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Maryland ACEP Medevac Update. Robert R. Bass, MD, FACEP Maryland Institute for EMS Systems. September 28, 2008 Crash of Trooper 2. Killed Pilot Steve Bunker Trooper/EMT-P Mickey Lippy EMT Tanya Mallard Patient – Ashley Younger Injured Patient - Jordan Wells. Medevac Issues.

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maryland acep medevac update

Maryland ACEP Medevac Update

Robert R. Bass, MD, FACEP

Maryland Institute for EMS Systems

september 28 2008 crash of trooper 2
September 28, 2008 Crash of Trooper 2
  • Killed
    • Pilot Steve Bunker
    • Trooper/EMT-P Mickey Lippy
    • EMT Tanya Mallard
    • Patient – Ashley Younger
  • Injured
    • Patient - Jordan Wells
medevac issues
Medevac Issues
  • Expert Panel - November 24-25, 2008
  • Trends in helicopter utilization
  • Number and location of bases
  • Fleet replacement
  • Safety
expert panel members
Expert Panel Members
  • Robert C. MacKersie, M.D. – Chairman, Expert Panel; Professor of Surgery in Residence and Director of Trauma Services, San Francisco General Hospital, San Francisco, CA.
  • John A. Morris, M.D. – Professor Surgery, Director, Division of Trauma & Surgical Critical Care, Director, Trauma, Burn & LifeFlight Patient Care Center, Vanderbilt University Medical Center, Nashville, TN.
  • Ellen MacKenzie, PhD – Professor and Chair, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health – Baltimore, MD.
expert panel members5
Expert Panel Members
  • Tom Judge, CCT-P – Executive Director, LifeFlight of Maine, Bangor, ME; Past-President, Association of Air Medical Services and volunteer paramedic.
  • Stephen H. Thomas, M.D., M.P.H. – Associate Professor of Surgery, Harvard Medical School, Department of Emergency Medicine, Massachusetts General Hospital, Associate Medical Director, Boston MedFlight Boston, MA.
  • Bryan Bledsoe, DO – Clinical Professor of Emergency Medicine, University of Nevada School of Medicine and University Medical Center, Las Vegas NV.
  • William R. Metcalf – Chief, North County Fire Protection District, Fallbrook, CA.
expert panel
Expert Panel
  • Maryland continues to be a model system
  • Trauma outcomes are at or exceed national norms
  • Field trauma triage protocol c/w national guidelines
  • Overtriage appears to exceed other areas of the country
  • MSP aviation has good safety record
  • Syscom is unique and a national model
expert panel7
Expert Panel
  • HEMS is an essential component of an system and can contribute to improved outcomes
  • MSP should change to FAA Part 135 and becomes CAMTS accredited
  • Continue and enhance helicopter utilization review
  • Should do an in-depth analysis of the number of helicopters needed and their overall role in the EMS system beyond trauma
medevac transports peaked in 2004 and dropped 23 by fy2008 graph scene and total transports
Medevac Transports Peaked in 2004 and Dropped 23% by FY2008(Graph = Scene and Total Transports)
slide12
Increased medevac utilization from 1998 – 2004

Changed protocols to emphasize the general lack of benefit when ground drive time to trauma center is less that 30 minutes

Helicopter Utilization Protocol

Transport to Trauma Center or Specialty Center per protocol; alert trauma team; consider helicopter transport if quicker and of clinical benefit.

post crash medevac protocol change category c mechanism and d other
Post-Crash Medevac Protocol ChangeCategory C (mechanism) and D (other)

Transport to trauma center; alert trauma team. Patients within a 30-minute drive time of the closest appropriate trauma/specialty center shall go by ground unless there are extenuating circumstances. Receiving trauma center medical consultation required when considering whether helicopter transport is of clinical benefit.

post crash statistics 27 weeks
1259 Requests

Fly: 65%

No fly: 35%

No Fly

45% Directed - land

27% Field cancelled

14% Field decision- land

14% Cancelled weather

Post Crash Statistics(27 Weeks)
estimated medevac transports 2009 based on current utilization
Estimated Medevac Transports 2009 Based on Current Utilization

2009??

80% of the estimated decline is the result of less medevac requests

fleet replacement
Fleet Replacement
  • Proceeding with RFP for multi-mission aircraft
  • Flexibility in number purchased
safety
Safety
  • Safety is “Job 1”
    • FAA 135
    • Safety equipment
    • Two pilots
    • CAMTS