Panel supports fewer medevac flights

The Baltimore Sun

Maryland's emergency medical helicopters could fly fewer accident victims to hospitals without reducing survival or affecting quality of care for patients, a panel of experts told state officials yesterday.

Several panel members also questioned the size of Maryland's state-run helicopter fleet, which numbered 12 aircraft before a fatal crash Sept. 28, and the need for the state's eight regional medevac helicopter bases. The group, convened in response to the crash in Prince George's County that killed four people, called for a task force to reconsider how many aircraft Maryland needs and where they should be located.

The report stopped short of calling for a specific number of helicopters and bases, or making a precise recommendation on how many of Maryland's 4,100 annual medevac flights might be excessive. But the findings could have implications for a $120 million proposal to replace Maryland's state-run medevac helicopter fleet, a plan under way before the crash.

Del. Norman H. Conway, a Wicomico County Democrat who chairs the House Appropriations Committee, said the panel's recommendations and a budget-slashing mood in Annapolis would trigger reconsideration of both the scope and timing of the helicopter replacement plan. But Conway, among the strongest medevac backers in the General Assembly, said he still believes the system is crucial to his constituents on the lower Eastern Shore.

"I would want to have a good, complete, full discussion" before making any decisions, Conway said.

Rick Abbruzzese, a spokesman for Gov. Martin O'Malley, said it was "too soon to tell" whether the panel's findings would affect the governor's continued support of the replacement plan.

"The governor is committed to the Medevac program," Abbruzzese said. "This will continue to be a topic of debate and discussion in Annapolis."

State emergency medical officials formed the seven-member panel in part to address criticism that the system flies too many patients unnecessarily - often a heated subject in Maryland, whose pioneering trauma center was the first to champion the "golden hour" concept of rapid medical transport. Two accident victims involved in the recent crash initially had no apparent injuries but were flown based on a protocol that also considers the condition of an accident victim's vehicle.

Maryland has already implemented a new triage procedure in response to the crash, instructing medics to consult with hospital doctors before summoning flights for patients without obvious injuries. And the panel's report concluded that the revised procedure is appropriate, saying some degree of "over-triage" is necessary to ensure patients with hidden injuries aren't turned away.

Still, the panel noted that more than 40 percent of Maryland trauma patients are discharged in less than a day, and concluded: "There is a high likelihood that opportunities exist for reduction in Maryland's [helicopter] transport of trauma patients without compromising patient outcomes or the quality of care."

Dr. Robert C. MacKersie, a San Francisco trauma surgeon who chaired the panel, called the recommendations a "further enhancement of an already very good system," and members repeatedly praised Maryland's trauma network as a model for the nation. They also called for some specific changes that could restructure much of the state's helicopter program if implemented.

The report recommended Maryland comply with national accreditation standards that require each helicopter to carry two medical providers on each flight, rather than the single paramedic used today. The Maryland State Police employs 45 flight paramedics, a number that would conceivably double if the proposal were adopted.

The experts also called for the state to meet Federal Aviation Administration standards for commercial medevac helicopters, which Maryland can circumvent because patients are not charged. Maj. A.J. McAndrew, commander of the State Police Aviation Command, said the service already meets most of the FAA's standards for equipment and maintenance but would probably have to implement a new record-keeping program and hire people to operate it.

And the panel called for something of a cultural shift, saying Maryland's trauma and helicopter system is overly focused on speed and not enough with quality and appropriateness of care before patients reach a hospital.

Dr. Robert R. Bass, executive director of the Maryland Institute for Emergency Medical Services Systems, said he expects the system's board members, who will formally receive the report in several weeks, to give the findings strong consideration.

"We do think we're a model for other systems, and we want to continue to be a model," Bass said.

But one member of the panel said the state might find the conclusions difficult to handle. Several proposed changes will probably cost money. And re-examining the value of widespread helicopter use could be tricky in Maryland, where the integrated trauma system was essentially invented.

"I think when people go back and look at the recommendations, they're going to see that it's a significant change, not only in the system in Maryland but also in the culture," said Dr. Bryan E. Bledsoe, a Nevada emergency room physician and frequent critic of medical helicopter use. "And I think that's what needs to happen. You're talking about a very expensive technology with questionable benefit."

The panel called on Maryland to monitor the relationship between helicopter use and benefits for patients. Flights have dropped more than 50 percent in the seven weeks since the crash, with no discernible change in patient survival. Maryland should continue collecting data to see whether that trend continues, the report suggested.

Del. Dan K. Morhaim, an emergency physician who attended yesterday's briefing said money could be redirected to other medical needs if Maryland's medevac system can be smaller without affecting patient care.

"If there are fewer helicopters, we can spend more money on the other aspects of emergency medicine - supporting our career and volunteer fire companies, homeland security, things like that," said Morhaim, a Baltimore County Democrat. "Maybe we can spend some of that money to reduce the kind of problems that bring patients to emergency rooms and trauma centers in the first place."

Baltimore Sun reporter Gadi Dechter contributed to this article.


The panel that reviewed medevac helicopter use in Maryland presented these recommendations:

* Reconsider whether Maryland needs 12 helicopters and eight bases. Several members called the fleet excessive.

* Adopt national accreditation guidelines mandating two health care providers on each flight, instead of the single paramedic used now.

* Monitor recent changes in triage to see if they continue to reduce the number of patients flown. Fewer patients can probably fly without affecting outcome.

* Comply with the same FAA standards as commercial helicopters.

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