HAGERSTOWN -- When there's a crash on Interstate 81 or on a rural road, or there's a motorcycle spill at the nearby Hagerstown Speedway, the volunteer ambulance corps in the small mountain town of Clear Spring jumps into action.
Until this month, its members would dash to the scene, then speed the patient to the regional trauma center 15 or 20 minutes away in Hagerstown.
But in the first 10 days of June, seven patients attended by the staff of the Clear Spring Ambulance Company have been flown by state police helicopter past Hagerstown to the Maryland Shock Trauma Center in Baltimore or west to a regional trauma center in Cumberland.
After local surgeons refused to continue to provide the required round-the-clock trauma staffing -- a problem some say will be felt at other nonmetropolitan hospitals as well -- Washington County Hospital abruptly shut its trauma center June 1, the first time a state trauma center had suspended service. Hospital officials hope the closing will prove temporary.
For the first week and a half, helicopters were available for all trauma calls in the county. But what worries the people who staff the county's emergency medical system is what will happen when the helicopters are grounded by the weather. The state's system of regional trauma centers and MedEvac copters was created to treat virtually all trauma patients within 60 minutes of injury, the "golden hour" after which there is usually less chance of saving the badly injured.
"It's at least a 45-minute drive to Cumberland and an hour and a half to go to Baltimore," said James Miller, chief of the Clear Spring volunteers. "Either way, the golden hour is shot."
Dan Shealy, a medic at the Williamsport Volunteer Ambulance Service, concurred. "It's only a matter of time until it's a rainy day, somebody wrecks, and it's, `Have a nice trip,'" he said.
Even when the helicopters are flying, it can take nearly an hour to get a patient to a trauma center. It takes 20 or 30 minutes for a state police helicopter to arrive, depending on whether the nearest, based in Frederick, is available or whether one is sent from Cumberland or Baltimore. It takes an additional 30 minutes or so to fly to a trauma center.
Apart from potential delays in care, Washington County EMS workers also worry about ambulances and staff members being out of the county for a three-to-five-hour round trip to Baltimore or Bethesda, said Joe Kroboth, county director of emergency services. Of the nine EMS stations in the county, several have only two ambulances, Kroboth said. The Clear Spring station, with three ambulances, is typically staffed by only two people during the day.
Although the hospital is hoping to reopen its trauma service within a few months, in the interim there are extra costs for the state police and for local rescue companies.
Capt. Carl Lee, assistant commander of the state police aviation division, said the MedEvac helicopter at Norwood, in northern Montgomery County, has gone from 20-hour operation to 24 hours since the Hagerstown trauma shutdown, triggering overtime payments for its staff. That's designed to provide more coverage for Central Maryland, freeing the Frederick-based helicopter for Washington County runs.
Also, he said, there's an added cost for each flight, and there have been quite a few more flights. In addition to the extra flights that have ferried patients out of Washington County, helicopters are being dispatched whenever a potential trauma case occurs rather than waiting for medics to arrive and assess the patient, a pre-emptive move designed to shave five or 10 minutes off the time for treatment.
"We call; they haul," said Brigitte Heller, EMS management specialist for the Washington County Volunteer Fire and Rescue Association.
20 flown out of county
Through the first 10 days of the month, 20 patients were flown out of the county, and helicopters were started 28 times, Kroboth said. Some of the choppers turned back after they started or got to the accident scene and decided air transport wasn't needed. Lee said the extra costs have not been tallied.
The rescue companies are wondering whether they, too, need to add more staff or equipment. Miller said the Clear Spring company bought two more backboard-and-head-block sets, at about $200 each, to make sure there's enough in Clear Spring while some of the equipment is tied up on flights to Baltimore.
People in Washington County have been "very, very upset" about the closing of the trauma service, said Penny Nigh, a member of the Hagerstown City Council.
Nigh was one of about three dozen people -- most in EMS uniforms -- who went to the volunteer firehouse in the Hagerstown suburb of Halfway Wednesday evening to express concerns and ask questions. A number of the questions had to do with how to decide whether to fly a patient out or drive to the emergency room in Hagerstown.