Support for medevacs

Our view: An expert panel took a critical look at Maryland's emergency medical system and offered sound advice on how to improve service without compromising patient care

November 28, 2008

It took outside experts to say what supporters of Maryland's much-praised emergency medical services system probably needed to hear: that Maryland State Police helicopters could fly fewer accident victims to trauma centers across the state without compromising the safety of patients or the integrity of the care. But now comes the tough part: acting on the panel's recommendations.

The findings of the seven-member panel may embolden critics of the system who say Maryland's emergency medical response system has come to rely on costly helicopter flights to transport accident victims to trauma centers when ambulances would get them to the hospital as quickly without compromising their health. Some of these same critics would like the state to scale back its plans to replace the 12-chopper fleet, at a cost of $120 million, and redirect some of the savings to medical needs that would serve the larger community.

But state lawmakers and budget analysts should proceed cautiously. The panel supported a state network rather than one that relies on private helicopters. That's a vote of confidence for the Maryland system, which pioneered this form of trauma care. Changes may be needed, but not if they compromise the quality of care and the state police's strong flight safety record. Fewer helicopters may be in order, but not at the expense of rural parts of the state that deserve the same access to top-flight medical care at trauma centers as citizens in the Baltimore metropolitan area.

The two-day review by a team of emergency medical specialists was prompted by September's crash of a state police chopper in Prince George's County in which four people died. The crash raised concerns about the medical criteria used to identify patients who should be flown to trauma centers. The two patients on the chopper were being flown based on the extent of damage to the car they were riding in, an accepted protocol that takes into account possible unseen internal injuries. Data from the Maryland Institute for Emergency Medical Services Systems also has shown that 43.7 percent of patients flown to trauma centers are released within 24 hours, a statistic that critics said suggested the choppers were used too often.

But the MIEMSS has been working for the past three years to reduce those numbers by improving and sharpening its criteria for flights. And since the September crash, medics on the ground have ordered fewer flights.

The expert panel has suggested that the MIEMSS review the number of patients that are transferred from hospitals to trauma centers via helicopter, which could play a role in deciding the size of the state police helicopter fleet. And it asked for additional personnel on board these flights, which would require additional resources.

The MIEMSS board is expected to review the panel's recommendations in January just as the Maryland General Assembly prepares to meet for its 2009 session. Reforms that preserve the integrity of the system and serve all Marylanders should be the goal.

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