Medevac Experts Advise Changes
Fewer Helicopters, Accreditation Urged
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By Rosalind S. Helderman
Washington Post Staff Writer
Wednesday, November 26, 2008; Page B01
A panel of national experts, convened to examine Maryland's air ambulance system after a deadly September crash in Prince George's County, has recommended a review of the state's helicopter needs that could shrink the state police fleet.
The panel also said the fleet should seek a national accreditation that would require helicopters to be flown with two paramedics instead of one, as is standard practice in Maryland.
The experts' wide-ranging recommendations could result in fewer helicopter flights as state managers reevaluate whether Maryland patients are "overtriaged" and flown unnecessarily.
Other proposals could be costly, including a suggestion that state medical flights meet the Federal Aviation Administration's most stringent requirements for helicopters, designed for passenger transport rather than commercial aviation.
The Maryland State Police operate 11 helicopters that log more than 4,000 flights annually. A 12th helicopter was destroyed in the Sept. 27 Prince George's crash, which killed three rescue workers and a patient.
Responding to the recommendations, one state police major said he believes that service would be diminished with fewer helicopters.
Members of the seven-member panel, which included doctors from top trauma programs across the country and other air medical experts, said they believe helicopter transport in Maryland is generally safe, calling the Maryland State Police program a national model that can nevertheless be improved. Maryland operates the nation's only publicly run medical helicopter system.
"I would without question put a family member of mine in the care of the program here in Maryland," said Tom Judge, executive director of LifeFlight of Maine and a past president of the Association of Air Medical Services. "That said, you can always do things better."
The group's recommendations will be finalized and presented to the state's 11-member Emergency Medical Services Board. The report will probably serve as a backdrop to legislative discussions about the system when the General Assembly meets in January.
The legislature decided last year to buy three helicopters a year until the Maryland State Police's aging fleet has been replaced, at a total cost ranging from $120 million to $200 million. But with tightening budgets and questions raised by the fatal crash, some lawmakers believe the state's system should be reexamined.
Some lawmakers have recommended greater reliance on privately run air ambulance services. Others have proposed leasing helicopters instead of buying them. They have also questioned whether medical work should be commingled with law enforcement and homeland security efforts, as it is now.
Several of the experts said they believe Maryland could meet state needs with fewer helicopters.
"It is clear that as the numbers start to increase, there is a diminishing return on improvements in outcomes. The economic side of that is really a policy decision: What do you want to pay for it?" said Bryan Bledsoe, a clinical professor of emergency medicine at the University of Nevada School of Medicine. Bledsoe said he thinks that the state could probably meet patient needs with six helicopters.
The group also said Maryland should seek accreditation by the Commission on Accreditation of Medical Transport Systems, a national group that has approved about half of flight programs nationally. The accrediting group would require that Maryland have two medical caregivers on every helicopter flight.
Maryland State Police Maj. A.J. McAndrews said the service has looked at the accreditation program in the past, as well as the possibility of meeting the tougher FAA requirements. Both might be good ideas, he said, but they are costly. Adding another paramedic to all flights would require doubling the state's 45-member police paramedic force, he said.
McAndrews also said he does not believe the fleet is too big. "We could not do what we do now with fewer," he said.
Del. Dan K. Morhaim (D-Baltimore County), an emergency medicine doctor and co-chairman of General Assembly's Joint Committee on Health Care Delivery and Financing, said he would like to see more data as lawmakers tackle policy choices, including information about whether trauma patients have historically fared any worse when helicopters are grounded because of weather. He also has asked for information about whether patient outcomes have been affected by the reduction in flights in the weeks since the crash.
He said the panel's findings offered an initial suggestion that the state might be able to operate a "safer, more efficient, more effective system with fewer helicopters."
Fewer Helicopters, Accreditation Urged
Discussion PolicyYour browser's settings may be preventing you from commenting on and viewing comments about this item. See instructions for fixing the problem.
