How to heal Shock Trauma

March 10, 1993

Politics and Maryland's famed shock-trauma emergency medical system are so intertwined it may be impossible to separate the two. That was clear from the five-hour hearing this week in Annapolis over the latest furor to rock the medical system. Coming up with a plan that improves oversight and coordination but does not impinge on the Shock Trauma Center's high level of care is what state legislators should aim to achieve.

Separating both the Shock Trauma Center in Baltimore and the statewide EMS network of Medevac helicopters and ambulance and rescue units from the University of Maryland would be a mistake. It is not UM's control of the shock-trauma system that is at the heart of the current turmoil there but the abrasive personalities involved. Now that most of these individuals have been removed from the scene, there is no need for major open-heart surgery.

Yet given the upheaval that has already taken place, certain changes do seem appropriate. A gubernatorial commission is recommending that the EMS network be spun off under a new panel that answers directly to the governor. This might finally provide the kind of firm, centralized control that the EMS network long has lacked. This impartial panel would coordinate and crack the whip over the statewide system. That is especially important when it comes to imposing medical-care standards on volunteer and paid fire and rescue squads.

Separating the Shock Trauma Center from the University of Maryland Medical System should not even be considered. A close linkage between the two medical providers is absolutely critical to the success of the center. The link cannot be severed without seriously affecting the quality of care -- or costing the state tens of millions of dollars each year to set up an expensive stand-alone trauma hospital. Losing the tie-in with the UM medical school would also prove devastating.

We agree with the General Assembly's own analyst, who studied the shock trauma situation and recommended that the legislature "act cautiously before making major changes to a system that has worked so well for the state."

Most of the problems at shock trauma, the analyst concluded, can be resolved "primarily by establishing a strong oversight committee with policy-making authority for EMS." The governor's plan would do just that. It would give the statewide system the kind of firm guidance it has never had before while leaving the Shock Trauma Center's ties to the UM hospital intact. That may allow a much-need healing process to begin.

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