MIEMSS: MISSION/VISION/KEY GOALS

The Maryland Institute for Emergency Medical Services Systems (MIEMSS) overseesand coordinates all components of the statewide EMS system (including planning,operations, evaluation, and research), provides leadership and medical direction, conductsand/or supports EMS educational programs, operates and maintains a statewidecommunications system, designates trauma and specialty centers, licenses and regulatescommercial ambulance services, and participates in EMS-related public education andprevention programs.

MIEMSS provides the executive support for the EMS Board in reviewing andapproving the budgets for agencies receiving funds from the EMS Operations Fund,developing and promulgating regulations and protocols, proposing EMS system legislation,licensing/certifying and disciplining EMS providers, and conducting other EMS Boardbusiness. MIEMSS also provides the administrative and staff support for the StatewideEMS Advisory Council (SEMSAC) and five EMS regional councils.

MISSIONConsistent with Maryland law and guided by the EMS Plan, to provide the resources

(communications, infrastructure, grants, and training), leadership (vision, expertise, andcoordination), and oversight (medical, regulatory, and administrative) necessary forMaryland’s statewide emergency medical services (EMS) system to function optimally andto provide effective care to patients by reducing preventable deaths, disability, anddiscomfort.

VISIONTo be a state EMS system acknowledged as a leader for providing the highest quality

patient care and that is sought out to help other EMS systems attain the same level ofquality care.

KEY GOALS• Provide high quality medical care to individuals receiving emergency medical

services.• Maintain a well-functioning emergency medical services system.

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2003–2004 ANNUAL REPORTCONTENTS

MIEMSS Vision/Mission/Key Goals inside front cover

Joint Report from the EMS Board Chair & MIEMSS Executive Director 1

MIEMSS Administration 3Aeromedical Operations 3 Attorney General’s Office 4Compliance Office 5Education, Licensure, and Certification 5Emergency Health Services Department,

University of Maryland Baltimore County 6Emergency Medical Services for Children 7 Field Operations

(Communications Engineering Services, EMRC/SYSCOM, Emergency Operations) 10Hospital Programs Office 12Information Technology 12 Maryland Critical Incident Stress Management Program 13Medical Director’s Office 13Policy and Planning (Program Development, DNR, Epidemiology) 15Public Information and Media Services 17Quality Management 18 Regional Programs (Regions I, II, III, IV, and V) 19State Office of Commercial Ambulance Licensing and Regulation 24

Maryland Trauma and Specialty Referral CentersOverview 26Trauma Center Categorization 27Adult Trauma Centers

PARC: R Adams Cowley Shock Trauma Center 27Level I: Johns Hopkins Hospital 29Level II:

Johns Hopkins Bayview Medical Center 29Prince George’s Hospital Center 30Sinai Hospital 31Suburban Hospital 31

Level III:Peninsula Regional Medical Center 32Washington County Hospital Center 33Western Maryland Health System–Memorial Trauma Center 33

Specialty Referral CentersBaltimore Regional Burn Center, Johns Hopkins Bayview Medical Center 34Burn Center at the Washington Hospital Center 34The Curtis National Hand Center, Union Memorial Hospital 35Hyperbaric Medicine Center, R Adams Cowley Shock Trauma Center 36Maryland Eye Trauma System: The Johns Hopkins Wilmer Eye Institute 36Neurotrauma Center, R Adams Cowley Shock Trauma Center 37Pediatric Trauma Center, The Johns Hopkins Children’s Center 37Pediatric Trauma Center, Children’s National Medical Center 38Perinatal Referral Centers 39

Poison Consultation Center, Maryland Poison Center 39

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Rehabilitation 41

Maryland Trauma StatisticsCombined Adult & Pediatric Trauma Statistics Report 42Maryland Adult Trauma Statistics Report (Tables & Graphs)

