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Sun Apr 29 06:39:01 BST 2007

Posted by the Asbury Park
Press<http://www.app.com/apps/pbcs.dll/misc?URL=/misc/register_zago.pbs&Category=zago&Destination=http%3A//www.app.com/>on
04/22/07

BY JAMES W. PRADO ROBERTS <JWR at APP.COM>
STAFF WRITER

If your house is burning, the closest firefighters douse the flames.

If a burglar is prowling, the closest police officer gives chase.

If you are critically injured in an automobile accident and need to be
airlifted to a trauma center, you'd think you would always get the closest
available medevac helicopter crew.

Not in New Jersey.

Across the state, victims of horrific auto accidents and other major trauma
injuries have waited up to a half-hour longer than necessary for state-run
air rescue crews to reach them. Private medevac helicopters that are much
closer to some accident scenes are often deliberately not called by state
medevac dispatchers, the Asbury Park Press has found.

At least 24 times since July, state medevac dispatchers sent a State Police
helicopter to pick up seriously injured victims in Ocean and Burlington
counties, even though a closer medevac operated by MONOC could have arrived
to fly the patients to a trauma center faster, according to MONOC and a
review of state medevac dispatch recordings.

Patients in those cases faced delays of three to 28 minutes, according to
MONOC, a nonprofit regional emergency response organization, and records
reviewed by the Press.

"I think it's a turf battle, and they are playing it with people's lives,"
said Assemblyman Peter J. Biondi, R-Somerset, sponsor of a bill that would
require the closest-available medevac to be dispatched to a trauma scene.

On at least two occasions, ground-based rescue crews canceled the medevac
and drove to a hospital rather than wait for a state helicopter, according
to Jeff Behm, MONOC's vice president of operations.

In February, Miguel A. Flores of Toms River waited an estimated 17 minutes
longer than needed for an air transport. A State Police helicopter was
called first, even though a MONOC medevac craft was much closer. Members of
his family assumed that everything possible was done to help Flores, who
later died from his injuries.

"I want to know what the heck happened," said his sister, Maritza Flores.
"We have been in the dark."

The New Jersey State Police say their two medevac units have saved thousands
of patients - including Gov. Corzine, who was seriously injured in a motor
vehicle accident April 12 on the Garden State Parkway. They also say private
medevac operators aren't as safe, while MONOC said its program is as safe or
safer than any in the industry.

"Our record speaks for itself. In every case we've delivered our patients
safely," said State Police spokesman Capt. Al Della Fave.

Because traumas by their nature are life-threatening, no one has said for
sure if transportation delays led to permanent disability or death for
patients in these cases.

But at least two victims, Flores in Toms River, and another in Sparta,
Sussex County, later died of their injuries in hospitals.

Flores, 31, was critically injured shortly before 2 a.m. Feb. 22 when his
Toyota severed a utility pole adjacent to Hooper Avenue in Toms River.
Flores was thrown through his driver-side window and landed 42 feet away.

At the time, MONOC's air ambulance was available seven miles away at the
Robert J. Miller Airpark in Berkeley, MONOC said.

But the state's medevac dispatchers sent a New Jersey State Police
helicopter dubbed SouthSTAR (Southern Shock Trauma Air Rescue). It was 42
miles away in Voorhees.

It took SouthSTAR 27 minutes to arrive, according to recordings of State
Police radio transmissions.

MONOC says it could have been on the scene within 10 minutes.

After SouthSTAR arrived, Flores' heart rate dropped, and he eventually
needed CPR, according to the dispatch recordings. As a result, he couldn't
be airlifted to the region's trauma center, Jersey Shore University Medical
Center in Neptune. Instead, an ambulance drove Flores to Community Medical
Center in Toms River, where he died at 3:21 a.m.

Flores was in bad shape - and he may have died even if MONOC's helicopter
was dispatched, said Behm of MONOC. But because he was not flown to a trauma
center by the closest medevac, there is no way of knowing, Behm said.

In another accident, just after 10 a.m. on Sept. 17 in Sparta, Gary J.
Wasilewski's motorcycle collided with a Honda CR-V. Paramedics at the scene
asked that a nearby private medevac be dispatched, according to Assemblyman
Biondi and dispatch recordings. It could have arrived in 12 minutes, he
said.

The request was rebuffed by the dispatcher, who said, "You know what the
rules are, and I'm not gonna, with the atmosphere here, I'm not gonna change
anything."

The State Police's helicopter NorthSTAR, which had been in Mercer County,
didn't arrive until 27 minutes after it was dispatched, radio recordings
show.

"The policy is State Police first; however, we expect dispatchers to get the
most appropriate helicopter there," said David W. Gruber, a senior assistant
commissioner in the state Department of Health and Senior Services.

When NorthSTAR brought the 54-year-old Wasilewski to the roof of Morristown
Memorial Hospital, his heart stopped, according to Biondi. Wasilewski fell
into a coma and was taken off life support a week later, according to his
fiancee, Denise Danzeisen.

"Why? Why? They were sitting right there," she said of the private medevac
helicopter located in Netcong and operated by the Atlantic Health hospital
chain. "Why couldn't they do it? It makes no sense."

The state health department is currently reviewing its medevac dispatch
policy, and an independent consultant's report is due in June. It is also
reviewing whether the State Police should put a third medevac helicopter
into service in central New Jersey.

NorthSTAR has been dispatched since 1988 by University Hospital in Newark.
The hospital took over dispatch responsibilities for SouthSTAR last fall.

Anna Farneski, a spokeswoman for the University of Medicine and Dentistry of
New Jersey, which operates University Hospital, declined to comment on
specific dispatches, citing patient privacy laws. The Press asked
specifically about dispatch decisions, not patients' conditions.

