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Health

A look at Maryland's emergency medical system

The state of Maryland created one of the nation's first statewide emergency medical systems to ensure that patients got consistent and timely care no matter where they were. The Maryland Institute for Emergency Medical Services Systems now oversees and coordinates the providers from the field to the emergency department, according to James W. Brown, director of educational support services, from headquarters in Baltimore.

When was MIEMSS formed and what are its responsibilities now?

The statewide EMS system had its origins nearly 50 years ago when plans were developed by Dr. R Adams Cowley to create a statewide system and to transport serious trauma patients by Maryland State Police helicopter. In the early 1970s, education programs were implemented to train ambulance personnel, standards of emergency care were established and transportation and communications systems were developed. In 1973, the governor issued an executive order that established the Maryland Institute for Emergency Medicine and a Division of EMS. Both entities were subsequently combined into the Maryland Institute for Emergency Medical Services that consisted of EMS Field Operations, the R Adams Cowley Shock Trauma Center, and the National Study Center for Trauma and EMS Systems.

In 1993, MIEMSS became an independent state agency, governed by an 11-member EMS board. A statewide EMS advisory council, comprising representatives from organizations involved in providing emergency care services, was created to advise and assist the board. The Maryland Emergency Medical Services System is a coordinated statewide network that includes volunteer and career EMS providers, medical and nursing personnel, communications, transportation systems, trauma and specialty care centers and emergency departments. MIEMSS oversees and coordinates all components of the statewide EMS system, including planning, operations, evaluation and research. In addition, MIEMSS provides leadership and medical direction, conducts and supports EMS educational programs, operates and maintains a statewide communications system, designates trauma and specialty centers, licenses and regulates commercial ambulance services and participates in public education and prevention programs.

How many emergency personnel are there in Maryland and how are they distributed?

There are currently 27,016 emergency medical services providers in Maryland. More than half are volunteers, while others are employed as career EMS providers by public service agencies and/or commercial EMS services. Maryland EMS providers are divided into two areas: Basic Life Support and Advanced Life Support. Basic is provided by state-certified emergency medical dispatchers, emergency medical responders and emergency medical technicians. Advanced is provided by state-licensed cardiac rescue technicians-99 and paramedics.

How is uniform training of emergency responders and trauma centers ensured?

Volunteer and career pre-hospital personnel are certified or licensed by MIEMSS and authorized to provide care in accordance with the Maryland Medical Protocols for EMS Providers. All volunteer and career EMS personnel are trained to the same levels throughout the state. These protocols are updated annually. Providers must take continuing education programs and advanced providers are re-licensed every two years and basic providers are re-certified every three years. The trauma and specialty centers must submit applications to MIEMSS, complete the initial designation process and be re-designated every five years. They are also constantly reviewed through various processes.

How do dispatchers in the local jurisdictions and at headquarters decide where patients are sent?

It is imperative that all seriously ill and injured patients be delivered in a timely manner to the closest appropriate facility. When a call comes into a local jurisdiction for medical assistance, emergency medical dispatchers follow protocols in determining what resources to send to the scene and when to provide pre-arrival instructions to the caller before the EMS providers arrive. The provider in the field decides where the patient goes depending on the patient's needs. Maryland's EMS communication system — one of the first statewide systems in the country — integrates the entire EMS system in Maryland and allows the provider to receive medical direction if needed. Through the use of radio and microwave technology, the statewide communication system links ambulances, helicopters, and hospitals and allows communication between system components at anytime. For example, a paramedic on-scene with a patient in Western Maryland can talk directly with a local emergency department physician or, if needed, can obtain medical consultation from a specialty center in Baltimore. All local 9-1-1 centers are staffed with certified emergency medical dispatchers.

Because of the high volume of EMS calls in certain areas of the state, a communications center at MIEMSS assists with the heavy demand for medical communications. The Emergency Medical Resources Center coordinates medical consultation between medic units and hospital physicians.

How do hospitals become designated for certain specialties such as trauma or cardiac care?

There are 48 hospital emergency departments in Maryland. When patients need a higher level of care, MIEMSS has designated trauma centers and specialty referral centers including ones for burns, spinal cord injuries, pediatrics, eye, hand/upper extremity, hyperbaric, neurotrauma, perinatal, stroke and cardiac centers across the state. These hospitals apply to MIEMSS to be designated, which includes documentation on the facilities capabilities, data from their admissions, as well as a site survey with outside experts in the field.

What does the system cost and where does funding come from?

Funding for the EMS system is supplied through an automobile registration surcharge of $11 that goes into the Maryland EMS Operations Fund. Currently the fund generates $52,319,166. These funds are divided up between MIEMSS, the Maryland Fire Rescue Institute, the Maryland State Police Aviation Command, the Maryland Shock Trauma Center and the Amoss Fund, which goes to assist local volunteer companies.

meredith.cohn@baltsun.com

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