Total Cases Reported by Trauma Centers (3-Year Comparison) 42Gender of Patients 42Occurrence of Injury by County 43Residence of Patients by County 43Patients with Protective Devices at Time of Trauma Incident 43Age Distribution of Patients 44Emergency Department Arrivals by Day of Week 44Emergency Department Arrivals by Time of Day 44Mode of Patient Transport to Trauma Centers 44Origin of Patient Transport to Trauma Centers 44Number of Deaths by Age 45Number of Injuries by Age 45Number of Injuries and Deaths by Age 45Etiology of Injuries to Patients 45Blood Alcohol Content of Patients by Injury Type 45Injury Type Distribution of Patients 46Etiology Distribution for Patients with Blunt Injuries 46Etiology Distribution for Patients with Penetrating Injuries 46Etiology of Injuries by Ages of Patients 46Final Disposition of Patients 47Injury Severity Score by Injury Type 47Injury Severity Scores of Patients with Blunt Injuries 47Injury Severity Scores of Patients with Penetrating Injuries 47Injury Severity Scores of Patients with Either Blunt or Penetrating Injuries 47

Maryland Pediatric Trauma Statistics Report (Tables & Graphs)Total Cases Reported by Trauma Centers 48Gender Profile 48Emergency Department Arrivals by Day of Week 48Emergency Department Arrivals by Time of Day 48Occurrence of Injury by County 48Mode of Transport 49Origin of Patient Transport 49Disposition of Patients 49Outcome Profile 49Etiology of Injuries by Ages 49Mechanism of Injury 50Injury Type 50Number of Injuries and Deaths by Age 50Number of Injuries by Age 50Number of Deaths by Age 50Children with Protective Devices at Time of Trauma Incident 51Residence of Patients by County 51

National Study Center for Trauma and EMS 52

Current Listing of EMS Board, Statewide EMS Advisory Council, and MIEMSS Executive Staff inside back cover

Over the years as Chairman of the EmergencyMedical Services Board and Executive Director ofMIEMSS, we have used our opening messages totrumpet the accomplishments of the emergencymedical services system in Maryland. We haveendeavored to underscore our progress whiledefining our future needs.

This year we offer not our own judgments andviews but rather report on an assessment offeredby objective, subject-matter experts who measureEMS programs on a national scale by stringentstandards.

The National Highway Traffic SafetyAdministration (NHTSA) is charged with reducingaccidental injuries on America’s highways. One ofNHTSA’s key missions is to assist states in devel-oping integrated emergency medical services pro-grams that promote comprehensive systems oftrauma care. NHTSA appoints TechnicalAssistance Teams with demonstrated leadership,expertise, and experience who measure EMS pro-grams on the basis of ten component areas, eachwith a set of "gold standards."

NHTSA’s assessment was aimed toward mea-suring Maryland’s progress since its last visit andevaluation completed in 1991. At that time,Maryland’s EMS system was going through signif-icant change brought about by the death of RAdams Cowley, MD, the founder and leader ofEMS in Maryland for over 20 years, and an eco-nomic environment that threatened to dismantlemuch of what he had imagined and created.

The 1991 NHTSA report noted the "uniqueand pioneering EMS history" of Maryland and its"strong and charismatic leadership." The reportrecognized enthusiastic volunteers, career profes-sionals and medical personnel, the most extensiveair medical program in the country, and the inte-gral association of the lead EMS agency with theShock Trauma Center.

However, the report also defined as the "sin-gle biggest obstacle to the further development ofEMS services in Maryland" the "absence of clearlegislative authority and responsibility vested in astate agency." Lacking that authority, Marylanddid not have the ability to ensure statewide confor-mity to approved policies and regulations. Therewere no uniformly enforced personnel certificationand decertification procedures, no uniformstatewide ambulance licensure and inspection reg-ulations, and no quality assurance requirements.

The 1991 NHTSA report, as well as the workof the EMS Commission which deliberated during1992, served as the catalysts for change inMaryland. Legislation passed in 1993 created anew EMS system structure and authority for oper-ations. Funding from motor vehicle registration feesurcharges provided the fiscal underpinnings ofthe system.

NHTSA’s reassessment, completed in June2004, states that since 1991, "…the Maryland EMSsystem has embraced change with impressiveresults." While citing the significance of the pas-sage of the enabling legislation and the regulations

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JOINT REPORT FROM THE EMS BOARD CHAIR &THE MIEMSS EXECUTIVE DIRECTOR

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to implement the 1993 law, the report notes thatMaryland has "…implemented a vision of excel-lence through collaboration and consensus." Thereport cites the many presenters during the pro-ceedings who noted that "…MIEMSS fosters aspirit of teamwork and cooperation. MIEMSS hasprovided the resources, leadership, and neutralposture that supported the many system stakehold-ers to come together for planning, implementa-tion, and evaluation of the system."

