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Tue Nov 25 18:48:38 GMT 2008

A couple of thoughts after reading these posts and having spent hours in
meetings over these issues.

1. Dr. Bass and staff want to fix any problems in Maryland. I am convinced
of that.  They are in political positions, but they are physicians and good
people. The panel was not paid and MIEMSS staff was not a part of the
process nor did they try and influence the process.
2. The panel was well-balanced although the time was short. The members of
the panel worked collegially and diligently and we were surprisingly on the
same page.
3. This panel was to look at Maryland issues.  We would be naïve to think
that other states were not watching. However, we were here for the people of
Maryland.
4. The panel's recommendations are only recommendations and will go to the
Maryland EMS Board. The report is incomplete and may change.
5. There were numerous recommendations and these were by no means a
"whitewash" as some have implied.
6. Recommendations included making a transition from a response time
oriented system to a critical care provision system.  Also, MSP should
become CAMTS accredited and obtain their own Part 135 and fly under FAR Part
135 at all times (for EMS missions). These recommendations will mandate
fundamental changes in the system and culture including two medical crew
members. The number of helicopters appears to be excessive in this area (MD,
VA, DC, PA). It is up to the people of Maryland to decide how many they want
and how many they are willing to pay for. There is a point of diminished
return after a critical number of helicopters have been placed. A task force
with experts in asset placement should look at that. There is a difference
between helicopter triages and trauma center triage. These are often
confused. The C&D category patients are currently being screened by a
physician and this seems to be working as flights are now decreased. Flights
are already being reduced and will be reduced further making a large number
of helicopters unnecessary. The HEMS system needs to look at non-traumatic
time-sensitive conditions as well (e.g., STEMI, stroke, neurosurgical
vascular lesions). The ghost of Cowley haunts Maryland in that everything is
trauma, trauma, trauma. 

The trauma surgeons (John and Bob) and Steve, Tom, Bill and Ellen each
brought something unique to the table.  What resulted is a good review for
Maryland and I commend the MIEMSS people, Dr. Bass, Dr. Flocare and others.
I am sure that this was painful for them but I am sure their intentions and
dedication are genuine.

>From a "helicopter critic"....

Bryan

Bryan Bledsoe, DO, FACEP
Clinical Professor of Emergency Medicine
University of Nevada School of Medicine
University Medical Center

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