The Maryland Gazette
BALTIMORE — Maryland’s one-of-a-kind state police helicopter medevac system is a good thing. It saves lives. But you can have too much of a good thing, and overpay for the same results you could get for less. And no important state service should be immune from periodic evaluation.
For years, the taxpayer-funded medevac system — which could always draw on emotional testimonials from accident victims — enjoyed that sort of immunity. This has changed only recently. After questions from legislators, a state audit released in August and a fatal helicopter crash in September, the program is finally under the microscope.
The latest step is a review by a panel of national experts — academics and hospital administrators with expertise in trauma care.
The group’s time was limited, its focus was narrow and it had to cope with a lack of data. Its preliminary report, released last week, was hardly an indictment of the medevac operation. Even one of the most vocally critical members of the panel didn’t go beyond saying that the system needs “tweaking.”
Still, the report bears out things we suspected. Chief among them: The state helicopter fleet - 12 helicopters, at least before the crash on Sept. 28 — doesn’t need to be as big.
Noting that more than 40 percent of the state’s trauma center patients are discharged in less than a day, the panel wrote that the state can probably reduce the number of patients flown “without compromising patient outcomes or the quality of care.”
This point has already been tacitly conceded. After the crash, Robert Bass, the executive director of the Maryland Institute for Emergency Medical Services, changed the rules, directing paramedics to consult with trauma center doctors before making decisions on transporting less seriously injured patients. Since then, the number of patients flown has dropped by about 50 percent - without, so far, any discernible changes in survival.
In other words, even given the margin of safety that must be built into such decisions, the helicopters were being overused. That has obvious implications, especially as the aging helicopter fleet is due for replacement, at a cost of at least $120 million.
The expert panel also recommended that the state meet Federal Aviation Administration standards for commercial medevac helicopters — standards that are not required now because patients aren’t charged anything. And it recommended that the program apply to the Commission on Accreditation of Medical Transport Systems. This would lead to more detailed reviews, and a requirement of a second paramedic on flights.
Desirable as such changes might be, they would be costly — particularly if the fleet remains at its current size.
The panel of experts didn’t give any concrete recommendations on how much the fleet should be reduced. It also didn’t examine any of the basic assumptions of the program. Does this service need to be completely taxpayer-financed? Shouldn’t it charge insurance companies for the transport, as is done virtually everywhere else?
In short, the recommendations — which go to the State Emergency Medical Services Board on Dec. 9 — are just a beginning. The ultimate decision, naturally, rests with the governor and the legislators.
So, do those officials have the guts to seriously examine a highly popular program — and look at whether the state can provide its citizens with exactly the same protection, for less money?