Indeed it is this spirit that the EMS Boardadopted as its guiding principle at its first meetingin July 1993. "Cooperative excellence" is at leastas compelling as "legislative authority" in ourdeliberations and actions. While the NHTSAreport accurately identifies the EMS Law as inte-gral to establishing the foundation for growth, italso acknowledges the spirit of collaboration as theengine driving advancements in the system.Certainly the report provides a number of sugges-tions and recommendations that will help us focusin on areas that will be addressed as we continueto improve the system of delivery of EMS care toMaryland’s citizens. But just as certain is the factthat our success will be determined more by con-tinued emphasis on consensus building than bythe authority provided through statutes and regu-lations.

The NHTSA report’s summarizing paragraphclearly reflects our thoughts as we contemplateEMS in Maryland in 2004 and beyond: "Thegreatest asset that Maryland’s EMS system pos-sesses is its people. As a team, they have beenfaithful to the original vision of Dr. Cowley. Thatvision has been expanded by the EMS Board’s

contemporary approach of cooperative excellenceand the Executive Director’s program of qualityimprovement. At every level, the people involvedin Maryland EMS are committed and capableabout the work they do. MIEMSS brings themtogether as a force multiplier. The citizens and vis-itors to Maryland are well served by the accom-plishments that MIEMSS has achieved and thework that it will do in the future."

We welcome you to read the full report that isavailable on MIEMSS website,www.MIEMSS.org.

In the following pages you will find a numberof initiatives described that define our determina-tion to continue as leaders in EMS. The imple-mentation of EMAIS (the electronic ambulancerun information-gathering tool) and FRED (theonline EMS resource catalogue), our continuedengagement in WMD (weapons of mass destruc-tion) and bioterrorism event preparation, hospitalovercrowding and work-force issues, and layper-son AED (automated external defibrillator) effortssymbolize the breadth of our involvement inessential matters influencing the quality of lifeMaryland’s citizens.

We look to the past with sincere appreciationfor the rich history of EMS and to the future toreinforce our partnerships to strengthen ouropportunities to make a difference.

Donald L. DeVries, Jr., Esq.Chair, EMS Board

Robert R. Bass, MD, FACEPExecutive Director, MIEMSS

Robert R. Bass, MD, FACEPExecutive Director, MIEMSS

Donald L. DeVries, Jr., Esq.Chair, EMS Board

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ADMINISTRATIONMission: To secure and effectively utilize financialand personnel resources that will enable MIEMSSto meet its goals and objectives in a manner that isconsistent with state regulations and policies.

The Administration Office is responsible forthe financial, purchasing, and human resourcesservices of MIEMSS.

The finance staff is responsible for accountingprocesses to ensure that expenditures are in com-pliance with applicable regulations. The staffdevelops the budget, tracks and monitors expendi-tures, and performs year-end closing. The stafftracks special funds, grant funds, and reimbursablefunds.

The purchasing staff procures all necessarysupplies, materials, and services for the MIEMSSstaff. It is also responsible for the timely paymentof invoices.

The human resources staff is responsible forrecruitment, timekeeping, payroll-related services,benefits and retirement coordination, personnelevaluation processes, and other traditional person-nel functions.

The Administration Office is also accountablefor inventory control, fleet management, travelservices, and building operations and mainte-nance.

Most administrative, fleet, meeting, and officecosts are centrally funded through theAdministration’s budget.

MIEMSS FY 2004 budget information is dis-played by state object code and department in thecharts on page 4.

AEROMEDICAL OPERATIONSMission: To provide the physician medical supportnecessary for the Maryland State Police AviationDivision to meet the emergency helicopter needs ofMaryland’s citizens. The State Aeromedical Directoris actively involved in the ongoing training and ver-ification of skill proficiency for the State Policeflight paramedics. He provides around the clockconsultation support to SYSCOM for med-evacrequests and medical direction and is activelyinvolved in the development of new patient careprotocols and the oversight of ongoing care.

