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Emergency workers on ground decide -- helicopter or ambulance?

August 04, 2008

When a motorist is injured in a traffic accident in Maryland, responding ambulance crews must decide whether the injured will go by ambulance to a nearby hospital or by helicopter to a trauma center.

No matter what the situation, it is emergency medical providers on the ground who are responsible for making the split-second decisions of whether to call in a helicopter.

A number of factors are taken into account, including the type of injury, where it occurred, whether a person is conscious and the distance from the nearest hospital or trauma center, according to Western Region supervisor Sgt. Joe George.

A story published March 30 in a Maryland newspaper said that about half of the patients flown to a trauma center by state police helicopters are not seriously injured and are released within 24 hours.

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George said all paramedics follow strict rules when making the mostly subjective decisions.

The Maryland Institute for Emergency Medical Services Systems issues the Maryland Medical Protocol, which provides instructions on how and where emergency medical technicians and paramedics should treat patients, based on certain situations.

"It is not our business to dictate what they call for," George said. "We are not in the business of going to a scene and refusing to transport."

George said, however, that the protocol might need to be re-evaluated to adjust for things that have changed.

"A car rolling used to be an automatic trip to shock trauma but cars are safer now and a roll doesn't mean they are necessarily hurt," he said. "We are going through a learning curve."

George said there are examples of people who looked fine when the helicopter arrived on a scene but were already suffering fatal internal injuries. And, he said, there are examples of people who looked like they were in bad shape but were released from hospitals within hours.

"After the fact we can say that maybe a person didn't need to go in a helicopter or to shock trauma but it is all about circumstances," George said. "It is about making quick decisions that are best for the patient."

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