Md. EMS Is Pressed To Share Triage Study

As Maryland lawmakers wrestle with the future of the state's emergency medical service following the fatal crash of a state helicopter taking accident victims to a hospital, a private company has come forward with a new concern about the independent agency.

The company accuses state EMS leaders of dragging their feet in releasing the results of a study of a new method for triaging patients in mass casualty incidents, a method that company leaders believe could save lives.

In a Jan. 19 letter, Thomas B. McCord, the chief executive of Bel Air-based ThinkSharp, wrote that the Maryland Institute for Emergency Medical Services System, the group that oversees all emergency medicine in the state, had displayed "disregard, disbelief and delay" about the results of the April 2007 study that the company conducted jointly with the state group.

"To me, it's just wrong to sit on this information for this long," McCord said in an interview about the 22 months that have passed since the study was done. "No matter what your reasons are -- it's wrong."

Institute Executive Director Robert R. Bass said the agency is still interested in publishing a paper with ThinkSharp on the test of the company's triage method and said the delay stemmed from discussions about what the paper should say. He said that the method requires further study and that some paramedics have found the method to be confusing and difficult to use.

Maryland has one of the nation's most centralized systems for conducting emergency medicine. All state ambulance services and hospitals are overseen by the institute, which is led by a director hired by an 11-member board of gubernatorial appointees. The system has long been considered a national model for coordination between first responders and hospitals.

However, the agency also oversees the Maryland State Police medical helicopter program, which has been under scrutiny since the Sept. 27 crash that killed four people in Prince George's County. Flights since the crash have decreased significantly, with no immediate adverse impact on trauma victims, leading some lawmakers to question the size of the program. They say they believe that the institute, once a national leader, has become resistant to change.

"These are the most politically wired interest groups in the state, and they are aligned to prevent change," said Sen. E.J. Pipkin (R-Queen Anne's), who is pushing a bill to replace Bass with a Cabinet secretary who answers to the governor. "Whether it's this company or another, I think the question they raise about MIEMSS are valid," he said.

The helicopter issue has also highlighted national discussions about how triage decisions are made. The family of a car accident victim killed in the helicopter crash has questioned whether her injuries warranted an airlift in the first place.

ThinkSharp developed the triage method under study and estimates that it would cost Maryland about $3.9 million over three years to adopt it. The method is designed to use statistical data of survivability rates of people with certain symptoms to help paramedics decide the order in which to dispatch injured patients to hospitals in mass casualty events. Examples of such an event include train accidents and natural disasters, plus more routine accidents in rural areas where a serious car crash could swamp emergency resources and force workers to prioritize care.

Paramedics are trained to use a variety of factors, including physical condition of a patient and how an injury occurred to assign patients a color-coded tag -- red, yellow or green. Red indicates immediate need of attention, green signals minor injuries. But some studies have shown inconsistency in paramedics' tagging decisions.

ThinkSharp's method is designed to eliminate guesswork by assigning each patient a number, derived by adding up scores tied to different physical symptoms. The scores are based on a mathematical formula developed by William J. Sacco, a statistician long involved in trauma care, and are designed to take into account the chances that a patient treated quickly will survive given different patient characteristics, such as pulse.