In FY 2004 there were 5,428 patients trans-ported by the Maryland State Police (MSP)Aviation Division. Of these patients, 5,144 (95%)were transported from the scene of injury at therequest of the local fire services, and 284 (5%)were transported between hospitals to a higherlevel of care.

Types of calls included the following:• Motor vehicle crashes 2,544• Falls 706• Pedestrians 300• Gunshot wounds 132• Assaults 113• Burns 87• Industrial accidents 86• Stabbings 73• Hand injuries 58• Hyperbaric patients 14• Eye injuries 13• Drownings 12• Electrocutions 6

Interfacility transports included the followingtypes of patients:

• Trauma 157• Medical 88• Neonatal 39FY 2004 saw the Aviation Division’s contin-

ued participation in the Adult and Pediatric RapidSequence Intubation (RSI) pilot programs.Designed to address the needs of patients with

MIEMSS

EMS Operations Fund

MFRI = Maryland Fire & Rescue Institute • STC = R Adams Cowley Shock Trauma CenterMSP = Maryland State Police

AmossFund

$10.0 m

MSPAviation

$14.8 m

Volunteer Co.Assistance Fund

$6.4 m

STC Building/Equipment

Fund$3.5 m

FY 2004($54,182,241)

MIEMSS$10.1 m

MFRI$5.9 m

STC$3.5 m

FY 2005($50,700,000)

MIEMSS$10.4 m

MFRI$6.0 m

STC$3.5 m

STC Building/Equipment

Fund$3.5 m

Volunteer Co.Assistance Fund

$1.4 mAmossFund

$10.0 m

MSPAviation

$15.9 m

severe head injuries, these RSI pilot protocolsallow MSP flight paramedics to use neuromuscu-lar blocking agents in the field to provide endotra-cheal intubation for patients who are not breathingadequately.

Scenario-based simulation training was againutilized for division flight paramedics in verifica-tion of advanced skill proficiency. These exercisesallowed life-like simulation of patient care situa-tions as would be faced by flight paramedics in thecourse of their normal duties.

FY 2004 also saw the continuation of efforts tocomputerize the documentation of all patient careinformation. Once complete, this process will bet-ter allow for linkage with patient outcome infor-mation, thereby giving greater ability to evaluatehow best to optimize patient care.

ATTORNEY GENERAL’S OFFICEMission: To provide legal advice to the EMS Board,the Statewide EMS Advisory Council, andMIEMSS in connection with all aspects of emer-gency medical services, the ongoing administrativefunctions of the agency, and the regulation of com-mercial ambulance services. The Attorney General’sOffice also serves as the administrative prosecutorfor cases involving allegations of prohibited acts byEMS providers before the EMS Provider ReviewPanel, the EMS Board, the Office of AdministrativeHearings, and the courts.

During the past fiscal year, the AttorneyGeneral’s Office continued to support MIEMSS inpromulgating and implementing the agency’s regu-lations, procurement and contracts, including tech-nology initiatives.

The Attorney General’s Office reviewed andprosecuted 35 cases of alleged prohibited acts byEMS providers and applicants, litigated and settleda claim under the Americans with Disabilities Act.

The Attorney General’s Office participated ina variety of committees, task forces, and workgroups. The Attorney General’s Office workedwith MIEMSS to implement changes to theEmergency Medical Services Do Not Resuscitateprogram. The Attorney General’s Office also par-ticipates in a work group of Assistant AttorneysGeneral representing several state agencies study-ing the state’s response to bioterrorism and othersecurity issues. In addition, the Attorney General’sOffice participated in task forces monitoring theAutomated External Defibrillator (AED) program,the Yellow Alert program, and developing EMAISto replace the current paper runsheet with a com-

puter software application. The Attorney General’s Office presented edu-

cational programs on the Health InsurancePortability & Accountability Act (HIPAA) Privacyregulations, the role and responsibility of EMSoperational program medical directors in the quali-ty assurance process, and developments in EMSlaw, including duties relating to the transport ofminors.

