Maryland EMS Under Fire From For-Profit Medicine

My friend and EMS educator, Greg Friese (EPS411.com) sent me this article which somehow skipped my radar scans of the web.  Maryland Lawmakers and private companies are lined up bashing the Maryland Institute of Emergency Medical Services, the state agency responsible for overseeing the statewide EMS program here.

Maryland EMS System Under Attack

Ever since the Maryland State Trooper medevac helicopter crash last year, the for profit aero-medical transport services and other medical service businesses in the state have been lining up to bash the agency for a whole list of complaints.  The key here is that all of the “concerned” citizens and lawmakers who want the agency dismantled in part or as a whole have connections to businesses who stand to profit from their demise.

Maryland supports a largely volunteer EMS service except in the most populated areas of the state.  The state provides free training for EMT-Bs, free ALS and BLS continuing education for licensed state providers, and supports a completely free trauma medevac service funded by the automobile registrations across the state.

For a long time the local hospitals with helicopter services have been hounding the legislature to get a piece of the State Police medevac service.  The problem for the state is that people will be charged for a service that is normally free.  In the more remote regions, where ground transport to a specialty center is more than 45 minutes, the state supports discretionary transport by air for stable priority three trauma patients from severe mechanism of injury events.

Stable Trauma Patients May Still Be In Danger

Their theory is that patients who appear stable, but actually have internal injuries, will be better served going directly to the trauma center than initial transport to a local facility.  The downside is that to protect the few patients who actually have these life threatening problems, you have to transport all patients meeting the criteria.

Until we can do ultrasounds, CTs and xrays in the back of our ambulances, we can only go by the mechanism of injury, patient presentation, and history of risk factors (pregnancy, elderly, cardiac, very young, etc.).  Maryland EMS (MIEMSS) has decided that the few lives that are actually in danger despite immediate presentation on the scene are worth the additional cost and challenges with flying the larger percentage patients, too.

For Free!

The directors at MIEMSS are very conservative (read Dr. Scalea’s open letter here).  It’s a complaint of many of the EMTs and paramedics here.  Our statewide protocols don’t allow us to perform EMS procedures or administer meds that are standard in other regions.  Only certain areas are allowed to RSI and our meds list is basic compared to others just to name a few.

Dr. Scalea says in his letter to the EMS community:

“In the wake of this tragedy, I fear that some will seek to weaken our system, forgetting that the genius of Maryland’s trauma response system is its singular focus on doing what is best for the patient, not what is best for Shock Trauma, or Johns Hopkins, or the Medevac fleet.”

Most of the EMS providers in the state operate as volunteers in rural areas with a limited opportunity to practice seldom used skills.  I don’t mean to say that volunteers are not professionals.  I think that volunteers are in some ways more professional because they are volunteers, but our state medical director has decided to err on the side of caution and maintain a support system that provides strong resources in local hospitals, regional specialty treatment centers, and a university based training and continuing education system that works!

Maryland EMS is the Best Option

The simple fact of the matter is that EMS in Maryland is a strong provider of services that is handled at a greatly reduced cost to what the citizens of the state would pay for paid ambulance services in their areas, often with less coverage.

If you are reading this, you need to call or email your state legislators and urge them to support our system and not cave to companies who see an opportunity to make a profit at the cost of the patients currently served for little or no cost.

Tell the Podmedic What You Think

I welcome your comments using the links below!  Or, Email me at Comments@MedicCast.com

Call the voicemail line 941-306-3342 (941-30-MEDIC)