- The Washington Times - Wednesday, November 26, 2008

LINTHICUM, Md. | More patients are flown on helicopters to trauma centers in Maryland than in comparable states or regions with medevac programs, and the state probably has too many helicopters in its fleet, members of an expert panel said Tuesday.

However, the panel stopped short of recommending that the state cut the size of its 11-helicopter fleet or change its guidelines for transporting trauma patients by air. Panelists urged the state to review data on whether patients benefit medically from being flown before implementing any such changes.

“We felt there are too many helicopters - not just in Maryland but in the Washington-Baltimore-Philadelphia corridor,” said Dr. Bryan Bledsoe, a professor at the University of Nevada School of Medicine. “That said, there’s no clear definition of what is a correct number.”

The agency that coordinates Maryland’s emergency services convened the panel in response to a helicopter crash in September that killed four people, including one of two teenage car accident victims. The young women did not suffer obvious trauma after the car crash but were flown anyway because of the damage to their car and their distance from the nearest trauma center.

The surviving victim, Jordan Wells, 18, had her right leg amputated below the knee after being thrown from the plummeting helicopter. Her best friend, Ashley Younger, 17, was killed, along with a pilot, a paramedic and an emergency medical technician.

Nationwide, nine emergency medical helicopters have crashed during the last 12 months, killing 35 people. That led Dr. Bledsoe and other critics to suggest helicopters were overused nationwide.

The panel also concluded that some patients were being flown in Maryland who had injuries that did not merit such urgency - a practice known as “overtriage.”

“A level of overtriage is occurring that exceeds that of comparable systems,” said panel chairman Dr. Robert C. MacKersie, director of trauma services at San Francisco General Hospital. “There is a high likelihood that opportunities exist for reduction in Maryland’s (helicopter) transport of trauma patients without compromising patient outcomes or the quality of care.”

Since the crash, Maryland has implemented new protocols that call for paramedics to consult with a physician before flying patients who do not have obvious injuries but are at risk because of the way they were injured or because of underlying medical problems.

That change, combined with what state officials described as “skittishness” about requesting helicopters, has led to a dramatic reduction in flights in the eight weeks since the crash. At the current pace, Maryland would transport about half as many patients by helicopter in the current fiscal year. More than 4,100 patients were flown in the fiscal year that ended in June.

Panelists said there aren’t enough data for them to draw conclusions about the extent to which flights should be reduced.

“I don’t think we know which patients benefit” from being flown, Dr. Bledsoe said. “Until we can delineate that, it’s best to err on the side of caution.”

Despite the criticism, panelists described Maryland’s helicopter system as among the nation’s best, praising the communication between all involved, the safety record and the timeliness of response.

“I would without question put a family member of mine in the care of the program here in Maryland,” said panelist Tom Judge, head of a private helicopter service in Maine.

The panel recommended that a second paramedic be added to each crew to improve patient care in flight.

The panel outlined its recommendations in draft form Tuesday. It will submit a final report in January to the State Emergency Medical Services Board, which will have the final say on whether to enact them. Dr. Robert R. Bass, executive director of the EMS agency, said some of the changes - particularly adding a second paramedic - would be costly.

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