MIEMSS FY 2004 EXPENDITURE BY OBJECT CODE (INCLUDES SPECIAL,

REIMBURSEABLE AND FEDERAL FUNDS)

FY 2004 Actual

Number of Positions 92.6Salaries and Wages $6,282,529Technical/Special Fees 516,864Communication 971,626Travel 109,608Fuel and Utilities 49,720Motor Vehicle Operation and Maintenance 191,145Contractual Services 1,590,191Supplies and Materials 204,981Equipment—Replacement 41,047Equipment—Additional 178,954Fixed Charges 72,067Grants 1,118,701

Total Salary and Wages $6,799,393Total Operating Expenses $4,528,035Total Expenditure $11,327,428

MIEMSS FY 2004 APPROPRIATION BY DEPARTMENT

Administrative OfficesExecutive Director, Legal Office $759,307Financial & Human Resources Administration 1,008,493Planning/Program Development/Total Quality Management 230,542

CommunicationsEquipment 1,270,745Maintenance 1,131,044EMRC/SYSCOM 948,941

Education/Public InformationEducation, Licensure, & Certification/Compliance 1,229,396Public Information & Media Services 510,518Emergency Health Services Program 93,500

Information Technology 1,013,107

Medical ServicesOffice of Medical Director 583,463Office of Hospital Programs 108,647EMS-Children 159,712

Regional Administration 837,570

Commercial Ambulance Program 220,000

GrantsEMS-Children 207,000Perinatal Center Designation Program 75,000Rural Access to AED 200,186Improving EMS in Rural Areas 40,000

TOTAL $10,627,171

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The Attorney’s General’s Office assisted in theadministration of state and federal grants, and inlicensing the MIEMSS Facility ResourceEmergency Database (FRED) program.

COMPLIANCE OFFICEMission: To ensure the health, safety, and welfare ofthe public as it relates to the delivery of emergencymedical services by Emergency Medical ServicesProviders throughout Maryland. To that end, theCompliance Office is responsible for ensuring qualityof care by investigating complaints and allegationsof prohibited conduct.

The Compliance Office works closely with theProvider Review Panel (PRP) (the 13-memberpanel composed of all levels of EMS providers;physicians representing the Maryland Board ofPhysicians, the Maryland Medical ChirurgicalSociety, and the EMS Operational ProgramMedical Directors; the State EMS MedicalDirector; the MIEMSS Executive Director; theEMS Board; and the Attorney General’s Office).The PRP reviews complaints, as well as the resultsof the investigations conducted by the ComplianceOffice, and recommends to the EMS Board anyfurther action.

ACTIVITY REPORT OF THE INCIDENTREVIEW COMMITTEE (IRC), EMSPROVIDER REVIEW PANEL (PRP), ANDTHE EMS BOARD

• Incidents Reported to IRC 291• IRC Investigations Initiated 248• IRC Investigations Conducted 198• IRC Investigations Continued 50• IRC Complaints Forwarded to PRP 37• Complaints Dismissed by PRP 2• Complaints Forwarded to EMS Board 35

EMS Board Action• Reprimands 3• Probation 9• Suspensions 2• Revocations 10• Remedial training 2• Surrenders 1• Evaluation 3• Applications Denied 3• Case Resolution Conferences 8• Dismissed 3• Counseling 2

EDUCATION, LICENSURE, ANDCERTIFICATION

Mission: To coordinate a variety of services to protectthe public and promote and facilitate the develop-ment of knowledgeable, skilled, and proficient pre-hospital professionals who deliver emergency care inthe Maryland EMS system.

During FY 2004, the number of career, volun-teer, and commercial prehospital providers inMaryland was 29,552, with the following break-down:

• First Responders 10,551• Emergency Medical

Technicians-Basic 15,323• Cardiac Rescue Technicians 361• Cardiac Rescue Technicians-(I) 252• Emergency Medical

Technicians-Paramedic 2,192• Emergency Medical Dispatchers 873

Education programs offering courses leadingto EMS certification or licensure are required toobtain approval from the EMS Board. Theapproval process involves a comprehensive self-study and a site visit. The site visit team is com-prised of a medical director and educator fromoutside programs, as well as MIEMSS staff. Thefindings of the self-study and site visit are thensubmitted to the EMS Board for approval. DuringFY 2004, the Office conducted five site visits forthe advanced life support (ALS) and basic life sup-port (BLS) education program approval processes.As of June 2004, nearly 15 education programs arescheduled to complete the entire approval processby October 2004. In addition, nearly 30 lawenforcement agencies, which are approved by theMaryland Police and Corrections TrainingCommissions, are to be approved by the EMSBoard by October 2004.

