Maryland has already implemented a new triage procedure in response to the crash, instructing medics to consult with hospital doctors before summoning flights for patients without obvious injuries. And the panel's report concluded that the revised procedure is appropriate, saying some degree of "over-triage" is necessary to ensure patients with hidden injuries aren't turned away.
Still, the panel noted that more than 40 percent of Maryland trauma patients are discharged in less than a day, and concluded: "There is a high likelihood that opportunities exist for reduction in Maryland's [helicopter] transport of trauma patients without compromising patient outcomes or the quality of care."
Dr. Robert C. MacKersie, a San Francisco trauma surgeon who chaired the panel, called the recommendations a "further enhancement of an already very good system," and members repeatedly praised Maryland's trauma network as a model for the nation. They also called for some specific changes that could restructure much of the state's helicopter program if implemented.
The report recommended Maryland comply with national accreditation standards that require each helicopter to carry two medical providers on each flight, rather than the single paramedic used today. The Maryland State Police employs 45 flight paramedics, a number that would conceivably double if the proposal were adopted.
The experts also called for the state to meet Federal Aviation Administration standards for commercial medevac helicopters, which Maryland can circumvent because patients are not charged. Maj. A.J. McAndrew, commander of the State Police Aviation Command, said the service already meets most of the FAA's standards for equipment and maintenance but would probably have to implement a new record-keeping program and hire people to operate it.
And the panel called for something of a cultural shift, saying Maryland's trauma and helicopter system is overly focused on speed and not enough with quality and appropriateness of care before patients reach a hospital.
Dr. Robert R. Bass, executive director of the Maryland Institute for Emergency Medical Services Systems, said he expects the system's board members, who will formally receive the report in several weeks, to give the findings strong consideration.
"We do think we're a model for other systems, and we want to continue to be a model," Bass said.
