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Experts tell state medevac program is worthwhile
Panel was asked to weigh in after September crash killed 4 passengers
Wednesday, Dec. 3, 2008
"I would without question put a family member in the care of the program in Maryland," said panel member Tom Judge, executive director of LifeFlight of Maine.
The crash occurred during a flight that began at the scene of a Waldorf car accident Sept. 27. The helicopter crashed shortly after midnight Sept. 28.
The four people who died in the crash were state police pilot, Stephen H. Bunker, 59, of Waldorf; state police flight paramedic, Mickey C. Lippy, 34, of Westminster; an EMT with the Waldorf Volunteer Rescue Squad, Tonya Mallard, 38, of Waldorf; and Ashley J. Younger, 17, of Waldorf, who was a passenger in the car that crashed, according to a state police news release. All were pronounced dead on the scene.
Jordan A. Wells, 18, of Waldorf, the driver in the initial car wreck, survived the helicopter crash.
Younger came home from a Baltimore hospital last week.
Seven emergency medicine experts from around the country took about four hours of testimony last week and then spent as many as nine hours more considering recommendations for the helicopter program, which is run by the Maryland State Police and the Maryland Institute for Emergency Medical Services Systems.
One of the recommendations at the Sept. 17 hearing would require state police to use the same flight rules that govern commercial aircraft instead of the rules that oversee private aircraft. The differences would affect equipment, maintenance and pilot testing.
It also would mean the aircraft would fly less in bad weather, said Maj. Andrew J. McAndrew, commander of the state police aviation division.
Weather was a factor in the Sept. 28 crash. A state police helicopter was flying two accident victims in fog from Waldorf to the Prince George's Hospital Center when the chopper went down.
Many of the flight rules already are in place, McAndrew said. To fully comply with the new rules would require more record keeping, with a ballpark cost of $500,000, he said.
Robert C. MacKersie, director of trauma services at San Francisco General Hospital in California said the medevac program should seek accreditation with the Commission on Accreditation of Medical Transport Systems. That would mean the helicopters would fly with two paramedics, instead of one, which is the current practice.
Some procedures are difficult to perform with one person in an emergency room; in the field, it could be even more difficult, said Dr. Bryan Bledsoe, a panel member who is a clinical professor of emergency medicine at the University of Nevada School of Medicine.
The panel also recommended that MIEMSS convene a task force to study the number and distribution of helicopters, which could mean a reduction of the 12-chopper fleet. But panel members said they lacked the data to offer a specific recommendation on the number of helicopters the state needed.
"That's not something a group of guys spending eight hours in Maryland can do," said Dr. John A. Morris, director of the LifeFlight Patient Care Center, Vanderbilt University Medical Center in Nashville, Tenn.
MacKersie praised the Maryland emergency medical system as one of the best in the country.
"This has the potential for change, and change, hopefully, that will result in an enhancement of this system that will take the nation to the next level," he said.
The panel heard MIEMSS representatives describe the program, which was started in 1970 by Dr. R. Adams Cowley and led to the famed Shock Trauma Center at University of Maryland Hospital in Baltimore.
About 15 people, most of whom work in emergency medicine, offered testimony that largely praised the program.
Dr. Robert Bass, executive director of the Maryland Institute for Emergency Medical Services Systems, asked the group to meet in the wake of the crash.
"There's no question in my mind that helicopters can benefit. The question is, ‘What patients and when?'" Bass said after the session.
One lawmaker told reporters the session was a "public relations stunt." Sen. E.J. Pipkin criticized the bureaucracy surrounding EMS and the protocols used to transport accident victims to regional trauma hospitals.
"I want to make sure [changes are] based on how many lives are saved, and if it means more resources have to go to ground EMTs, then so be it," said Pipkin (R-Cecil).
Bledsoe has been a critic of helicopter programs because they are overused. Current research, he said, shows that the time it takes to get a patient to a trauma hospital does not predict outcome.
"Then, what is the role of the helicopter? That is not clear. This isn't just a Maryland problem; it's a global problem," Bledsoe said.
First responders typically call for a helicopter after observing an accident scene. Following the crash, the state changed the rules on how to handle patients who might require a medevac flight based on less-obvious factors, such as age or the severity of the accident.
Previously, a consultation between on-the-scene emergency medical personnel and emergency room doctors was optional. Now it's mandatory.
The helicopter program has faced legislative scrutiny for years. Several of the 11 remaining helicopters are 19 years old, and lawmakers have been pushing state police for proposals on replacing the fleet.
In August, legislative auditors faulted the state police management of the helicopter program, making it difficult to pin down costs that would measure the benefit of new aircraft, which can cost between $15 million and $18 million each.
"The question is, do we lease, do we retrofit or do we purchase? Those questions are still out there," said Sen. Ulysses Currie (D-Prince George's). Currie, who chairs the Senate Budget and Taxation Committee, was among the audience Monday of about 50 at the Four Points Sheraton at BWI Thurgood Marshall Airport.
After receiving testimony, the panel met privately to consider its recommendations. No written report is available yet. MacKersie delivered the panel's findings and recommendations verbally.
A preliminary report will be delivered to the 29-member Statewide EMS Advisory Council next month, and a final report is expected in January, MacKersie said.
State police helicopters fly between 4,000 and 5,000 trauma patients a year, according to data presented at the meeting.
Since the crash, helicopters have flown 226 missions, which would annualize to 1,679, Bass said. He attributed the drop-off to apprehension on the part of first responders to summoning choppers.
Del. Dan K. Morhaim, an emergency room physician, monitored the session.
He testified that the state should put more money into efforts that would prevent accidents in the first place, such as programs to encourage bicycle helmets.
The recommendations are just a start, he said. "But one thing that came through was how much information is needed and needs to be collected," said Morhaim (D-Baltimore County).
For example, the state should be able to generate data comparing patients who can't be transported because of bad weather that could help paint the program's value, he said.
