Richardson, 45, was on vacation with one of her young sons at Quebec's Mont Tremblant resort March 16 when she fell on a beginner's slope known as Nansen, a run popular for its gentle slopes and forgiving turns. Although her fall may have first appeared minor – she reportedly refused to be taken to hospital at least twice – the head injury she suffered is a type that, if tended to quickly at a qualified trauma center, can often treated successfully – and can just as easily turn fatal if not treated in time.
The New York City medical examiner's office ruled March 19 that Richardson died from blunt trauma to the head, causing massive internal bleeding in the brain. In such cases, blood from a damaged but still-pumping artery can quickly pool in the brain, creating pressure that must be relieved before irreparable damage is caused.
Time of the EssenceMedical experts tell PEOPLE that time is of the essence in increasing the chances of survival. Yet patients and untrained observers often don’t realize the grave danger they are in since patients may experience periods of lucidity during which they can walk and talk – a scenario known as "talk and die."
Yves Coderre, director of operations for Ambulances Radisson, the company that responded to both 911 calls for Richardson on Monday, says nearly four hours elapsed between the actress's tumble and her admission to a local hospital. Coderre, who has reviewed 911 dispatch records, tells PEOPLE a member of the ski patrol summoned the first ambulance to the scene at 12:43 p.m. on Monday, not long after her fall toward the bottom of the run. The ambulance arrived just after 1 p.m. and waited near the bottom of the mountain while a ski patrol member followed protocol by placing Richardson in a toboggan to transport her down the hill.
Coderre, who has been a paramedic for 28 years and a member of a local ski patrol for eight years, said the paramedics in the ambulance saw Richardson whisk by on the sled without stopping. Minutes later, their dispatcher called them and said they were free to go because the actress had refused treatment.
Right to Refuse Care"They just saw her on the sled for a split second, nothing more," said Coderre, who explained that Richardson was brought to a small clinic at the mountain, rarely staffed by a physician, where a member of the ski patrol and her instructor, a female university student, talked to her.
"The protocol in these situations is that the person is told that she would be wise to seek medical attention but she always has the right to refuse," said Coderre. "The only time a person can be overruled is if she is thought to be under the influence of drugs or alcohol or if she is showing visible signs of head trauma and seems to be intellectually incapacitated in some way."
Skiers are asked to sign a document if they refuse medical treatment. "They'd never let her go without her signing it," said Coderre of Richardson.
Richardson left the clinic still accompanied by her ski instructor and returned to her suite at the nearby luxury hotel where she was staying. Once there, her condition began to deteriorate. "She came back to the hotel [after the accident] and the instructor was right with her and took her to the room," a source tells PEOPLE.
Still Lucid"The instructor called the [hotel's] general manager and said Richardson had a headache and she was not feeling well. The GM went to see her and said she was going to call an ambulance. Richardson said she didn’t need an ambulance or a doctor – and the GM insisted that an ambulance come and get her."
Another call was placed from the hotel to the paramedics at about 3 p.m. and an ambulance arrived nine minutes later, according to Yves Coderre. He says Richardson was still lucid and coherent when she spoke to paramedics, but her condition had worsened and there were signs she might be in danger.
"[The paramedic] saw something that wasn’t right," says Coderre. "He saw some signs indicating her condition was destabilizing. He called ahead to the hospital to let them know of her condition and he put the siren on." Coderre declined to specify what the exact signs were.
The ambulance carrying Richardson left Mont Tremblant at 3:47 p.m. for Centre Hospitalier Laurentian in Sainte-Agathe-des-Monts, a small hospital some 25 miles away, where Richardson was stabilized, transferred to an ambulance and began the trip to the trauma center of Sacre-Coeur hospital in Montreal, a distance of 52 miles. She arrived there close to 7 p.m., according to Toronto’s Globe and Mail newspaper.
(Coderre’s timeline conflicts with a press release issued by the ski resort Tuesday stating that medics were called to Richardson’s hotel room about an hour after her fall. The resort did not respond to an email seeking further comment on the sequence of events.)
No Helicopter AvailableWhy had it taken nearly six hours for the patient to arrive at a facility capable of treating her critical needs?
Witnesses agree that Richardson herself repeatedly declined to be taken to a hospital. But once it became obvious that her condition required it, Quebec's antiquated medical evacuation system played a part: the region has no helicopters to move patients from the field to hospitals in Montreal – a situation that has already stirred controversy in the wake of Richardson’s death.
"Our system isn't set up for traumas and doesn't match what's available in other Canadian cities, let alone in the States," Tarek Razek, director of trauma services for the McGill University Health Centre in Montreal, which represents six of the city’s hospitals, told the Associated Press. Montreal and its suburubs, the second largest urban region in Canada, has a population of more than 3.6 million. Richardson was treated in the intensive care unit at Sacre-Couer and it is believed her husband, Liam Neeson, first saw his wife after her fall there sometime Monday night after abruptly leaving a Toronto film set.
On Tuesday, Richardson was flown from Montreal to New York in dire condition. One report said the actress was seen on a yellow stretcher wrapped in blankets as she made her final journey home with her worried-looking husband by her side. She was admitted to Lenox Hill Hospital in Manhattan and family members held vigil at her bedside. The family announced her death Wednesday evening.
Reporting by LIZ McNEIL and MARY GREEN