Md.-Run Medevac Practices At Issue

Helicopters' Use Of Rescue Scene Medics Scrutinized

When she climbed aboard a medevac helicopter in Charles County in September, emergency medical technician Tonya Mallard had no helmet, no flame-retardant flight suit and virtually no training. Hold the patient's hand and listen to the flight paramedic, a colleague told her over the roar of chopper blades.

Had it been almost any other medevac flight in the country, Mallard would not have boarded. Maryland's state-run service is among the 3 percent of operators whose crews include only one staff medic. In one of every five missions, the helicopters pick up another medic from the rescue scene to care for a second patient or one who is critically injured.

The helicopter that carried two victims from a Waldorf car accident Sept. 27 crashed in Prince George's County, killing four people, including Mallard, a volunteer with a Waldorf fire department. She suffered severe head injuries, chemical burns and bone fractures.

For decades, the Maryland State Police medical helicopter program has been praised as a national model for emergency care, but documents compiled since the crash make clear that it adheres to some safety and flight standards that are less rigorous than industry norms.

Police officials say adding a second medical provider to each flight would be a poor use of resources. State lawmakers are expected to discuss the issue and other possible changes to the program this week.

The sole survivor of the Washington area's only other fatal medevac crash in many years, a 2005 accident that killed a pilot and a paramedic near the Woodrow Wilson Bridge, called recruiting medics from the ground "one of the most egregious breaches in air medical safety."

"They are putting these ground providers on helicopters who have never had survival training, no helmet, no flight suit, no boots, no idea how to use the medical equipment," said Jonathan Godfrey, who was a staff nurse on a flight run by a private service. "It's all of this risk with very little benefit to anyone."

In addition to using a single crew medic, the Maryland service follows less restrictive Federal Aviation Administration flight rules than private medevac companies do, meaning the state's operation is not subject to the same inspection and maintenance rules.

Maryland's pilots are not required to conduct a written or computerized risk assessment before accepting a mission, a routine step for most private medevac companies.

Maryland State Police pilots are trained to mentally evaluate potential risks posed by weather, crew fatigue, distance, the type of mission and other factors, officials said. They are allowed to turn down missions and are not punished for doing so.

On the night of the September crash, pilot Stephen H. Bunker discussed the possible flight with a duty officer who did not mention that two patients would be transported. It was stormy, and the two discussed flying conditions, according to a transcript of the exchange.

Bunker, who was among those killed, reviewed cloud ceiling reports and noted that a MedStar helicopter had just landed at Washington Hospital Center in the District.