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Sun Apr 29 12:11:56 BST 2007

But there is more to the story....

http://www.app.com/apps/pbcs.dll/article?AID=/20070427/OPINION/704270390/1030/POLITICS

On 4/29/07, S Schecter <schecters at gmail.com> wrote:
>
> 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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-- 
V/R

Forrest Robleto
R House Health & Safety
www.RHouseTraining.com
FRobleto at RhouseTraining.com
609-792-9047

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