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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. 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

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

  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

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

  4. 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.

  5. 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.

  6. 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

  7. 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

  8. Helicopter Utilization

  9. Total Trauma Patients Transported from Scene FY 1998 - 2007

  10. Percent of Injured Patients Treated at Trauma Centers FY 03 - 07

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

  12. 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.

  13. Scene Transports to a Trauma Center Air v. Ground - FY 03 - 07

  14. 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.

  15. Medevac Requests to SYSCOM Total By Week Post Crash

  16. Medevac Requests to SYSCOMOutcome: Fly versus No-fly

  17. 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)

  18. Medevac Requests to SYSCOMTransports by Patient Category

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

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

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

  22. Safety • Safety is “Job 1” • FAA 135 • Safety equipment • Two pilots • CAMTS

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