General Assembly Journal 2009 – Part 6
Another whirlwind week in Annapolis. From helicopter trauma transport to expensive steak lobbying dinners, the range of topics spans the important to the ridiculous.
As previously mentioned, I was asked to chair a small but intense review of the medical protocols used by emergency medical personnel and first responders. These protocols guide the scene responders as they consider the most appropriate immediate actions and transport methods available to get a patient to the next level of care.
Our state healthcare delivery system is a complex conglomeration of care providers and reimbursement methods all designed to meet one simple test: The best care possible for a patient, regardless of their ability to pay.
My conservative friends sound a warning note about this “single-payer” system. They suggest that similar efforts in other places will result in socialized medicine. I had a hearty chuckle two weeks ago listening to radio-talk maven Laura Ingraham issue dire warnings of any attempt to implement single-payer healthcare in the United States.
Apparently, Ms. Ingraham was too busy to recognize that the single-payer model is already working pretty well right here in Maryland. Could it be better? Of course it could. Is our system better than most? The statistics from non-partisan analysts suggest it is.
One of the best aspects of our healthcare network is our trauma care. We have a network of sophisticated facilities that can receive, process, and care for a range of trauma patient needs.
Our primary adult care resource (PARC) for adult trauma patients is the R. Adams Cowley Shock Trauma Center at the University of Maryland Hospital in Baltimore. This trauma intake unit was designed by and named for the father of trauma care in Maryland. Dr. Cowley created the concept of the “golden hour” of trauma, the recognition that intensive treatment of a patient in the first 60 minutes following a serious trauma incident dramatically increases the chance of survival.
In addition to the Cowley Shock Trauma Center, we have a number of smaller trauma hospitals spread geographically around Maryland, as well as specialty trauma centers for eye, hand, and burn injuries.
The key to accessing these trauma centers is the on-scene care and transportation of a patient. Our system in this regard is nationally recognized as a model of efficiency and efficacy. Instead of a bill sent to your insurance company, your vehicle registration fees pay for this helicopter transport system.
An emergency medical technician (EMT), who is dispatched to an accident scene, is equipped with the tools needed to initiate this trauma system. For more complex situations, a qualified paramedic possessing additional training and certifications may also be sent.
Upon arrival, the real work of trauma care begins. Our system includes a structured process to assess a patient. First, the physiology is considered. This includes vital signs, obvious external injuries, and an assessment of any other conditions. Second, the anatomical assessment is undertaken. Third, the “mechanism of injury” is reviewed. A fall from a height greater than three times the standing height of the victim, or a vehicle accident with passenger compartment “intrusion” greater than 18 inches, have been reasons to call for a Medevac helicopter flight.
Early last year, a team of experts determined that some minor changes in these protocols might be justified. Cars and trucks are built much more sturdily than in the past, and passenger safety mechanisms are also more sophisticated.
In July of last year, a series of changes were introduced to the field, including a requirement that any trauma scene within a 30-minute drive of a trauma center should result in ground transport of the patient.
Late this past summer, a tragic crash of Trooper 2, a Maryland State Police helicopter, near Andrews Air Force base resulted in the death of several trauma care workers and a crash victim. Following the crash, the mandatory National Transportation Safety Board review was conducted.
Since the accident, we’ve seen a dramatic drop in Medevac flights. Is it because of the protocol changes, or is it a potentially dangerous intentional under-utilization to avoid another bad outcome?
The truth is that we simply don’t know. Our existing helicopter fleet is past its useful life, and needs some dramatic relief. We either need to buy some new machines, upgrade operating and maintenance procedures, and enhance staffing, or we need to consider a policy choice to privatize the service and shift the cost burden to insurance companies and families of trauma victims.
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Annapolis isn’t all dire policy choice and difficult decisions. Sometimes, the decisions are very simple but have hidden consequences. A recent example is an invitation to a dinner with members of the Frederick County Chamber of Commerce at Lewnes Steak House in Annapolis. Pronounced lou-nesses, this is one of the best dining establishments in the state capitol, the scene of nightly committee dinners paid for by powerful lobbying and special interests.
These expensive steak dinners are perfectly legal, in spite of the appearance question. While these invitations are a regular part of the legislative experience, I routinely turn them down. A recent invitation to dinner with our own Chamber of Commerce Board was extended and accepted.
Approximately 35 people rented a bus in Frederick and rode down to Annapolis to dine with the delegation. Bechtel, SAIC, the Plamondon Companies, Fort Detrick, Frederick County Public Schools officials, and Frederick Community College leaders were among the attendees. It’s rare to be able to spend an evening with a room full of Fredericktonians, especially in Annapolis during the session.
Within 24 hours, press reports of the dinner included commentary of one fellow delegation member indicating that they didn’t need an expensive steak dinner to communicate with the business community back home. It isn’t clear that was the issue, though.
Thirty-40 people, both Republican and Democratic voters, took a day away from business and family to drive to Annapolis to express their concerns, interests, and priorities to their elected leaders. Is it any more worthwhile to spend an evening being feted by Annapolis lobbyists and power brokers?
If a legislator is going to be influenced to vote a certain way based on a steak dinner, then are fundamentally unfit to serve. One important task of an elected representative is to listen to people back home, to synthesize their interests into the policy making process.
Glibly passing off that obligation may say more about a particular legislator’s decision-making process than dining at a steakhouse with a group of business and civic leaders from back home.