www.baltimoresun.com/health/bal-md.medevac05sep05,0,1332561.story

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Medevac copters' usage curtailed, legislators told

Evolving rules reduce unnecessary flights, senior official says

By Gadi Dechter

September 5, 2008

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Maryland's medevac program this year implemented changes designed to reduce unnecessary use of state police helicopters, a senior official told lawmakers in Annapolis this morning.

Patients who are within a 30-minute drive to a trauma center must now be transported by ambulance, unless there are "extenuating" circumstances, said Dr. Robert R. Bass, head of Maryland's emergency medical response network.

He also said paramedics will no longer automatically send to trauma centers patients who have been involved in automobile roll-over accidents, high-speed crashes, vehicle extractions lasting longer than 20 minutes and other situations that were formerly believed to indicate a high likelihood of serious injury.

Bass, speaking to the Joint Committee on Health Care Delivery and Financing, was defending his agency's performance in light of statistics showing that almost half of the patients flown by helicopter to Maryland trauma centers are released within 24 hours - suggesting many of them may not have needed the costly helicopter flight.

Between 4,500 and 5,000 patients are transported to hospitals by the state's medevac unit every year, at a cost to taxpayers of about $4,000 per trip, Bass said.

The hearing, called by Del. Dan K. Morhaim, a Baltimore County Democrat and co-chairman of the committee, was also prompted in part by a legislative audit last month that was critical of the Maryland State Police's fiscal management and maintenance of the program's aging 12-helicopter fleet.

Morhaim, a former emergency room physician, praised Bass for taking steps designed to improve the medevac system's efficiency. But he and other legislators said the program's high cost and possibly "marginal" benefit to patients was still a concern at a time when politicians are looking for ways to cut the state budget.

"Clearly, you can't put a dollar value on saving a life," said Sen. Rob Garagiola, a Montgomery County Democrat and committee co-chairman.

"But we've got to make decisions in tight fiscal times," Garagiola added, referring to a list of currently underfunded health care programs, such as preventive care for mental health patients. "Can we use some [medevac] dollars for other aspects of the health care system?"

Morhaim questioned the value of helicopter transports, pointing out a recent review of scientific literature that concluded that there was "no measurable health benefit" to patients transported by air.

Bass, who is director of the Maryland Institute for Emergency Medical Services Systems, said the usefulness of medevac programs "is an ongoing source of debate" and that there are "plenty of articles suggesting they are effective."

He presented evidence from Maryland medical reports suggesting that seriously injured patients who were transported by helicopter were more likely to survive than those taken by ambulance or other ground conveyance.

Critical hearings into the state's medevac program - considered the oldest in the country and one of the best - will continue next week when the General Assembly's joint audit committee takes up the recent investigation by the legislature's Office of Legislative Audits.

Last month, auditors reported that the state police did not maintain up-to-date maintenance records for its helicopters, keep critical parts in stock or effectively manage parts inventories.

Given those and other problems raised by auditors, Sen. John C. Astle, an Anne Arundel County Democrat and former helicopter pilot, has said he and others on the audit committee would likely question the wisdom of purchasing new helicopters.

Many members of the General Assembly, particularly those in rural parts of the state, strongly support replacing the aging 12-helicopter fleet. Gov. Martin O'Malley has made a complete overhaul of the fleet by 2012 a goal of his administration.

"We may not be as rapid in the total replacement" given the current budget situation, said Del. Norman H. Conway, the Eastern Shore Democrat who is chairman of the House Appropriations Committee, "but I think we have to begin the process of replacement."

Yesterday, Bass told lawmakers that a consultant has estimated the replacement cost of the fleet at $130 million, though he cautioned: "We suspect it may be higher than that."