By Jenna Johnson
Washington Post Staff Writer
Tuesday, October 7, 2008; B02

Maryland emergency medical workers will begin consulting with trauma center doctors before using helicopters to transport patients who do not have obvious severe injuries, authorities said yesterday.

The change -- first responders previously decided whether to summon a helicopter without such a consultation -- was announced eight days after a Maryland State Police helicopter crashed in Prince George's County, killing a patient and three rescue workers.

The helicopter was transporting two teenagers who complained of chest, neck and side pain after a car accident. The mother of Ashley Younger, the 17-year-old patient who was killed, has questioned whether she was airlifted unnecessarily.

Robert Bass, the state's chief of emergency medical response, also announced that a panel of national emergency response experts would be convened to evaluate Maryland's system of deciding which patients to transport by helicopter from accident scenes. Patients with external or internal injuries that need immediate attention will continue to be immediately transported by helicopter without a consultation, he said.

In many cases, however, there are no obvious severe injuries but the circumstances -- such as a car-crushing accident or a patient who is pregnant -- raise the possibility of internal injuries or other concerns. In those cases, trauma doctors will consult with emergency responders to ensure that a helicopter ride is necessary, Bass said.

The calls will last less than two minutes and will be a way for the emergency responders to more thoroughly consider all factors. Trauma doctors will most likely trust the judgment of the volunteer and professional medics with the patient, said Thomas M. Scalea, physician-in-chief at the Maryland Shock Trauma Center in Baltimore.

"I have trouble overruling somebody who is at the scene," he said.

Critics say that an overabundance of caution during triage results in the expensive and unnecessary use of medevac helicopters. But Scalea said under-triaging and not using the quickest method to transport patients to a trauma center can cost lives. Scalea said there have been numerous times that patients are stable until they reach the trauma center, where they quickly deteriorate and need immediate attention.

"If you are lying on the side of the road, you deserve to hear the helicopter land," he said. "You deserve to be transported."

The sole survivor of the deadly helicopter crash, Jordan Wells, was in critical but stable condition at the shock trauma center and will need at least a year of rehabilitation, Scalea said. Her father, Scott Wells, said tubes were removed from his daughter's throat yesterday, and she was able to speak to her parents.

State police grounded its remaining 11 helicopters after the crash until they could be inspected. The three helicopters that service Southern Maryland, Baltimore and the Eastern Shore have been reinstated, and the others are expected to be back in operation this week, Bass said.

Last year, state lawmakers approved the purchase of three helicopters each year until the aging fleet is replaced. Funding for the first three helicopters has been approved, but the state has not yet sought bids.