Since 2018, University of Maryland Medical System’s ExpressCare critical care transport team has deployed the Maryland GO-Team six times. The most recent response came after a crash involving a Maryland Transit Authority bus and two passenger vehicles in Baltimore.
Just after midnight, an ExpressCare crew based at the University of Maryland Medical Center was dispatched about a mile from the R Adams Cowley Shock Trauma Center, Maryland’s only primary adult resource center, according to ExpressCare Medical Director Dr. Ben Lawner.
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Baltimore City Fire Department initially dispatched the incident as a “rescue assignment,” signaling the potential for trapped patients and the need for additional technical rescue resources and command staff, Lawner said.
As crews arrived, they realized the crash would require a prolonged and delicate extrication. That prompted the request for Maryland’s GO-Team, a specialty response team made up of a physician and certified registered nurse anesthetist from Shock Trauma.
ExpressCare ground crews transported the GO-Team and its equipment to the scene.
“As the ground deployment component of the GO-Team, ExpressCare was dispatched to transport the clinicians and equipment to the emergency scene,” Lawner said.
Rare GO-Team ground deployment
Lawner said it is unusual for critical care ground teams to transport the GO-Team to active incident scenes because most deployments are handled by the Maryland State Police Aviation Command.
At the scene, the GO-Team and ExpressCare crews reported to the incident commander and integrated into EMS operations. They assisted with rescue operations, resuscitation efforts and patient transport.
“Crews moved the patient to the ambulance once BCFD completed the technical rescue,” Lawner said. “ExpressCare clinicians administered warmed blood, placed an advanced airway and transitioned the patient to a mechanical ventilator.”
Lawner credited strong communication and coordination between responding agencies. He said his role as medical director for the Baltimore City Fire Department helped create familiarity with crews and officers on scene.
Inside the ExpressCare model
While this March 19 incident drew attention to ExpressCare’s field response capabilities, the program primarily operates as an interfacility critical care transport service. More than 99% of its missions begin and end at hospitals, Lawner said.
The program was established in 1993 by the University of Maryland Medical Center and Shock Trauma to transport critically ill patients between facilities.
“The bottom line is to get the patient to definitive care,” Lawner said. “It is very complex to get the patient there in a way that is safe.”
ExpressCare crews include an EMT/EVO, a critical care transport nurse and a critical care transport paramedic. The service’s specialty care transport designation allows teams to provide therapies beyond those included in Maryland EMS protocols.
ICU-level care on the move
Lawner described ExpressCare as an ICU-level transport resource capable of delivering advanced care during transport. Capabilities include advanced airway management, mechanical ventilation, vasoactive drug infusions, blood administration, ECMO transport, transvenous and transcutaneous cardiac pacing, prone patient transportation and focused surgical procedures.
ExpressCare operates three teams from the University of Maryland Medical Center downtown campus, along with additional units in Aberdeen and Easton to support rural coverage on Maryland’s Eastern Shore. The program also partners with PHI Air Medical to operate a helicopter based at Martin State Airport in Baltimore County.
Training for high-acuity patients
Lawner said training standards are a major differentiator for the program. Team members participate in quarterly education sessions and high-fidelity simulation training twice a quarter. New clinicians complete a 12- to 16-week orientation that includes classroom instruction, clinical rotations and high-fidelity simulations.
Additionally, team members typically have 2-3 years of experience in a high-volume EMS system or critical care setting. Nurses usually have 2 years in an ICU setting, Lawner explained.
“A highly focused orientation includes didactic learning, clinical rotations, high fidelity simulations,” spanning 12-16 weeks, Lawner said.
If not already completed, team members are expected to achieve advanced certifications in their respected fields of practice within a set timeframe, after employment.
“We do peer review every day of calls,” and care for any type of complex patient with the exception of neonatal cases, Lawner said. “Team members work diligently to adopt and maintain a crew resource management focused approach to critical illness and injury.”
