October 7, 2008

State’s Helicopter Trauma Transports Getting a Second Look

By EARL KELLY Staff Writer

The heads of the state trauma center and emergency medical system were expected this afternoon to call for a review of the criteria for flying patients aboard state police helicopters.

The move comes in light of a crash last month that killed the three-member crew and one patient, who was being transported by helicopter for minor injuries.

Currently, roughly 50 percent of patients who are flown by helicopter have nonlife-threatening injuries, and an even greater percentage of patients treated at the state's trauma centers are released within 24 hours.

Dr. Robert Bass, executive director of the Maryland Institute for Emergency Medical Services Systems, and Dr. Thomas M. Scalea, physician-in-chief at shock trauma center, called the news briefing at the University of Maryland Shock Trauma Center, according to their offices.

Neither doctor was available for comment this morning.

Dr. Bass said last week he was assembling a team of medical scholars, including some from Johns Hopkins University, to review the guidelines.

The state criteria for transporting patients is based on guidelines drafted by the American College of Surgeons. The standards include treating patients at trauma centers and for transporting them by helicopter if the accident they were involved in could have produced internal injuries.

In some cases, the patients don't show symptoms of injury, but the "mechanism of injury" requires field paramedics to send patients to trauma centers aboard helicopters.

Called "mechanism of injury" cases, these patients qualify for treatment at a trauma center when, for example, someone falls three times his height or is thrown from a bicycle at any speed.

If the patient is more than 30 minutes' travel time by land from a trauma center, the ground paramedic is to call for a helicopter.

Some trauma medicine experts say there is less than a 20 percent correlation between mechanism of injury and actual injury. Also, studies have shown that patients in some states recovered more quickly when transported by land instead of by air.

The existing standards have their defenders, however.

"There is not always an exterior manifestation of injuries, but there could be a lacerated liver, a torn bowel or a ruptured spleen," Dr. Bass said in an interview last week. "The patient may be in trouble, but look OK."

The two patients who were being transported when the crash occurred late at night on Sept. 27 were Priority 2, Dr. Bass said, a class of patients defined as those with "less serious condition, requiring emergency medical attention but not immediately endangering the patient's life."

Several members of the General Assembly have been calling for the review, and a story in The Capital in March reported the dangerous and expensive problem of over-triage. Some lawmakers said they did not want to face the lobbying pressure put on them by the Maryland State Police, until the report openly publicized the problem.

Currently, the state is looking to spend $140 million or more to replace the Maryland State Police's fleet of 12 helicopters. Also, it costs about $20 million a year to keep the fleet flying. The helicopters are used in a number of law-enforcement operations, with medevac flights making up the bulk of the missions.


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