October 2, 2008

Crash Prompts Question About Standards for Medevac Flights

By EARL KELLY Staff Writer

Reports that the patients aboard a state police medevac helicopter that crashed this weekend had only minor injuries have some lawmakers saying the state needs to reconsider the standards for air transport.

Four people died in the crash.

Ground paramedics use a sliding scale in deciding which patients should be flown by helicopter to a trauma center.

At one end of the scale are patients who have highly visible injuries, while at the other, the patient may not show any injuries but the "mechanism of injury" was such that emergency responders assume there could be injuries.

State standards say ground paramedics must consider transporting a patient to a trauma center any time a car accident results in an intrusion of more than 12 inches on the driver's side or 18 inches anywhere else in the compartment.

In such cases, paramedics usually have patients transported to a trauma center, generally by a helicopter.

About half of all patients transported by Maryland State Police helicopter in a year have only minor injuries and are treated and released within 24 hours.

Proponents of the existing system say patients cannot be screened properly unless they undergo a battery of sophisticated tests, and those tests must be done in a trauma center.

"We have said as a medical society 'We will over triage, we will bring people here who don't need to be here, rather than miss someone,'" Dr. Thomas M. Scalea, physician-in-chief at shock trauma, told The Capital when it did an expose on excess flights in March.

But, some experts say that flying patients who have minor injuries puts an unnecessary stress on the system, and exposes patients and flight crews to needless risks.

"We don't have X-ray equipment in the field, but my argument is: Couldn't community hospitals - which all have X-rays and sonograms - make the diagnosis and then transfer patients to trauma centers who need it," Del. Bob Costa, a Republican from Deale and himself a career paramedic, said this morning.

Dr. Robert Bass, executive director of the Maryland Institute for Emergency Medical Services Systems, which oversees setting the standards, could not be reached for comment.

The Baltimore Sun reported today that Dr. Bass said the auto crash victims who were being transported on the ill-fated medevac flight had only minor injuries.

Paramedic reports showed they had "chest pain, neck and back pain," and "one had a large bruise between her ribs and hips," according to the paper.

The car accident that injured the women happened late Saturday night in Charles County, and emergency medical personnel there cited privacy laws in declining to comment today.

One of the patients, Ashley J. Younger, 17, of Waldorf, died in the helicopter crash and another, Jordan A. Wells, of Waldorf, remains in critical condition at Shock Trauma Center in Baltimore.

The pilot, retired state police officer Stephen J. Bunker, 59, and flight paramedic Trooper First Class Mickey C. Lippy, 34, of Westminster, also died.

Also killed was EMT Tanya Mallard, 39, a member of the Waldorf Rescue Squad who was assisting with transporting the patients.

The crash came only days after two state lawmakers asked the Federal Aviation Administration to audit the state police helicopter operations because of allegedly poor maintenance and inadequate records.

It was the first fatal crash of a state police aircraft in 22 years, and the deadliest in the department's 47-year history.

Maryland State Police operate 12 Eurocopter Dauphin twin jet engine helicopters, which are stationed at eight bases around the state.

The state is considering spending between $130 million and $200 million to replace the aging fleet of helicopters. It costs taxpayers about $20 million a year to operate the machines.

State police immediately grounded the remaining 11 helicopters after crash, but late yesterday cleared Trooper 1, the base at Martin State Airport, to resume operations.

Maryland State Police Sgt. Arthur Betts said this morning that more of the bases may resume operations today.

Sunday's crash involved the Trooper 2 base, located at Andrews Air Force Base.

The helicopter that crashed was N95, which was purchased in June 1989 and the second oldest in the fleet, according to state police.

State police announced today that a viewing for Trooper Lippy will be held tomorrow from 2 to 8 p.m. at Gamber & Community Fire Company Station 13 located at 3838 Niner Road in Gamber. His funeral will be on Friday at 11 a.m. at the fire station.

A viewing for Mr. Bunker will be on Friday from 2 to 8 p.m. at South Potomac Church, 4915 Crain Hwy., in White Plains. His funeral will be on Saturday at 11 a.m. at the church.

Authorities have determined that the helicopter was returning to Prince George's Hospital Center late Saturday night when it may have encountered bad weather.

Mr. Bunker requested permission to land at Andrews, but the chopper went down shortly before midnight in a wooded area inside Walker Mill Regional Park, off Walker Mill Road in Forestville.

The four victims were pronounced dead at the scene, and the surviving patient was transported by ambulance to Prince George's Hospital Center.

The helicopter underwent a major inspection, as required by aviation regulations, last week.

Sens. John Astle, D-Annapolis, and E.J. Pipkin, R-Elkton, wrote to the FAA last week, asking the federal agency to audit state police aviation maintenance practices.

Their inquiry was prompted by a state audit last month that brought into question state police helicopter maintenance programs and recordkeeping.

Some industry experts have said that it would be more efficient, and safer, for the state police to lease their helicopters and operate them, but have the vendor conduct maintenance.

The National Transportation Safety Board is conducting an investigation. No final report is expected for several months.

Medics in the field must make decisions about suitable hospitals and transportation methods based on a "trauma decision tree," or chart, developed by the American College of Surgeons and modified by the Maryland Institute for Emergency Medical Services Systems.

Some examples of who gets referred to a trauma center are patients who:

Have pelvic fracture, paralysis, skull fracture or penetrating injuries to head, neck or torso, or a mangled extremity.

Most of the minor injuries deal with "mechanism of injury" cases, where patient may appear unharmed but:

Was in vehicle rollover and not using suitable restraints.

In car accident that penetrated greater than 12 inches into the vehicle on the occupant's side or more than 18 inches on any part of the vehicle.

Bicyclist thrown at a significant speed.

Motorcyclist in crash of 20 mph greater.

Pedestrian hit by vehicle.

Has fallen three times their height, even if they appear unharmed. {Corrections:} {Status:}

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