Defining the golden hour

Our view : State police need to produce credible data to support purchase of new choppers by showing that reasonable response times are being achieved

August 26, 2008

There is a golden hour between life and death. If you are critically injured, you have less than 60 minutes to survive." That's R. Adams Cowley, the pioneering physician and architect of trauma medicine who founded the nation's first shock trauma center in Baltimore, explaining the defining element of trauma care. It's because of Dr. Cowley's ground-breaking work that the Maryland State Police flew their first medevac transport in 1969. In the years since, medical advances have extended the golden hour in some instances, but the helicopter unit's work has continued to be founded on the concept. Still, a recent legislative audit has shown, the state police's clock is slightly off. The time element is critical not only to saving lives but also to developing and managing the emergency medical response fleet. Without reliable data, it's tough to assess if Maryland has too few or too many choppers in use today.

The issue is timely now because state transportation officials are getting ready to send out bids for three new choppers, the first of a planned $120 million purchase of 12 helicopters. The audit, requested by state legislators, found fault with the state police's flight time records, both their accuracy and compilation. And as far as the "golden hour" goes, the unit's concept doesn't compute with Dr. Cowley's. The clock starts running when state police aviators get the call for help, which is some time after an ambulance arrives on the scene of a car crash or a multiple shooting and medics assess the extent of injuries.

There's been no indication that the time discrepancy has cost lives, and the state police safety record exceeds the national standard. They claim 95 percent of their patients get to a trauma unit within the 60-minute golden hour, and their survival rate is 90 percent. But the Aviation Command readily conceded to legislative auditors that some of the data showed that choppers were delivering patients in 20 minutes, a near impossibility based on the unit's own determination of how long it takes to get the chopper in the air and down on the ground. That's unacceptable.

If the "golden hour" concept can't be reasonably applied to the use of the choppers, another relevant measure should be established to assess a chopper's response time.

State transportation officials are going forward with plans to purchase the three choppers this fiscal year. But until the time difference is reconciled with either new measures or record-keeping systems, no other choppers should be purchased. Accountability has to be a priority, and one way to help ensure that would be to set up an independent compliance unit within the state police.

Another area of concern was helicopter maintenance. The fleet is aging, there's no doubt about that, and helicopter repairs take longer than they should in part because spare parts are in demand. (The military is a big competitor.) The audit's finding that a third of the helicopters were out of service for 51 days during the year that ended June 30 suggests the need for an updated and improved maintenance schedule.

The state police medevac choppers are a critical aspect of the live-saving work at the R. Adams Cowley Shock Trauma Center at the University of Maryland Medical Center. State police must make that case with credible data supporting the need for their replacement.

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