Washington Post: Choppy Winds for Air Rescue
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Choppy Winds for Air Rescue
Legislature Endorses $110 Million Overhaul, but Hospital Drama Looms
By Candace Rondeaux
Washington Post Staff Writer
Sunday, November 18, 2007; C01
Tree cover almost completely obscures the landing zone. Maryland State Trooper Joshua Chason searches the sprawling thicket of greenery about 1,000 feet below. The helicopter banks hard right as ground paramedics radio Chason an update.
Forty-seven-year-old man. Fell face-first three stories. Unconscious. Breathing labored. Blood pressure rapidly dropping.
The helicopter lands in an open field near a row of greenhouses in southern Charles County. Dust kicks up around Chason as he strides toward a waiting ambulance. Soon he is back in the air, wiping blood out of the unconscious man's mouth.
It's the first call of the day. In the next six hours, Chason will take off and land about 20 more times. Maryland State Police air rescue helicopter Trooper 2 will fly hundreds of miles across the District and four Maryland counties. With about 1,200 patients flown each year across a more than 1,400-square-mile area that includes parts of Prince George's County and Southern Maryland, Trooper 2 is among the busiest air rescue helicopters in the country.
Heavy demand has taken a toll on Trooper 2 and the 11 other helicopters in the state police air rescue operation, the only such statewide, publicly run service in the country and the national standard-bearer for safety. The 18-year-old fleet needs to be replaced. Last week, the General Assembly endorsed spending $110 million for an overhaul, despite a budget shortfall that could top $1.5 billion.
The alternative would be turning to the private air ambulance industry, which has grown rapidly in recent years as demand for emergency transport has soared. Patients, who are not charged for state-run flights, would pay dearly for private air ambulance service.
The state could save money immediately by no longer operating an air rescue service. But opponents of privatization say it would jeopardize safety and provide less coverage in rural areas where private service would be less profitable.
"Commercial helicopters want the business," said Mary Beachley, the state's trauma care coordinator, "but the problem is, if the state makes the decision that they're no longer going to carry the helicopter system, you're not going to have coverage in the lower rural counties because there's lower volume. It's economics."
Economics are hard to size up from where Chason is sitting. Hundreds of feet below, a golf course gives way to a strip mall. Subdivisions crest onto traffic-clogged roads. Within minutes, the red and white helipad at Prince George's Hospital Center floats into view.
The 47-year-old man's blood pressure is still dropping as Chason and hospital staff rush him to an emergency room that snaps to life the instant the patient enters. Chason briskly runs through the man's history, then heads back to the roof, where he spends a few minutes wiping blood off the helicopter's metal stretcher.
Blood is about the only constant. Chason has learned to expect almost anything on his 12-hour shifts. On any given day, a state helicopter can run a couple of medical calls, conduct searches for criminals or missing people, fly homeland security patrols, perform a water rescue, or all of the above.
"It's never a routine day," Chason says, a few hours later, back at Trooper 2's hangar at Andrews Air Force Base. A call comes in.
Lawn mower accident. Fifty-one-year-old guy in Charles County knocked unconscious by a machine gone berserk. Sounds bloody. Chason leans his head into the kitchen where pilot Ron Smith is gobbling down a plate of chicken.
"You've got to be kidding me. A flying lawn mower?" Smith, 56, says as he wipes his mouth and heads toward the cockpit.
By the time Trooper 2 touches down in a Waldorf parking lot, the man is conscious and seems to be alert. A ground paramedic explains that the man was talking to a salesman at a home improvement store when a lawn mower somehow came loose from an overhead display. The machine came crashing down on his head, briefly knocking him out.
Chason explains the situation to Smith over the chaotic chatter of dispatchers and air traffic controllers on the helicopter's six-channel radio while adjusting the man's neck brace. "He was shopping for a weed whacker and ended up with a head whacker," he says.
Some calls are a coin toss. The injury is serious but not necessarily critical. Or it's painful but not serious. Critics of the state-run system say that flights on a $6 million helicopter for such calls are unnecessary and costly. Low-priority missions, they say, should be left to private air ambulances to save taxpayer money.
But state police adhere to the concept promoted by the late R. Adams Cowley, the Maryland heart surgeon who dubbed the first 60 minutes after injury "the golden hour" and who helped found the state's aviation unit in 1970. Minutes saved on patient transport can prevent paralysis, coma or long-term disability, said Connie Potter, executive director of the National Foundation for Trauma Care, a New Mexico-based nonprofit group that advocates for trauma centers. "With trauma patients, it isn't just that they're going to die," Potter says. "It's that the outcome is miserable if they don't get immediate care. The recovery is more difficult."