In cooperation with the BLS Committee ofthe Statewide EMS Advisory Council (SEMSAC),the Office has initiated the development of arevised EMT-Basic Refresher Course. The themeof the course is "back to the basics" and focuses onskills practice. Through data analysis and inputfrom instructors, it was determined that basic skills(for example, splinting, bleeding control, tractionsplinting, spinal immobilization, etc.) need to be aprimary focal point in educational courses offeredto EMT-Bs. As of June 2004, the Committee com-pleted the needs analysis, data review, and designof the course and is working on its development.

The modified refresher course is scheduled forimplementation starting July 1, 2005 with all

EMT-B instructors being introduced to the curricu-lum in March and April of 2005.

In November 2003 and May 2004, firstresponder instructor courses in Frederick andHavre de Grace were held for law enforcementinstructors, educating over 40 new instructors.These instructors, as well as existing instructors,include automated external defibrillator (AED)training within all first responder courses. Giventhe prevalence of AEDs in public places, as well asthe inclusion of AED content in all CPR coursessince 2000, the addition of AEDs to the firstresponder curriculum was well received.

In cooperation with the Maryland Fire andRescue Institute (MFRI) and the MIEMSSPrehospital Education Quality ImprovementCommittee, the Education, Licensure, andCertification Office continues to analyze threeyears of data from the Maryland EmergencyServices Student Application (MESSA) andRegistry (MESSR). Information obtained from theMESSR data includes student outcome, studentdemographics, State written and practical exami-nation results, and more. The information can bebroken down and analyzed by instructor, county,region, and course type. Information derived fromthe MESSR will be utilized to maximize the quali-ty of EMS educational programs offered inMaryland. Furthermore, it will be used to bettermeet the educational needs of the all learners.

MIEMSS Education, Licensure, andCertification Office, in conjunction with MFRI,sponsored a statewide instructor rollout for"Geriatric Education for Emergency MedicalServices" (GEMS). The two-day rollout includes

the GEMS ALS course and an instructor/coordi-nator course to provide the state with 22 instruc-tors and course coordinators for implementationstatewide. The GEMS course focuses on olderpeople and the EMS provider, and the differencesthat complicate the emergency medical care deliv-ered to the elderly.

Working collectively with various MIEMSSdepartments and the Maryland State Firemen’sAssociation, Metro Chiefs, and Council ofAcademies, the Office has assisted with staffing theWorkforce Committee. The Workforce Committeeis comprised of representatives from around theState and is focused primarily on identifying issuesrelated to recruitment, retention, and the per-ceived shortage of EMS professionals throughoutthe State. The Committee is charged to gatherdata, review and identify issues, and make recom-mendations to the SEMSAC and EMS Board byJanuary 2005.

EMERGENCY HEALTH SERVICESDEPARTMENTUNIVERSITY OF MARYLAND, BALTIMORE COUNTY

Mission: To provide leadership in the field of emer-gency health services through excellence in education.This educational excellence is supported by an activeresearch agenda, service to the University and EMScommunities, and provision of professional continu-ing education. The EHS Department recognizes asconstituents the University of Maryland atBaltimore County, MIEMSS, and the Maryland,national, and international EMS communities.The Emergency Health Services (EHS)

Department received a continuation of its contractfor the fourth year with the Department ofHomeland Security (formerly with the U.S. PublicHealth Service) to develop and provide trainingand education for over 8,000 members of theNational Disaster Medical System (NDMS). Thisyear's budget is a little over $1 million. Headed byRick Bissell, the EHS team now has over 50 cours-es completed and available for NDMS membersnationwide.

Demand has increased for our students upongraduation, with an increasing shortage of quali-fied paramedics nationwide and rapidly growingemployment for management and graduate stu-dents in the realm of homeland security.Numerous current students and recent graduatesare now working for the Department of HomelandSecurity, the National Disaster Medical System,the Centers for Disease Control and Prevention,and related contractors.

