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Medevac Under Microscope

BALTIMORE -- The recent, tragic medevac helicopter accident that claimed four lives has focused the attention of Marylanders on our emergency medical services system. While there may be disagreement about the decision to make that particular medevac flight, every Marylander can agree that the goal of EMS should be to provide the best and most appropriate care to every patient.

To achieve that goal, we need to look at EMS as one cog within a much larger health care system. Each year in Maryland, there are about 5,000 helicopter flights, 500,000 ambulance runs and 2.3 million emergency room visits. Our health challenges are vast, and our budget is getting tighter all the time. I've been an emergency medicine physician for 30 years. I've seen how much suffering could be prevented with strategic investments, some of them relatively inexpensive. How do we make the most health-effective and cost-efficient choices to serve the most people and the most critical needs?

Some want to spend $120 million to $200 million for a brand-new state-of-the-art helicopter fleet, with an operating cost of $20 million to $25 million per year. Other experts point out that Maryland's triage protocols are out of step with current research, and in fact we may be making unnecessary flights. Many have suggested that we can obtain the same or better patient care and safety results with a far less expensive approach.

No helicopter trip should be undertaken lightly. Susan Baker of the Johns Hopkins Bloomberg School of Public Health points out that "there are 650 helicopters in the United States dedicated to air medical service, and ... an average of 12 helicopter EMS crashes per year in recent years. Thus, one medical helicopter in four is likely to crash during 15 years of service." Yet of the 5,000 Maryland helicopter trips each year, about 40 percent of the patients are discharged in less than 24 hours. Are we putting patients and EMS staff in danger unnecessarily?

Maryland paramedics are highly trained professionals who can provide sophisticated treatment at the scene of accidents and medical emergencies. Our emergency providers, in the field and in hospital ERs, are among the best.

Consider the larger picture. Were Maryland to have the best and most extensive helicopter fleet that money can buy, how do we reconcile that with our worsening infant mortality statistics, largely because mothers can't get prenatal care? When the mental health system is broken down? When addiction spawns crime and disease, and yet treatment slots remain underfunded? When asthma and cancer rates are on the rise? When seniors can't afford medications? When last year, a Maryland child died of an untreated toothache?

Here are some specific, unfunded health items (drawn up by the legislative staff of the House of Delegates' Health and Government Operations Committee) and their approximate price tags:

* $3.5 million for the Babies Born Healthy program.

* $3 million to institute a mental health crisis system.

* $3 million to ensure that all Maryland women can get breast and cervical cancer screening.

* $1 million to reduce minority health disparities.

* $12 million to help keep seniors in their homes and out of nursing homes.

If funded, these programs would help many thousands of Marylanders. In addition, they would reduce transports by the EMS system and avoidable visits to ERs, leading to better care all around. Can we find a right way to do with fewer helicopters - perhaps six to eight instead of 12 - so these vital programs can be funded?

Since last month's accident, there has been some movement to update triage protocols and enhance communications to reduce unnecessary flights. Additionally, there are options for leasing helicopters that meet the highest standards for our Maryland State Police, and suggestions that it may be better to use different types of helicopters for different missions: medical, police and homeland security. These recommendations have been brought up for years. The good that can come from the recent tragic accident is that they are now being evaluated seriously.

The EMS system should not be considered in isolation. Everyone wants a sound plan that improves all aspects of health care. Crafting it should be approached with an open mind, flexibility, careful analysis and mutual respect.

Dan Morhaim is a physician and a Democratic member of the House of Delegates who represents Baltimore County. His e-mail isdan.morhaim@house.state.md.us.

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