Discussion Policy CLOSEComments that include profanity or personal attacks or other inappropriate comments or material will be removed from the site. Additionally, entries that are unsigned or contain "signatures" by someone other than the actual author will be removed. Finally, we will take steps to block users who violate any of our posting standards, terms of use or privacy policies or any other policies governing this site. Please review the full rules governing commentaries and discussions. You are fully responsible for the content that you post.
Who's Blogging» Links to this article
By Rosalind S. Helderman
Washington Post Staff Writer
Wednesday, November 26, 2008; Page B01
A panel of national experts, convened to examine Maryland's air ambulance system after a deadly September crash in Prince George's County, has recommended a review of the state's helicopter needs that could shrink the state police fleet.
The panel also said the fleet should seek a national accreditation that would require helicopters to be flown with two paramedics instead of one, as is standard practice in Maryland.
The experts' wide-ranging recommendations could result in fewer helicopter flights as state managers reevaluate whether Maryland patients are "overtriaged" and flown unnecessarily.
Other proposals could be costly, including a suggestion that state medical flights meet the Federal Aviation Administration's most stringent requirements for helicopters, designed for passenger transport rather than commercial aviation.
The Maryland State Police operate 11 helicopters that log more than 4,000 flights annually. A 12th helicopter was destroyed in the Sept. 27 Prince George's crash, which killed three rescue workers and a patient.
Responding to the recommendations, one state police major said he believes that service would be diminished with fewer helicopters.
Members of the seven-member panel, which included doctors from top trauma programs across the country and other air medical experts, said they believe helicopter transport in Maryland is generally safe, calling the Maryland State Police program a national model that can nevertheless be improved. Maryland operates the nation's only publicly run medical helicopter system.
"I would without question put a family member of mine in the care of the program here in Maryland," said Tom Judge, executive director of LifeFlight of Maine and a past president of the Association of Air Medical Services. "That said, you can always do things better."
The group's recommendations will be finalized and presented to the state's 11-member Emergency Medical Services Board. The report will probably serve as a backdrop to legislative discussions about the system when the General Assembly meets in January.
The legislature decided last year to buy three helicopters a year until the Maryland State Police's aging fleet has been replaced, at a total cost ranging from $120 million to $200 million. But with tightening budgets and questions raised by the fatal crash, some lawmakers believe the state's system should be reexamined.
Some lawmakers have recommended greater reliance on privately run air ambulance services. Others have proposed leasing helicopters instead of buying them. They have also questioned whether medical work should be commingled with law enforcement and homeland security efforts, as it is now.
Several of the experts said they believe Maryland could meet state needs with fewer helicopters.
"It is clear that as the numbers start to increase, there is a diminishing return on improvements in outcomes. The economic side of that is really a policy decision: What do you want to pay for it?" said Bryan Bledsoe, a clinical professor of emergency medicine at the University of Nevada School of Medicine. Bledsoe said he thinks that the state could probably meet patient needs with six helicopters.
The group also said Maryland should seek accreditation by the Commission on Accreditation of Medical Transport Systems, a national group that has approved about half of flight programs nationally. The accrediting group would require that Maryland have two medical caregivers on every helicopter flight.
Maryland State Police Maj. A.J. McAndrews said the service has looked at the accreditation program in the past, as well as the possibility of meeting the tougher FAA requirements. Both might be good ideas, he said, but they are costly. Adding another paramedic to all flights would require doubling the state's 45-member police paramedic force, he said.
McAndrews also said he does not believe the fleet is too big. "We could not do what we do now with fewer," he said.
Del. Dan K. Morhaim (D-Baltimore County), an emergency medicine doctor and co-chairman of General Assembly's Joint Committee on Health Care Delivery and Financing, said he would like to see more data as lawmakers tackle policy choices, including information about whether trauma patients have historically fared any worse when helicopters are grounded because of weather. He also has asked for information about whether patient outcomes have been affected by the reduction in flights in the weeks since the crash.
He said the panel's findings offered an initial suggestion that the state might be able to operate a "safer, more efficient, more effective system with fewer helicopters."
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