sulheim et al.  Ski-related deaths occur in about 1 per 1 million skier visits.  They occur more often in males (81%), during the middle of the day, and are more likely to be traumatic collisions (65%) according to Xiang and colleague.  In evaluating head injuries during three ski seasons, Diamond et al found that 24% of these injuries were skull fractures, 39% were intracranial lesions and 79% suffered amnesia.  Levy and colleague in another study suggest that even though head injuries only amount to 3 to 15% of all ski related injuries, ski equipment has improved and while this may account for the decrease in extremity related injuries, the faster speeds and higher levels skiers are reaching may support the increase in neurologic injury rates.  Ski and snowboarding helmets should be mandatory for children, and free for adults to help prevent serious head injury. 

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