The Baltimore Sun
BALTIMORE — When portable ultrasound machines become standard equipment for emergency medical crews, the ability to assess the internal injuries of accident and shooting victims on the spot should vastly improve. Until then, such teams in Maryland will continue to rely on their best judgment and a national checklist of standards to identify patients in need of air transport to a local trauma center. At least 4,500 patients are flown by state police helicopter to trauma centers across the state annually. But some legislators are questioning whether that’s too many.
Their concerns about the state police’s management of the fleet are reasonable, but lawmakers should avoid second-guessing the medical need to airlift injured patients. That’s a decision best left to the experts.
The legislators’ inquiry began as a review of the planned $120 million replacement of the aging fleet, a hefty expense at a time of reduced revenues and growing deficits. It followed a critical audit of the state police helicopter unit that found lax maintenance of equipment, poor or nonexistent record-keeping and an inability to reconcile flights with hospital arrival times.
More questions were raised by state data that wrongly suggested 50 percent of flown patients were released from trauma units within 24 hours. The figure, since corrected, is 34 percent. State emergency medical systems officials insist that’s reasonable when you consider the range of standards used to assess an injured patient at an accident scene and the hospital technology and expertise employed to decide that a patient can be discharged within 24 hours.
The helicopter unit deserved scrutiny after the auditors found a series of problems while at the same time commending their safety record. Let’s forget for a moment that a chief critic of the helicopter unit, state Sen. John C. Astle of Annapolis, works for a company that operates a helicopter fleet. As a former helicopter pilot, he does know something about this equipment.
But questions about the percentage of flights should have been clarified by Robert R. Bass, chief of the Maryland Institute for Emergency Medical Services Systems. He told a legislative hearing that the network this year refined the standards used to decide whether a patient needs to be flown to a trauma center to meet national protocols. It’s too soon to tell the impact on flights.
The lapses in helicopter maintenance and other problems cited in the legislative audit must be fixed before any choppers are bought, and state police commanders say they are committed to the task. This year, Col. Terrence B. Sheridan ended the practice of flying to locations strictly for demonstrations because of fuel costs and wear and tear on the fleet. That should save tens of thousands of dollars.
The age of the helicopters — at least half date to 1989 — requires their replacement, and in the interim, at a minimum, a robust maintenance regime. The revised triage protocols may well decrease the number of flights, data that could justify reducing the fleet. But an emergency medical system that saves more than 90 percent of the patients in its care should soar on its own merits, and Maryland’s has shown that it does.