Nov 25, 2008 7:09 am US/Eastern
Medevac Flights Down Significantly Since Crash
LINTHICUM, Md. (AP) ―
Far fewer patients have been flown to Maryland trauma centers in the eight weeks since the fatal crash of a state police helicopter, the head of the agency that coordinates state's emergency response said Monday.
Dr. Robert Bass spoke before a panel that will recommend changes to Maryland's Medevac program on Tuesday. He said part of the decrease in flights since the crash can be attributed to a new protocol under which paramedics consult with trauma surgeons before deciding whether certain patients who don't have obvious injuries should be flown.
But Bass also said he was concerned that some patients who need to be flown are instead being taken to hospitals by ambulance.
"I think people are apprehensive," Bass said, adding that emergency care providers "don't want to be looked at as being people who abused the system."
Bass noted that the decision to fly the two patients who were in the helicopter that crashed Sept. 28 and killed four of the five people aboard "was completely consistent with protocols."
The two young women had been in a car accident and showed no obvious signs of trauma, but the state protocol calls for patients to be flown if their vehicles have sustained heavy damage, because such damage can cause internal injuries.
One of the car accident victims, 17-year-old Ashley Younger, was killed, along with the helicopter pilot, an in-flight paramedic and an emergency medical technician. The other car accident victim, 18-year-old Jordan Wells, survived the helicopter crash.
Wells spoke to reporters Monday at the University of Maryland Shock Trauma Center. She had her right leg amputated below the knee and suffered a broken neck, among numerous other injuries, and will face 6 to 12 months of rehabilitation, said Dr. Thomas Scalea, chief physician at Shock Trauma.
"I just wish that someone would find what's wrong with all these helicopters and fix them," Wells said, "so this won't ever happen again and no one would have to go through what I've been through."
Wells was released from the trauma center about two weeks ago and is now being treated at a rehabilitation center, said Cindy Rivers, a Shock Trauma spokeswoman.
Between the crash and Monday, 226 patients had been airlifted statewide, Bass said. At that pace, 1,679 patients would fly on medevac helicopters in a year. In the most recent fiscal year, 4,114 patients were flown to trauma centers, state aeromedical director Douglas J. Floccare told the board.
"This is a difficult period," Floccare said. "There is some skittishness" about requesting medevac service.
The seven-member board gave little indication of what changes it might recommend. Dr. Robert C. MacKersie, director of trauma services at San Francisco General Hospital and the board chair, described its job as to "take what is undoubtedly a very good system and make it a lot better."
Some lawmakers have criticized the panel for not being sufficiently independent and for meeting in private before announcing its recommendations Tuesday. It was assembled by the state Emergency Medical Services board, which would also have the final say on whether to implement the panel's recommendations.
"Thanksgiving is coming early. We're being served a pile of turkey," said state Sen. E.J. Pipkin, R-Cecil. "This is a public relations stunt that we're watching here today."
Pipkin said he wanted the legislature to examine the state's emergency services program and possibly act to reduce the number of flights.
"I believe we can move more resources to the ground emergency personnel, and be able to let them treat people on the scene before we pick them up and fly," Pipkin said.
Bass, however, said he trusted that the panel would not sugarcoat its recommendations.
"They clearly are willing to express their points of view," he said.
Panel member Dr. John A. Morris, trauma director at Vanderbilt University Medical Center, questioned the state's practice of including just one paramedic with flight training on its helicopters. Sometimes, as in the fatal crash, a second emergency medical technician who treated the patient on the ground will come along for the ride.
"That is a prescription for sub-optimal performance, both on the medical side of the equation and on the aviation safety side," Morris said later. "This is not pickup basketball. This is the NBA."
More than a dozen people, most of them medical or emergency services professionals, spoke during the public comment section of the meeting, and most of them expressed their support for the medevac program.
However, Mick Naven, who helped develop a scoring system for trauma patients called the Sacco Triage Method, claimed that the state's system for evaluating patients frequently resulted in unnecessary flights.
"It's both shocking and dangerous to know that in 2008, we're not using medical evidence to make these decisions," Naven said.
Bass said more study was needed to determine how the Sacco Triage Method could be integrated into the decision about whether to fly or to drive a patient to a trauma center.
(© 2009 The Associated Press. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed.)
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