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Shock Trauma control of EMS is criticized Surgeon endorses independent oversight


The leader of a group of doctors representing Maryland trauma hospitals said yesterday that the nationally recognized Shock Trauma Center should be stripped of control of the state's Emergency Medical System.

Dr. Timothy G. Buchman, president of the Maryland Trauma Center Network, called a news conference to urge the state to create a "medical triage and transportation authority," independent of any hospital, that would run the system.

The Emergency Medical System directs the state's trauma care, setting standards for emergency medical workers and dispatching the state's medical evacuation helicopters.

In a separate news conference, the state's volunteer firefighters complained that Shock Trauma officials have not consulted them on important decisions effecting the system. They cited a recent move to restrict use of a controversial device that clears the air passages of accident victims.

At his news conference, Dr. Buchman said Shock Trauma's new director, Dr. Kimball I. Maull, has eroded the center's traditional arm's-length relationship with the University of Maryland hospital.

(Both institutions have been operated by the same non-profit corporation, the University of Maryland Medical Systems, since 1984. But under its founder and first director, the late Dr. R Adams Cowley, Shock Trauma remained autonomous.)

This spring, Dr. Maull gave himself the title of state EMS director. On July 1, he transferred the care of patients suffering from knife and gunshot wounds from the university's emergency room to )) Shock Trauma. Last week, Dr. Maull fired three surgeons at Shock Trauma, accusing them of opposing his decisions.

Dr. Buchman, a Hopkins trauma surgeon, said the past independence of the center ensured that the EMS sent patients where they would get the best treatment.

The recent changes, he suggested, may give Shock Trauma an incentive to absorb more patients instead of sending them to other trauma centers.

If other hospitals decide "that patients are being rationed to any particular institution for political or economic reasons," Dr. Buchman warned, they may drop out of the state's trauma network.

Dr. Rhonda Fischel of Sinai Hospital, another officer of the network, said: "In order to maintain strong trauma centers, it's important to see a significant amount of trauma on a regular basis."

Ellen Beth Levitt, a spokeswoman for the University of Maryland hospital, said there has been no merger of Shock Trauma with the hospital, only a shift in the care of some trauma patients.

She denied that patients would be diverted from other hospitals.

Dr. Buchman would not say how many of the doctors representing the 10 hospitals in the group endorsed his statement, or even whether a majority did so. None opposed it but some abstained, he said.

The hospitals in the network are scattered around the state, and include Peninsula General Hospital in Salisbury, Prince George's Hospital Center, Washington County Hospital, Shock Trauma and the University of Maryland hospital.

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