Don't privatize state medevac system

Wednesday, March 11, 2009

The state police's program has been heralded as one of the premier medevac systems in the nation along with having an excellent safety record despite the tragic crash of Trooper 2 last September, their first mishap in 22 years. Prior to the loss of Trooper 2 the system had fallen under the budgetary scrutiny of Annapolis; now it is under additional scrutiny for safety.

State Sens. John Astle and E.J. Pipkin have proposed legislation to privatize the Maryland State Police medevac system under the pretext of cost savings and increased safety, and also propose to provide additional state government oversight of all emergency responders and trauma centers in bills SB650 and SB764. Having utilized Trooper 2 in an emergency situation, we have followed this issue with interest and concern.

As part of their justification for privatization, these senators claim the state police make unnecessary flights. Yet requests for medevac are made by the on-scene EMTs based on accepted standards for triage. The Free Lance Star Newspaper in Fredericksburg, Va. ,published an article in 2005 discussing the need for oversight of the booming private medevac industry in Virginia due to suspected overutilization. Privatizing the Maryland State Police medevac system would not prevent overutilization as it is an issue with on-site triage, and as illustrated here, occurs with private providers also.

To further push their claims of overutilization, Sens. Astle and Pipkin have commented that more than 50 percent of the medevac flights are for non-life-threatening injuries. But the same is true for private medevac providers. Even if not life threatening, there are trauma injuries that require rapid, specialized treatment in order to prevent a loss of limb or to avoid complications that could significantly impact recovery and the patient's quality of life.

It should be noted that Sen. Astle was formerly a senior pilot for MedStar, a private medevac provider operating in Maryland. Privatizing the Maryland State Police's medevac system would bolster MedStar's operations.

In regard to safety the Federal Aviation Administration and National Transportation Safety Board have been focusing on improving safety in the industry since 2005 in response to the rapidly increasing number of mishaps including 11 crashes and 18 deaths in 2004, a trend that has continued. NTSB's report on Trooper 2's crash found no mechanical issues with the helicopter and was critical of a five-hour-old weather report provided to Trooper 2 by air traffic control and critical of the lack of a qualified controller at Andrews Air Force Base who could perform a radar-assisted approach requested by Trooper 2. Transcripts indicate the pilot was unsure about flying based on his personal weather observations when dispatched by SYSCOM, but SYSCOM informed him that MedStar was operating in the area, therefore private providers were operating in the same questionable weather conditions.

It is not conclusive that any Maryland State Police safety policies directly contributed to the crash. Prior to the crash Maryland's Department of Legislative Services audit published in August 2008 stated, "Specifically, the current helicopter fleet ... has flown almost 90,000 hours without a National Transportation Safety Board reportable accident, injury, or fatality, giving the Command a safety record well above the national average for emergency medical services." The audit did cite issues with maintenance record tracking, but not with maintenance procedures or safety.

Using state funds Maryland has been a pioneer in trauma treatment and has set national standards for emergency rooms, EMTs, and medevac systems. This is not to say there is not room for improvement, but is privatizing the Maryland State Police medevac system and adding a state cabinet position to oversee all emergency responders and trauma centers necessary? We are not convinced at this point and we question the motives of Sens. Astle and Pipkin.

Scott Pankiewicz, Jane Miller-Pankiewicz

California