Bass, executive director of the Maryland Institute for Emergency Medical Services Systems, said the nurses are more important for the private runs, which generally ferry patients between hospitals with complex monitoring and medication needs. The state police do add help when needed, such as specialized nurses when transporting a newborn for intensive care or adding a second medic from an ambulance crew in certain accidents.
Last month, for example, the state police sent two helicopters to an accident in Bel Air that pinned a 15-year-old against a guard rail. One chopper went directly to the crash scene; the other stopped at Maryland Shock Trauma Center to pick up a surgeon and a nurse anesthetist. The patient was anesthetized to make it easier to extract him from the wrecked car. His leg injuries weren't as bad as expected, so the surgeon ultimately wasn't needed.
The state police fleet is used not only for trauma transport, but also for search-and-rescue missions, suspect chases, homeland security monitoring and other emergencies.
"We pull people out of the bay," Bass said. "We pull them off the top of burning buildings."
The question of public vs. private air transport also raises issues about who should pay.
Backers of the private companies contend a medevac flight is an ambulance ride, albeit at 1,000 feet - the kind of service generally billed to patients and insurers. But supporters of the current system said that while patients might be able to absorb a $300 or $400 bill for ground ambulance, the cost of a helicopter medevac at nearly $8,000 could be devastating. The private services counter that they don't hound patients who can't pay.
According to testimony at a hearing in November of a legislative task force studying a variety of trauma issues, for all its operations, the bulk in Pennsylvania, STAT collects most of its revenue - 77 percent - from private insurers. Another 15 percent comes from Medicare and Medicaid, and 8 percent out-of-pocket from patients.
A study by an actuary concluded that adding the cost of air transport to the $8.2 billion that Marylanders pay in insurance premiums would increase insurance costs by just two-tenths of 1 percent, STAT officials told legislators.
But the point remains one of contention: The medevac operators see public service as essential to their mission.
"The system does what it is supposed to do and it does it without financially devastating anybody," said Bass, the director. "I don't want to be the one that hands the keys over."
State policy-makers don't seem ready to hand over anything either. Health Secretary Nelson J. Sabatini, among others, described the system as a national model not in need of redesign.
"I don't think the task force is going to recommend moving forward on any kind of privatization," concurred Charles County Sen. Thomas M. Middleton, who chairs the Finance Committee and co-chairs the legislative trauma task force. "We have a wonderful shock trauma system, the best in the world."
At the task force hearing, Middleton recalled how his Southern Maryland constituents fought for years to win a medevac base. To give it up eventually for privatization "starts eroding away something people have fought long and hard for," he said.
Even Rupert, whose Colorado-based air ambulance company would like to serve Maryland, acknowledged the power of politics in the overall analysis.
"It's not going to change in my lifetime," he said of the current system. "The state police have the most powerful lobby in the state."