Chason is told he'll have to fly the man injured by the lawnmower to Suburban Hospital in Bethesda because Prince George's has too many incoming patients. The reroute means a few extra minutes in the air but does not seem to mean a critical difference. The division's eight bases allow state police to be on scene anywhere in Maryland in 18 minutes or less.
During a shift change a few mornings later, Chason, 29, chats with Trooper 2 supervisor Cpl. Nathan "Sparky" Wheelock as a thick fog hovers over the hangar, temporarily grounding Trooper 2.
Wheelock, 34, got his start with a private ambulance in Massachusetts, later graduating from paramedic school in Boston. In his eight years as a state police air medic, Wheelock has saved a lot of lives. He has also watched the light go out of plenty of patients' eyes.
About eight hours into his 12-hour shift, Wheelock is in the back of the cramped helicopter cabin trying to stanch blood pouring from a woman's head. The stench of her vomit permeates the air along with the heavy fuel fumes from the helicopter's churning engine. Wheelock adjusts his helmet, then wipes vomit off the side of the stretcher as he calls ahead to Prince George's hospital.
A few minutes later, he calmly reels off the woman's condition as he and hospital staffers wheel her into the emergency room. The woman is in her 80s and was in a restaurant buffet line when she suddenly fell backward. A blood vessel in her head might have burst, Wheelock says.
As doctors and nurses swarm around the woman, Wheelock moves to the hallway and spends the next several minutes cleaning his equipment. "She's not in good shape at all," he says, shaking his head.
Neither is the hospital, and that worries some. Financially strapped, mired in a seemingly intractable tug of war between state and county officials and facing possible closure, the Prince George's hospital is part of a delicate web of trauma care centers the state police fleet flies to daily.
"We've just been holding our breath, because if they're going to close Prince George's, it's going to be a disaster," says Beachley, the state trauma director. "Not only will it be a disaster for trauma care, but for all the other medical services that are actually functioning in the area and the helicopter unit."
One less trauma center would mean longer flights for Trooper 2 to other hospitals. Longer flights could mean the difference between life and death.
"She needed immediate care," Wheelock says, nodding to the emergency room. "That would have been a 15-minute flight to Baltimore if the trauma center wasn't here. If they let Prince George's County hospital close, people like her might die."
Air rescue missions aren't just risky for patients. In a hallway at the hangar, six state troopers killed in three helicopter crashes stare out from a row of photos beneath the Gaelic words "Onoir du na marbh": Honor the dead.
Since the last crash in 1986, Maryland has become a model for safety. By contrast, crashes involving private air ambulances have soared in recent years, with 55 crashes from 2002 to 2005, according to a 2006 congressional report.
The recent spate of crashes prompted the National Transportation Safety Board last year to call for tougher safety standards that would restrict flights in adverse weather, enhance maintenance checks and upgrade technology. The agency also cited as contributing factors haphazard dispatching procedures and pressure to fly many missions as quickly as possible.
Rookie state Trooper Tabitha Long, 24, is too new to give crashes much thought.
Long flew her maiden mission as a state police air medic with the same pilot who carried her to safety when she was born prematurely a little more than two decades ago. "I've been wanting to do this since I was born," she says.
On the ground in Calvert County, Long listens intently as Bob Rogers, assistant fire chief for the town of Solomons, describes the condition of a young girl. Helicopter blades chop the air overhead.
Eighteen-month-old girl. Fell 14 feet from a porch deck.
As Long approaches the waiting ambulance, Rogers's face relaxes. "We couldn't do it without them because ground transport to the nearest hospital would take too long," Rogers says. "They have saved so many lives down here."
Back on the helicopter, Long rolls up the sleeves of her black flight suit and crouches over the girl to check her vitals. She adjusts the long cord stretching from the girl's tiny finger to a monitor. Wide-eyed and strapped to the stretcher, the girl stares silently out the window as Trooper 2's blades beat the twilight air.
The girl's mother looks on anxiously from a jump seat in the helicopter cabin as Long calls in the girl's condition to the Children's Hospital in the District. She chews her lip, her eyes never straying from the stretcher where her daughter lies beneath a heap of tubes and bandages.
Long gives the girl's hand a reassuring squeeze. She gives the girl's mother a thumbs up.
Gives me time for my assessment,treatment, IV, Monitor, O2, pulse-ox, med-patch and secondary assessment.
