Our Say: Medevac service due for cutbacks, legislative scrutiny

Published 09/07/08

After years of stubborn refusal to do so, the state police medevac unit has cut back on the use of its helicopters, which suggests that they were being overused in flying accident victims to the University of Maryland Shock Trauma Center.

Officials announced last week that the service will be transporting fewer patients. Unless there are extenuating circumstances, patients will be taken by ambulance to the nearest trauma center if that will take no more than 30 minutes. In addition, paramedics will not be automatically flying patients who have been involved in roll-over accidents, high-speed chases and other situations that don't always result in serious injury.

The unit's director avoids admitting that the expensive, tax-paid program has been abused, but has instead launched a pre-emptive strike to offset legislative scrutiny. The legislature needs to approve a request for more than $130 million to replace the program's aging fleet of 12 helicopters.

The legislative examination follows a Capital story (March 30) revealing that almost half of the patients transported to the shock trauma center - at a cost of $6,000 each - were not seriously injured. These patients had non-life-threatening injuries and were released within 24 hours, raising the question of why less-expensive ambulances weren't used to transport them instead.

The helicopter unit, operated by the Maryland State Police, is the only one in the country supported by taxes.

Emotional stories generated by the program's undeniable successes, and the anxieties of Marylanders who like such a service available, have allowed the police to deflect any serious questions about operations. Until now the rhetoric has justified a $20 million annual budget, and helped the state's vaunted shock trauma center keep busy.

We don't dispute the need for a helicopter medevac unit or the stellar reputation of this country's first shock trauma center - Marylanders are lucky to have such services. But patient transportation fees can be paid by insurers, as they are elsewhere, and this service has been overused at great cost to taxpayers. We're happy that medevac administrators are finally cutting back.

Dr. Robert Bass, director of the Maryland Institute for Emergency Medical Services Systems, was called before the Joint Committee on Health Care Delivery and Financing last week. Next he'll face the legislature's Joint Audit Committee, where state Sen. John Astle of Annapolis, a former medevac helicopter pilot, is expected to grill Dr. Bass on maintenance issues.

The committee's job will be to determine if all 12 helicopters recommended by Gov. Martin O'Malley are really necessary. If ambulances could offer essentially the same services in nearly half of the 5,000 or so cases each year, we suspect they aren't. And it appears that helicopter maintenance logs are incomplete or nonexistent, putting a further obstacle in the path of legislators who want to understand how wisely the $20 million annual allocation is spent.

Until now the medevac unit has escaped serious scrutiny because no one wants to publicly challenge a popular service that saves lives. But given that, half the time, the lives of those using the service are not in any danger, the scrutiny is reasonable.

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well said - September 9, 2008

Well said in all the previous comments. Every precaution should be taken when a life (or limb) is at stake. Lets spend the money on the continued excellent service, not spending the $$ on a study to see how much the service is needed.

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Brian N. - Annapolis, MD - Karma: Neutral

MSP - September 8, 2008

That many patients are released in 48 hours or less is not surprising. Those are patients who experienced some sort of traumatic injury that has been known to have a high liklihood of internal comlications that could kill them quickly. As a provider in the field, I can perform many life saving techniques, but I can NOT do surgery. Our local facilities do not have the resources to handle a patient with internal injuries from trauma. And with the clock ticking on these people lives the second the injury occurs, the risk of sending them to a local ER often outweighs the benefit of flying them to definitive care. While there is often debate about the "Golden Hour", most agree that time is crucial. The golden hour dictates that someone with severe injuries has an hour from the time of injury to definitive (surgery at a TRAUMA center) care or their chance of survival decreases dramatically. What this means is that a seemingly stable patient with significant mechanism of injury may be out of luck by the time he shows the signs and symptoms of his true internal injuries. How many of you have been to the ER lately? While I won't place the blame on the hospitals themselves, unless you have serious life threatening signs when you arrive, you may be waiting HOURS for tests. On the other hand, a patient flown to Shock Trauma is seen immediately by a SWARM of physicians and surgeons. My point is many patients are flown as a precaution to avoid delays in surgical care. If we eliminate the option of precautionary transports, we will have many more deaths from the patients who did not have serious symptoms, but did sustain massive injury. Also, don't forget it is not always about life, but also limb.

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D. F - Baltimore, MD - Karma: Bad

?????? - September 8, 2008

Granted, there is no excuse for sloppy record keeping. However, to fault MSP for responding to calls for service from ground EMS units is ridiculous. Are they supposed to, from the hanger, decide if ground units called for an "appropriate" reason? No. Ground units have to quickly assess a patient and determine the level of care required, the most appropriate facility to transport to, and finally how to get there. Of all the things to nickel and dime - this ain't it. BTW, I thought part of our MVA fees were dedicated to fund this program as opposed to money from the general fund? If they cut the helo budget are our MVA fees going to decrease? I doubt it.

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Jeffrey O. - Pasadena, MD - Karma: Neutral

MSP Air Rescue - September 7, 2008

Carrying the critically injured/ill is not the medivac team's only purpose. Its detractors ignore the multitude of other Aviation program missions. Apparently someone wants to divert the special taxes collected for the MSP program to some other area of less import. Wake up, Marylanders! Your life or that of someone you love may be at stake!

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Walter B. - Lakewood, CO - Karma: Bad