"We are unable to address misinformation disseminated by those who would
turn New Jersey's medevac service into a for-profit enterprise," Farneski
said.
*
First hour is critical*

It's called the golden hour.

Since the Vietnam War, emergency medical professionals have maintained that
60 minutes can mean the difference between life and death for the critically
injured.

Beginning in 1988, the New Jersey State Police have safely flown thousands
of patients to trauma centers within that time. State health department
policy gives the State Police a virtual monopoly over air rescues, as long
as a helicopter is available.

Private operators are called only if the state's medevac helicopters can't
respond, according to official dispatch rules and state policy letters.

Most other states rely on private medevac operations to ferry the critically
injured to trauma centers. But until two years ago, NorthSTAR and SouthSTAR
- the State Police's two helicopter rescue units - had operated here
virtually without competition.

Last year, the agency's medevac helicopters responded to 1,261 accident
scenes, and transported another 314 patients from one medical facility to
another.

But to settle a lawsuit, in 2004 New Jersey decided to allow private medevac
helicopters to be based in the state. There are now three private air
ambulances in the state, including MONOC's, which had its first flight in
April 2006.

By way of comparison, Maryland State Police, who pioneered nonmilitary
medevac operations in 1970, also relegate private medevac helicopters to
accident scenes only if the Maryland police can't respond. But Maryland
State Police ferry five times the number of trauma victims that New Jersey
State Police do, with eight medevac helicopters on standby throughout the
state. Maryland has only a third more land and fewer residents - 5 million,
compared to 8.7 million in New Jersey.

"We can have a helicopter anywhere in the state from 12 to 18 minutes," said
First Sgt. Richard Bruns, flight operations supervisor for the Maryland
State Police.

The Sikorsky helicopters used by the New Jersey State Police for medevac
operations, originally built to fly CEOs, not patients, are larger and
faster than some private air ambulances: At a cruising speed of 150 knots,
the State Police medevac could fly from the tip of Sandy Hook to the tip of
Cape May in 41 minutes - 4 minutes and 30 seconds
faster than MONOC's Eurocopter, which has a cruise speed of 135 knots.

But MONOC - which is owned and operated by a consortium of 20 hospitals from
Hudson to Cape May counties, including Jersey Shore - says it is wrong for
the state health department to force trauma patients to wait longer for the
State Police when another helicopter is closer.

"This is a no-brainer," Behm said. "This needs to be changed now."

MONOC's medevac does respond when SouthSTAR is unavailable, and Behm said
MONOC's helicopter has seen an increase in accident scene calls since Flores
died on Feb. 22.
*
Assembly bill considered*

In March, Assemblyman Herb Conaway Jr., a medical doctor, held a hearing on
a bill similar to Biondi's that would require the state to dispatch the
closest medevac helicopter to a trauma scene.

Conaway, D-Burlington, asked Dr. Eric Munoz, a fellow member of the Assembly
Health and Senior Services Committee, who teaches at UMDNJ and is a trauma
surgeon at University Hospital: "You are the trauma doc here. . . . Does 10
minutes matter?"

Munoz, R-Union, responded: "I don't think I've had once where I've said if
the helicopter got there earlier, this person would be alive. . . . I've
been working in Newark 20 years, I can't remember an incident."

Other agencies measure response times in seconds.

In New York City last April, officials announced that a pilot program to
install global positioning satellite equipment in ambulances had reduced its
emergency medical response times to the most serious calls by just 33
seconds. The city then spent nearly $50 million to install the equipment in
1,565 emergency response vehicles.

"In an emergency," New York Mayor Michael Bloomberg said at the time, "every
second counts."
*
Financial incentives?*

The question of which helicopter is asked to respond to trauma calls is not
just a question of patient care, as MONOC maintains - it's also a cash
competition, some say.

While the State Police itself does not charge patients for the flights, the
hospitals that provide in-flight medical staff charge a flat fee of $1,337
for each patient. A typical private medevac fee for an auto accident victim
is $8,000 or more, most of which is paid for by insurance.

The State Police medevac program is suppose to be funded by an annual
vehicle registration fee surcharge, which increased from $1 to $3 in July.

The medevac's revenue would have increased to $21.5 million, which could
have been used to replace the State Police's aging Sikorsky S76-B
helicopters. However, most of the money was diverted into the general
treasury for other purposes. This year, the medevac unit will receive the
same amount of money as it did in 2006 - approximately $8.5 million.

In addition to trauma rescue, the medevac helicopters perform various police
and security missions. The most junior State Police trooper pilot will
receive a $56,820 salary this year, according to Capt. Della Fave. There are
22 medevac pilots.

Hospitals that supply medical personnel on the flights will receive a total
of $2.5 million billing this year from the state, on top of the $817,000
they expect from patient flights.

The hospitals involved in the program are University Hospital, Virtua West
Jersey Hospital in Voorhees and Cooper University Hospital in Camden.

>From 2001 through 2006, University Hospital and Virtua received $10.2
million from the state, not including as much as $5 million more in patient
billings. Last year, the hospitals won a three-year grant to continue the
service. Income to the hospitals was expected to be $3.3 million this year.

The real reason private operators want to be called first, said Dr. Steven
Ross, chief of Cooper's trauma unit, is that auto accident victims in New
Jersey have good insurance policies that will pay for medevac services.

"You want my honest answer? It's a pure and simple profit motive. There's
money to be made," Ross said.

Stephen D. Olsen, MONOC's chief flight paramedic, disagrees.

"What we think this is is a patient care issue. If there was a fire, you'd
want the closest fire truck," he said. "This is the same thing."

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