Maryland's Emergency Medical System has been a model for similar systems, and is internationally recognized as a unique and well-coordinated system that is difficult to duplicate.
"While Maryland is relatively advanced in achieving the goals of coordination, regionalization and accountability, it is not clear how easily its system could be replicated in other states," according to a report from the Committee on the Future of Emergency Care in the United States Health System.
"Over the years, the system has benefited from stable leadership, strong support of government leaders and the public, a steady and reliable source of funding, a high concentration of career and volunteer EMS personnel and health care resources, and limited geography - something that many states do not currently enjoy," the report notes.
On March 19, 1970, the state police aviation command became the first civilian agency in the United States to transport critically injured patients by helicopter.
The current fleet consists of 12 helicopters flown from eight different bases across the state, including Trooper 3, which is stationed in Frederick, and Trooper 5, which flies out of Cumberland.
But as the fleet ages - nine of the helicopters are more than 18 years-old - state police see the need for an upgrade.
"It's like an '88 Camaro," said 1st Sgt. Charlie Eisele, the Southern region supervisor in a phone interview.
"It's a great car but they don't make the parts anymore. We are fortunate the legislature has agreed to help the fleet," said Eisele.
In March, the state legislature approved $33.6 million in the fiscal year 2009 budget for the state police to upgrade or replace its fleet of Eurocopter Dauphin helicopters.
In total, $110 million is earmarked for the upgrade over the next four years.
When a person registers a motor vehicle in Maryland, the fee includes a $13.50 surcharge, paid every two years, that goes toward funding the Emergency Medical System. Of that fee, approximately $5 goes directly to the state police aviation command, accounting for 80 percent of its nearly $23 million budget. The remaining 20 percent comes from the state police's budget.
Because of this, a patient flown on a Maryland state police helicopter, whether a state resident or not, will never receive a bill for the service, according to Eisele and George.
"We don't even have a billing department," George said. "It is only the ($5 split over two years) from the registration fee."
George also noted that citizens receive law enforcement protection, search and rescue services and homeland security protection on top of medevac services, all for the amount included in the cost of vehicle registration.
"How much is the helicopter worth when you are trapped under a waterfall or in an accident," George said. "What if it is your kid? You'd pay whatever it took to make sure your kid was OK."
The additional money earmarked for the helicopters will come from revenue the state will earn from the increase in sales tax from 5 percent to 6 percent. The additional revenue will not exclusively fund the helicopters; it will be used to support numerous programs across the state.
How the money for the helicopters will be used is under review by a helicopter replacement committee made up of top state officials including representatives from the Maryland Department of Transportation, Maryland State Police and a consultant group, according to state police spokesman Greg Shipley.
The committee must decide whether to replace the helicopters with new ones or completely rebuild the existing ones.
In the Service Life Extension Program - one of the options being considered - the helicopters are stripped down to their frames and completely rebuilt, George said. That process upgrades the helicopters but will cost less than purchasing brand new helicopters, although how much that would save was not yet known, state police said.
"We ask the helicopters to do a lot and we push them to the limits, but they are great machines," Eisele said. "Our mechanics are always working to keep the helicopters running because safety is most important."