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Undergraduate enrollment continues toincrease, especially in the paramedic track, whichopened a designated laboratory for skills and indi-vidualized instruction. One reason for the enroll-ment increase is the EHS Living Learning Center,an academic residential community for EHSmajors. The department continues to maintainMaryland accreditation from MIEMSS andnational accreditation through CAAHEP. EHSmajors are active members of 27 Maryland emer-gency services organizations.

To date, EHS has contracts with over 40 edu-cational institutions nationwide to provide criticalcare transport training utilizing the department’sCritical Care Transport Course. During 2003, 247Maryland providers participated in EHS continu-ing education courses, including 48 members ofthe Maryland State Police.

Between January 30 and February, JeffreyMitchell was invited to participate in a conferencejointly sponsored by the British Red Cross and theEuropean Union. He was the only American invit-ed to make a presentation at this prestigious inter-national conference. His topic was "DisasterPsychology and the need for a comprehensive andsystematic approach to mental health services."

EMERGENCY MEDICAL SERVICES FOR CHILDREN

Mission: To provide the leadership, direction, andexpertise in the coordination of resources that focuson the unique needs of children and their families ina manner that facilitates the efficient and effectivedelivery of prehospital, hospital, and restorative carethroughout the state. These resources include injuryand illness prevention, clinical protocols, standardsof care and facility regulation, quality improvementinitiatives, interagency collaboration, and initialand continuing education for providers across thecontinuum of care that will promote the health andwell-being of children in Maryland.

The Emergency Medical Services for Children(EMSC) Program is responsible for the develop-ment of statewide guidelines and resources for pedi-atric care, the review of pediatric emergency careand facility regulations, coordination of pediatriceducation programs, and collaboration with otheragencies and organizations focused on childhoodhealth and illness and injury prevention. TheEMSC Program coordinates the state PediatricEmergency Medical Advisory Committee(PEMAC), the state Pediatric Quality ImprovementCommittee (QIC), and the five Regional Pediatric

EMS Advisory Committees. Federal EMSC grantsare coordinated through the Maryland EMSCProgram Office, involving statewide projects, spe-cialized targeted issues, projects, and research initia-tives at academic universities.

The EMSC Program staff and medical direc-tors from PEMAC continued to support theMaryland Enhanced Prehospital Education forPrehospital Providers (PEPP) courses and coordi-nate the PEPP statewide steering committee tofacilitate sharing of faculty resources, plan forrecertification, and identify material that correlateswith the Maryland EMS Medical Protocols. Thissteering committee meets jointly with the statePEMAC and the Maryland chapter of theAmerican Academy of Pediatrics’ (AAP)Committee on Pediatric Emergency Medicine.Based upon the consensus process, the PEPP cur-riculum has been enhanced to include models thatcomplement the Maryland EMS MedicalProtocols and address those clinical skills that thePediatric QIC and Pediatric Base Stations haveidentified as high risk and low volume. TheChildren with Special Health Care educationalmodules and equipment have also been integratedin the PEPP courses offered and supported by theEMSC Office and the Maryland AAP. Forms andresources are available on the web athttp://www.miemss.org/EMSCwww/PEPPEnhanced.html.

Through the Maryland Medical Protocolreview process, establishment of current state-of-the-art clinical approaches to pediatric seizuremanagement and pediatric automated externaldefibrillator (AED) use have been developed andimplemented. Protocol revisions were based upona comprehensive evidence review and expert con-sensus process of the PEMAC. During each of theeducational seminars and conferences in Marylandduring 2003-2004, the Tracheostomy SkillsWorkshop was presented. Based upon bothprovider and instructor feedback, the EMSC staffexpanded the program and developed a CD-ROM training resource on Tracheostomy Care for All Ages that was reviewed by a statewide workgroup and approved by both PEMAC and theOffice of the Medical Director. This resource has

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been made available to all county and collegetraining programs and will be available on theMIEMSS EMSC website athttp://www.miemss.org/EMSCwww/PedsCE.html.

