Maryland Defends its Medevac Program

BALTIMORE --

If you're critically injured in a crash and need to get to a hospital fast, the WBAL TV 11 News I-Team discovered that the closest medical helicopter may not be the one called.

Geary Hoover, a Washington County resident, said he still has nightmares about a fatal crash that unfolded in front of him on a section of road many residents near Boonsboro call Dead Man's Curve.

"The accident happened right here as you come around the curve," he told I-Team reporter David Collins when they returned to the crash site.

"The two in this vehicle here that got hit were alive. She was unconscious at first. The gentleman over here in the other car was still alive. He looked up at me. I told him that help was on the way. I held his hand, and we prayed," Hoover said.

Emergency Medical Service crews requested a Medevac through SYSCOM, the state's helicopter dispatching center, but were told all Medevacs were grounded due to poor weather problems.

But Hoover said he recalled that the weather was OK at the crash scene.

"The visibility was fine," he said.

EMS command at the scene said they then pleaded for a commercial Medevac and eventually prevailed. SYSCOM dispatched Stat 12, a private Medevac based at the Hagerstown Airport. They flew the sole survivor of the crash to Shock Trauma in Baltimore.

In October 2006, Charles County EMS drove a pediatric patient to a landing zone at Maryland Airport. Medstar, the commercial Medevac based at the airport, wasn't allowed to transport the victim. Records show that the patient waited 21 minutes for a state police helicopter.

Two months later, Medstar was on the scene of a high-speed rollover crash that happened behind the airport's hangar, but Medstar wasn't allowed to transport again.

The state Medevac arrived 11 minutes later. State Police claimed they still had to wait for the patient to be extricated, but an EMS responder recalled that the patient was ready and waiting.

There's no way to determine if wait time made a difference in any of these cases, Collins reported.

Collins said that the state police and commercial Medevacs are in a turf battle. Private companies contend that, in all other emergencies, the first available and closest crew is dispatched to the scene -- but that's not the case with air ambulances.

According to a memorandum of understanding, the state gets all calls for critically ill patients unless its helicopter is more than 25 minutes away. If that happens, SYSCOM will call a private Medevac, but only if it is less than 10 minutes away from the scene.

If the private helicopter is more than 10 minutes away and still closer, the state police dispatcher decides who to call.

Overall, a state Medevac is almost always called, Collins reported. From January 2006 through September 2007, they flew more than 8,000 missions. Private companies got the call 44 times.

"I would argue that the system is working very well," said Dr. Robert Bass, director of the Maryland Institute for Emergency Medical Services Systems, or MIEMSS.

"If the patient comes first, why not use the first available aircraft to transport?" Collins asked Bass.

He responded, "We've got a very good response time on a statewide basis. And we track those response times very closely. We track when there is a delay. We review all cases of delays."

Bass said that one of the incidents in Charles County prompted an amendment to the memorandum of understanding. If a commercial Medevac is already treating a victim at the scene, it may transport the patient.

"We think it has been operating very well. We know of no incidents where a patient has been affected adversely because of our policy," said Maj. Ken McAndrew of the Maryland State Police Aviation Unit.

But commercial Medevacs claim that the system is set up to keep Shock Trauma in business and doesn't put the patient first.

From January 2006 to September 2007, the state Medevac flew patients to Shock Trauma 46 percent of the time. The state confirmed about 63 percent of Medevac patients do not have life-threatening injuries. State officials said if the numbers seem high, they are in line with other jurisdictions that follow the same national guidelines for patient triage.

"Those are very difficult decisions to make in the field. You don't have the CAT scanners, the ultrasounds, and you don't have the people in the field to make those decisions. So, we err on the side of the patient," Bass said.

SYSCOM tracks state helicopters and contacts them by radio. It keeps track of commercial services, too, but those pilots aren't tied into SYSCOM.

"Because they are not fully integrated, they are not aware of the calls that are out there that they might be able to service," said Ed Rupter, vice president of Air Methods, the largest helicopter air ambulance service in the U.S.

Air Methods flies in 42 states, but doesn't have a contract in Maryland, Collins reported. Rupert contended that private Medevacs are not interested in taking over, but rather seeking a better partnership with the state.

"I think when you don't send the closest resource, you are not doing the right thing for the patient," Rupert said.

Maryland law mandates that commercial Medevacs be certified by the Commission on Accreditation of Medical Transport Systems. Those rules require a nurse and paramedic to be on board. The state has public-use helicopters that are exempt from those standards.

"If we get to the scene and we see that the patient requires the care of a second provider, we will take a provider from one of the ground units on board our helicopter. We do that quite often," McAndrew said.

State police defended the system as cost-effective.

"Of course we transport all of our patients free of charge," McAndrew said.

Collins reported that's because the state Medevac is funded by a portion of driver registration fees. Private companies charge the patient, and the bill can be several thousand dollars.

"The commercial systems don't do anything different than what the hospitals do," Rupert said, meaning patients can submit that bill to private insurance or Medicare.

But what if a claim is rejected or the patient is uninsured? Eastern Shore Republican state Sen. E.J. Pipkin said he wants to use private Medevacs more often and make sure no patient has to pay.

"We want to make sure that the private helicopters are available and the citizens of Maryland don't get separately charged for that," he said.

If that means the closest Medevac is always dispatched, private Medevacs could control a larger piece of the sky, Collins reported.

Collins emphasized that 11 News has no way of confirming if Medevac wait time adversely affected any patient.

Earlier this month during a special session in Annapolis, legislators agreed to divert $110 million generated from increasing the sales tax to the State Police Helicopter Replacement Fund. According to the state police, as many as nine helicopters need to be replaced.