State emergency medical officials said yesterday that some ambulance crews in Maryland are "skittish" since a fatal medevac helicopter crash in September and might be too reluctant to transport accident victims to the hospital by air.
The concern was raised as members of an expert panel exploring the state's emergency medical system said they will take a critical look at the state's heavy reliance on helicopter transport. One even challenged the "golden hour" dictum born in Maryland that says patients should reach a hospital within an hour of injury.
Convened in response to the Sept. 28 crash in Prince George's County that killed four people, the seven-member panel plans to issue a report today on whether Maryland makes appropriate use of transport helicopters. Two patients involved in the crash were flown based on the condition of their wrecked vehicle, rather than apparent injuries, sparking a review of state medevac guidelines.
After hearing presentations from emergency medical officials yesterday, panel members were largely complimentary of Maryland's emergency medical system, calling it a national model.
Dr. Robert C. MacKersie, a San Francisco surgeon, said he hopes the group's work can spark a broader discussion leading to national triage guidelines.
But some members expressed skepticism about a heavy reliance on helicopters to transport accident victims to the hospital, a practice whose value has proved difficult to verify through study. One panel member, Vanderbilt University trauma surgeon John A. Morris Jr., questioned whether Maryland puts too much emphasis on getting patients to a trauma center as quickly as possible, a concept that has also never been validated by scientific evidence.
"I know that time is easy to quantify, and I know that I am in the home of the golden hour," Morris said, referring to the phrase coined by Shock Trauma founder R Adams Cowley. "However, I think it is naive to think in 2008 that the value of helicopter transport is time-based. The value of helicopter transport nationally is quality-of-care based."
One member of the panel, Nevada physician Bryan Bledsoe, has published studies raising doubts about whether helicopters get patients to a hospital faster and save more lives than ground ambulances.
Bledsoe and Morris said they were surprised to learn that Maryland's medevac flights carry one paramedic, while typical flights in other states include two health professionals.
