Doctor's OK to be required before some Medevac flights

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Doctor's OK to be required before some Medevac flights

By Little

The Baltimore Sun

AP Photo

PRINCE GEORGE'S COUNTY, Md. — In a move that could reduce the number

of medevac flights in land, state emergency medical officials

announced yesterday that ambulance teams will be required to consult

with doctors before deciding whether flying some accident victims to a

trauma center is better than driving them to a local hospital.

The change, in response to a deadly helicopter crash in Prince

's County about a week ago, won't apply to victims with

obviously traumatic injuries. But the state will stop automatically

ordering medevac transportation based on the nature of an accident, as

it does with hundreds of flights each year. Emergency workers will now

speak with doctors before deciding whether such cases warrant a

helicopter flight, said Dr. R. Bass, director of the land

Institute for Emergency Medical Services Systems.

Bass also said state officials will appoint a panel of national trauma

and emergency medicine experts to assess the state's emergency medical

system and recommend whether other changes are necessary. He said he

hopes to have a panel selected in several days, with the goal of

completing its report by the end of the year.

Bass said the protocol change is being implemented to address

criticism that land too often uses expensive and potentially

dangerous helicopters when a ground ambulance might be more

appropriate. The practice will be reassessed in several months to

determine if it made a difference.

The Sept. 27 medevac flight that crashed in Prince 's, killing

four people, was ordered because of the degree of damage to the

vehicle involved in the accident, rather than the injuries themselves.

Both patients were awake and alert after the car crash in Waldorf, but

the emergency medical crew chose to fly them to the Prince 's

Hospital Center because, under the state's emergency response

guidelines, the 12-inch dent in their vehicle predicted potentially

hidden injuries.

The state's leading trauma surgeon applauded the change yesterday but

said he couldn't be sure it would lead to fewer unnecessary medevac

flights. land's triage guidelines purposely err on the side of

getting patients more care than they might require.

" I have trouble overruling someone who is at the scene and can put

their eyes on a patient, " said Dr. M. Scalea, physician in

chief at the land Shock Trauma center in Baltimore, the state's

primary trauma center.

" They'll call, we will have a discussion, and then we will make a

joint decision about what is best for the patient, " Scalea said after

a news conference yesterday at the center. " But we'll continue to err

on the side of the patient. There are always people who are fine until

they land on our roof, and then all of a sudden they are not. "

Some trauma specialists have questioned the nation's increasing

reliance on helicopter transport, particularly in light of studies

casting doubt on whether medevac flights deliver patients faster and

lead to better medical results. Among the roughly 4,500 patients flown

in land last year, nearly half were discharged within 24 hours,

suggesting their injuries were not so severe that a ground ambulance

could not have offered acceptable treatment.

Dr. E. Bledsoe, a University of Nevada emergency medicine

physician and a frequent critic of what he perceives as overuse of

helicopter transport, praised yesterday's announcement but said he

thinks more sweeping change would be appropriate.

Recent scientific studies suggest that using the nature of a crash to

predict injuries is unreliable as much as 80 percent of the time.

" The thing is, the whole argument for the use of these helicopters is

speed and rapid transport to the trauma center. And this will add

time, " Bledsoe said. " I've taken calls like that. You might be

treating another patient, you might be suturing and have to take your

gloves off. Unless someone is sitting there monitoring the radio full

time, it could be difficult and time-consuming.

" What needs to be considered is the elimination of mechanism of injury

from the protocol entirely. "

Medevac helicopters will still begin the pre-flight warm-up process

when a call comes in, but won't fly to get the patient until the

doctor and medic agree that a helicopter flight is necessary. Bass and

Scalea estimated the process might add 60 to 90 seconds to response times.

" If there's any delay, it should be very minimal, " said Bass.

Bass and Scalea spent much of yesterday's news conference defending

land's trauma system, which has been copied around the world,

against what they perceive as criticism related to the recent crash.

Both said they support the new protocol and review but said officials

might ultimately determine that few meaningful improvements can be made.

" They're in the rain, in the dark, lots of noise, a dangerous

environment - they have to make these decisions very quickly, and they

are life-and-death decisions, " he said. " I have no doubt the system we

have now has saved thousands of lives. "

Wells, whose 18-year-old daughter, Jordan, survived last month's

crash and is being treated at Shock Trauma, was unaware of any calls

for changes to the system. But regardless of the questions about

whether his daughter needed to be flown, he said he is grateful for

the system that treated her.

" If the mission is saving lives, lives are saved. If the mission is

saving money, money is saved, " Wells said.

" I'm not going to say it hasn't been a nightmare, but her mother and I

are just extremely grateful for the pilot and the paramedics that came

out to save our daughter, and for everyone at the hospital who is

still working to save her. "