Maryland should create a Cabinet-level department to oversee emergency services and consider allowing a private company to run the state's helicopter transport fleet, say two lawmakers who pledged yesterday to spearhead reform during the legislative session that begins next month.

Maryland's medevac system for ferrying accident victims is expected to come under renewed scrutiny by the General Assembly after a September crash in Prince George's County killed four people. Sen. John C. Astle, an Anne Arundel County Democrat and retired helicopter pilot who flew medevac missions, and Sen. E.J. Pipkin, an Eastern Shore Republican, are working on legislation to overhaul the beleaguered system.

While Gov. Martin O'Malley's office said he had not reviewed the proposals, aides said the Democratic governor would not oppose elevating emergency management to a Cabinet-level agency, though the details would need to be examined.

O'Malley "looks forward to working with the General Assembly to ensure that Maryland's medevac system continues as a national model for first responders," spokesman Shaun Adamec said.

Astle and Pipkin, who sit on the Finance Committee, also call for splitting the helicopter program managed by the Maryland State Police into two fleets.

One would provide emergency medical services and be operated by either Maryland State Police or private contractors, depending on the winner of a bidding process. The other would serve law enforcement, homeland security and search-and-rescue functions.

State police leaders will review the proposals, spokesman Greg Shipley said. He declined to address the suggested changes but said that the system has worked well with one platform that includes medevac as well as the other functions.

"Ultimately the hard decisions about the future of Maryland's medevac program will be made by the members of the General Assembly, and we know they are very concerned about this," Shipley said. As part of the proposed legislation, safety standards would be changed to require that two medical crew members are on flights, rather than the single paramedic used now, and to meet national accreditation as well as Federal Aviation Administration standards, which Maryland can circumvent because patients are not charged.

Those recommendations also were made last month by a panel of experts convened by the Maryland Institute for Emergency Medical Services Systems, which oversees patient flights, after the fatal crash that ranked as the deadliest accident since the force started flying medevac missions nearly four decades ago.

"There have been some shortcuts taken that don't necessarily give us the safest possible operation," Astle said.

In addition, the lawmakers want to allow for reimbursement from private insurers and to ensure the dispatch system is run by medical providers.

While the lawmakers insist that their proposal would save money, system upgrades could prove costly and would likely be met with resistance from lawmakers who will be struggling to fill a nearly $2 billion budget shortfall next year. The medevac system is funded through fees residents pay on vehicle registrations, which generate $55 million a year.

The state medevac program, often credited with helping to pioneer the treatment of patients within the first "golden hour" as promoted by Shock Trauma founder R Adams Cowley, had been the subject of a critical legislative audit last summer that found problems with maintenance and data tracking.

Lawmakers also have debated replacing the aging fleet, which numbered 12 before the accident, and have budgeted about $120 million over the next four years. But the expert panel concluded that the state could run fewer flights without reducing survival rates, and some now question whether the expenditure is necessary.

But Pipkin said too much of the recent focus has concerned the number of medevac flights - 4,100 annually - instead of the number of lives saved.

He and Astle said their proposals would make the system more cost-effective and safe and said that creating a new department would not create a bigger bureaucracy but instead would streamline the operations. Pipkin said he would add a new board to give paramedics a voice and eliminate the department head earning more than $200,000 a year at the Maryland Institute for Emergency Medical Services Systems. That position is now held by Dr. Robert R. Bass, who couldn't be reached for comment.

"This is a bureaucracy that has grown out of control," Pipkin said, holding up an organization chart for the current system.

The lawmakers said they expect their proposals to provide the framework for intensive discussions during the legislative session. They said they have not spoken to legislative leaders, nor the governor's office, but expect resistance from the current system, spread across several agencies. They noted that an organized lobbying effort includes having patients and emergency medical personnel write e-mails to lawmakers.