Speed may not matter when it comes to the risk of brain injury during recreational activities.Speed may not matter when it comes to the risk of brain injury during recreational activities. (CBC)

Many brain injury experts want helmets to be required on ski hills and for other sporting and recreational activities, saying it doesn't take much to harm the brain.

It's not clear whether a helmet would have averted the death of British actress Natasha Richardson. The 45-year-old died this week of a blunt impact to the head, medical examiners said, after falling at Quebec's Mont Tremblant ski resort.

Quebec's emergency medical system questioned

In Quebec, the death of actress Natasha Richardson has shed new light on what some call a serious hole in the province's emergency medical system.

Unlike most provinces, paramedics in Quebec have no emergency medevac helicopter, which trauma surgeons and first responders say could lead to unnecessary deaths.

"If there is an accident like we saw with Natasha, there is no way to get someone to a trauma centre in any given time because we don't have a helicopter," said Daniel Gavin, who has been a paramedic for 24 years.

Helipads on the roofs of Montreal hospitals are barely used, Gavin said.

The head of one trauma department warned skiers to wear a helmet, saying they would likely never make it to his hospital in time if they're injured on the slopes.

Quebec coroner Jacques Robinson said even a helicopter may not have saved Richardson, because it is difficult to tell if someone has seriously injured the brain in a fall.

No one from Quebec's health ministry was available to explain the province's lack of a medevac service.

Many parents know the dangers and take precautions when their children participate in activities such as ice skating.

Lee Pioriello of Toronto straps helmets on to his three grandchildren, but doesn't wear one himself.

"I'm a slow skater," he said.

But many brain injury experts said speed may not matter during recreational activities.

"You don't have to hit your head hard at all," said neurosurgeon Dr. Simon Walling of Dalhousie University in Halifax. "In fact, you can end up with a serious brain injury just from falling on to the floor. The skull is incredibly thin in some places."

'Talk and die'

Doctors know what to look for in a patient who has fallen and may have ruptured a blood vessel in their skull.

The condition is called "talk and die," because the patient may feel fine after the injury, but within hours, the blood clot that forms cuts off circulation to the brain.

"It's a fairly rare event for the vast majority of the hundreds and hundreds of head injuries that we see," Walling said. "But we do recognize that it happens and it has such tragic consequences if it's not recognized quickly."

The Canadian Institute for Health Information's latest figures, which do not include those from Quebec, indicate 138 people were hospitalized across Canada in 2005-2006 because of a head injury sustained while skiing or snowboarding.

Emergency room doctors called on Quebec last month to make helmets mandatory.

Quebec Sport and Leisure Minister Michelle Courchesne said she would consider the idea in time for next year's ski season.

With files from Canadian Press