History Forum / General / British History / November 2007

Top Surgeon Lists Five Key Blunders That May Have Cost Diana Her Life

Hmmmmmmm...

Instructive.

I think I generally prefer the American and British ambulance procedures to
the French.

However, everything depends on the discrete set of circumstances, including
the severity of the injuries ---- and capabilities, both in the ambulance
and at the hospital.

DSH

Lux et Veritas et Libertas
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The Times
November 20, 2007

Top surgeon lists five key blunders that may have cost Diana her life

Patrick Foster

Diana, Princess of Wales, might have survived the car crash in which she
died had French medical staff not squandered vital time, her inquest was
told yesterday.

Sobering Revelation. -- DSH

Thomas Treasure, a leading British surgeon, told the inquest that a “window
of opportunity” may have existed to get her to hospital half an hour before
she was taken there. Professor Treasure, a former president of the European
Association for Cardiothoracic Surgery, said that medics had done “very
substantial good” in the initial period after the accident but that once the
Princess was in the ambulance time began “slipping away”.

The professor, who was asked to review records of the treatment given to the
Princess for Lord Justice Scott Baker, the coroner, conceded that the
combination of her internal injuries was extremely rare and serious but said
it was theoretically possible that she might have been saved.

The inquest heard of a sharp divide between the French approach to
multiple-injury patients — which favours treatment by doctors at the scene —
and the “scoop and run” approach taken in Britain. The jury has been told
that the Princess was freed from her Mercedes within 35 minutes of the crash
on August 31, 1997. She suffered an apparent cardiac arrest and had to be
given heart massage and stabilised on the road before being put inside the
ambulance, where she was intubated and ventilated and given a fuller
examination.

At one stage the Princess shouted out, pulled out her drip and was so
distressed that she had to be restrained, the inquest was told. It was not
until 1.40am that she was judged sufficiently stable to be taken to
hospital.

Dr Jean-Marc Martino, the emergency resuscitation specialist, then told the
ambulance driver to go slowly so as not to destabilise the Princess further.
At one point the vehicle had to stop for about five minutes near the
hospital entrance when her blood pressure dropped to perilously low levels
and she needed stabilisation.

A series of senior doctors have told the inquest that if she had not had
such intense treatment on the way she would have been dead on arrival.

Yes, that's one of the virtues of the French Protocol. -- DSH

The jury has been told how she suffered massive internal bleeding because of
a rupture to one of her pulmonary veins — attached to her heart — as well as
the casing of the heart itself. Once in hospital just after 2am, an X-ray
showed massive internal bleeding on the right side of her chest.

A surgeon opened up her thorax to search for the source of the bleeding but
could not immediately find the ruptured vessel.

Professor Alain Pavie, one of the top cardio-thoracic surgeons in France,
who had been called in from home, then took over, extending the cut to find
that the rupture was on the left rather than the right where the bleeding
was. He sewed it up but, despite prolonged resuscitation attempts with
oxygen, heart massage, electric shocks and massive doses of adrenalin,
doctors finally gave up the battle at 4am.

Professor Andreienhart, who reviewed the case for a French investigating
magistrate, told the inquest yesterday that there were no recorded cases in
medical literature of patients with the same combination of ruptures
arriving at hospital alive.

Hmmmmmmm... READ THAT AGAIN.  -- DSH

Professor Treasure said: “They had done some very substantial good
relatively quickly — stabilising the neck, getting her out of the car — with
just a brief episode when they lost the pulse, they got things going again
and produced a normal blood pressure.”

But, describing the further treatment at the scene and the subsequent
journey to hospital, he said: “That’s where the time was slipping away.”

He went on: “That’s my analysis, they had done a lot of good in that first
half hour but from there, the next big amount of good that could be done
required a surgeon.”

READ THAT AGAIN... -- DSH

...Back at the hospital -- and a specialist surgeon, with team, was
apparently not immediately available, even when Diana arrived there. --
DSH

Nicholas Hilliard, counsel to the inquest, asked: “Is it your view that part
of that time, the essential period, was squandered?” Professor Treasure
replied: “It’s a hard word, isn’t it, but I think opportunities were lost.”

A Much Fairer & Professional Judgement. -- DSH

He went on: “At the point at which she was in the ambulance and that initial
assessment had been done pretty accurately and the neck was stabilised and
the circulation . . . I’m not quite sure what happened after that, that they
didn’t have her in hospital and Professor Pavie alerted rather sooner.”

INDEED. --  DSH

We need a Detailed, Complete Timeline.  Perhaps we'll eventually get one. --
DSH

He added: “When I pick through this with the benefit of hindsight [and ask]
‘was this recoverable?’ the answer is, ‘Yes, it just about was’.”

He also questioned the large doses of adrenalin given to the Princess at the
hospital. “They ran out of syringes of adrenalin. It’s quite extraordinary,”
he said. “They didn’t lose for the lack of trying but it was not necessarily
productive trying.”

Professor Treasure, who is this week due to publish a study on how best to
treat multiple-injury patients, also questioned the decision to stop so near
to the hospital to stabilise the Princess when her blood pressure dropped.

The inquest continues.

What went wrong

Professor Treasure suggested that:

— A ventilation tube might not have been needed en route

— He questioned the decision to stop so close to the hospital rather than
speed up; the Princess might have survived if the journey to hospital had
been short

— A specialist team should have been on standby in advance

— Her chances would have been helped if a surgeon had opened up her chest
from the front rather than the side

— The amount of adrenalin that she was given during surgery may have been
counterproductive
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All this is with the benefit of HINDSIGHT of course.

DSH

Lux et Veritas et Libertas

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