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Cabinet-Level Proposal for State s Emergency Medical Services is Overkill

BALTIMORE -- A new proposal to create a Cabinet-level department to oversee Maryland's emergency medical services is no remedy for what ails the trauma care system. The idea, as floated by two legislators, sounds more like a grandiose prescription for trouble - and a scheme to privatize the state-run medevac helicopter service.

The Maryland Institute for Emergency Medical Services Systems has come under scrutiny since a state police helicopter crashed in Prince George's County in September while en route to a trauma center. It was the worst fatal crash - four people were killed - since the system began operating in the 1970s. Sens. John C. Astle of Annapolis and E.J. Pipkin of the Eastern Shore have made the pitch for Cabinet status as an accountability and cost-containment measure. Mr. Astle also referred to "shortcuts" that have compromised safety.

But the fleet's safety record hasn't been the issue because it has had an exemplary one. The criticism has focused more appropriately on an overuse of the choppers, when an ambulance may have gotten a patient to a hospital faster, and the expected $120 million cost of replacing the helicopter fleet. An independent review of the MIEMSS made a critical finding this month: The system can fly fewer accident victims without compromising safety and care. And fewer patients flown to hospitals or trauma centers would reduce the need to replace the entire fleet. Since the September crash, fewer requests for helicopter transport have been made. MIEMSS officials also began requiring ground medics to consult a trauma physician before ordering a chopper. That was an important change.

Such self-corrections being implemented by MIEMSS - with proper oversight - should help ensure that medevac helicopters are used efficiently and for the right medical reasons. More can be done to reform the system, including requiring two rather than one paramedic on each flight and seeking national accreditation.

The system isn't broke. It needs to be updated to meet changing needs. If stronger oversight later proves needed, Senators Astle and Pipkin should focus their energies there. But blowing up the current system and repackaging it as a Cabinet-level department is a response to a problem that doesn't exist.

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