Maryland ACEP Medevac Update Robert R. Bass, MD, FACEP Maryland Institute for EMS Systems

September 28, 2008 Crash of Trooper 2 Killed Killed *Pilot Steve Bunker *Trooper/EMT-P Mickey Lippy * EMT Tanya Mallard *Patient – Ashley Younger Injured Injured *Patient - Jordan Wells

Medevac Issues Expert Panel - November 24-25, 2008 Expert Panel - November 24-25, 2008 Trends in helicopter utilization Trends in helicopter utilization Number and location of bases Number and location of bases Fleet replacement Fleet replacement Safety Safety

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. 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. 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. Ellen MacKenzie, PhD – Professor and Chair, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health – Baltimore, MD.

Expert Panel Members Tom Judge, CCT-P – Executive Director, LifeFlight of Maine, Bangor, ME; Past-President, Association of Air Medical Services and volunteer paramedic. 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. 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. 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. William R. Metcalf – Chief, North County Fire Protection District, Fallbrook, CA.

Expert Panel Maryland continues to be a model system Maryland continues to be a model system Trauma outcomes are at or exceed national norms Trauma outcomes are at or exceed national norms Field trauma triage protocol c/w national guidelines Field trauma triage protocol c/w national guidelines Overtriage appears to exceed other areas of the country Overtriage appears to exceed other areas of the country MSP aviation has good safety record MSP aviation has good safety record Syscom is unique and a national model Syscom is unique and a national model

Expert Panel HEMS is an essential component of an system and can contribute to improved outcomes 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 MSP should change to FAA Part 135 and becomes CAMTS accredited Continue and enhance helicopter utilization review 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 Should do an in-depth analysis of the number of helicopters needed and their overall role in the EMS system beyond trauma

Helicopter Utilization

Total Trauma Patients Transported from Scene FY

Percent of Injured Patients Treated at Trauma Centers FY

Medevac Transports Peaked in 2004 and Dropped 23% by FY2008 (Graph = Scene and Total Transports)

Increased medevac utilization from 1998 – 2004 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 Changed protocols to emphasize the general lack of benefit when ground drive time to trauma center is less that 30 minutes Transport to Trauma Center or Specialty Center per protocol; alert trauma team; consider helicopter transport if quicker and of clinical benefit. Helicopter Utilization Protocol

Scene Transports to a Trauma Center Air v. Ground - FY

Post-Crash Medevac Protocol Change Category 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.

Medevac Requests to SYSCOM Total By Week Post Crash

Medevac Requests to SYSCOM Outcome: Fly versus No-fly

Post Crash Statistics (27 Weeks) 1259 Requests 1259 Requests Fly: 65% Fly: 65% No fly: 35% No fly: 35% No Fly 45% Directed - land 27% Field cancelled 14% Field decision- land 14% Cancelled weather

Medevac Requests to SYSCOM Transports by Patient Category

Percent Enhance COMAR (ISS + ICU + OR + Death + Transfer)

Estimated Medevac Transports 2009 Based on Current Utilization 80% of the estimated decline is the result of less medevac requests 2009??

Fleet Replacement Proceeding with RFP for multi- mission aircraft Proceeding with RFP for multi- mission aircraft Flexibility in number purchased Flexibility in number purchased

Safety Safety is “Job 1” Safety is “Job 1” *FAA 135 *Safety equipment *Two pilots *CAMTS