Prehospital continuing education programswere offered at several conferences throughout thestate. Pyramid 2003 included both BLS PEPP andpreconference workshops on moulage, in additionto the annual session on Pediatric Case Reviewsfrom the Pediatric Base Stations. Winterfest 2004featured a moulage preconference session and aconference presentation on pediatric trauma. TheMiltenberger EMS & Trauma Conference includ-ed a lecture and workshop on child victimization.The EMS Care 2004 state conference included aMaryland Enhanced ALS PEPP course, as well aspresentations on child victimization, pediatric car-diac arrest and the AED, crash reconstruction,

pediatric seizure management, Pediatric TraumaCase Reviews, a pediatric resuscitation update,and JUMPSTART with tabletop exercises.

MIEMSS has again been awarded an EMSCState Partnership Grant from the Maternal ChildHealth Bureau of the Department of Health andHuman Services in joint sponsorship with theNational Highway Traffic Safety Administration(NHTSA). The 2003-2006 EMSC PartnershipGrant continues to build on the integration ofEMSC with new interagency collaborations withthe Maryland chapter of the American Academyof Pediatrics and the Maryland State Departmentof Education.

This grant will provide for further integrationof the Kids in Disasters initiatives with a review ofexisting programs, plans, and policies for inclusionof the needs of children and families and expan-

Applicant

Region IIFrederick County Departmentof Fire & Rescue Frederick SAFEKIDS

Region IVShore Health Systems EMSProgramQueen Anne & Talbot EMS

Region VEmergency Education CouncilRegion V Bowie VFD Auxiliary

Region VMontgomery County Fire &RescueCounty SAFEKIDS

Region VEmergency Education CouncilRegion V MSFA Prevention Committee& Bowie VFD Auxiliary

Region VMontgomery County Fire &RescueCounty SAFEKIDS

Target Area

Children 0-8 & families inFrederick Co

Pilot in Queen Anne and Talbotcounties with replication onEastern Shore.

School-age children in Bowie,Maryland with replicationplanned for the county andregion

School-age, middle-school chil-dren in Montgomery County

Schools in Central andSouthern Prince George’sCounty with statewide presentation for duplication.

School-age children inMontgomery County

Summary of Project

Children Riding in Vehicles Safely: Joint projectbetween Fire & Rescue, Frederick County SAFEKIDS,and Frederick Memorial Hospital Wellness Center toupdate CPS materials in those fire stations with trainedCPS technicians.

"Latch Key Kids: Making It Safer": Review of existingprograms and materials and development of SafetyChecklist and Emergency Response Plan for middleschool children at home alone after school.

"Operation Safe Arrival—Bike Safety for Tulip GroveElementary School": Pilot project with Bowie, Marylandto saturate elementary school-age children and familieswith bike helmets and bike safety information. Pre- andpost-intervention observational tool development included.

"Saved by the Helmet": Bike helmet and safety inter-vention with high-risk, multi-lingual communities.Partnership between Fire & Rescue, SAFEKIDSCoalition, and National Capital Park Police.

"Adapting RISKWATCH for Children with SpecialNeeds": Replication of successful project in Special Needswith the adaptation of the NFPA RISKWATCH curricu-lum tools, presentations, and evaluations for 2-6-year-oldswith special learning and medical needs.

"Mobile Safety Resources": Enhancement of mobilesafety trailer to incorporate video material and PSA forchildren between skill stations at open houses, safety fairs,school prevention events.

Maryland EMS for Children Program2003 Injury Prevention Special Projects

EMS Based Injury Prevention Program for ChildrenJuly 2003—January 2004

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sion of the JUMPSTART triage training and disas-ter preplanning with schools. The Kids in Disastersproject includes the following initiatives:

1. Pediatric Triage Training with START andJUMPSTART workshops with correspondingtabletop exercises and scenarios focused on chil-dren. Educational opportunities are being expand-ed to include school and public health nurses withscenarios involving children with special learningand health needs. The Maryland MedicalProtocols for EMS Providers now includes thecombined START and JUMPSTART triage tool.

2. A Maryland Moulage Team has beenrecruited to assist in the preparation of victims forfull-scale drills. Many of the members of this teamhave taken the moulage workshops offeredthrough the EMSC Program and coordinated bythe MIEMSS regional offices. Resources onmoulage are available on the EmergencyEducation Council of Region 5 websitehttp://www.eecreg5.org/moulage/index.htm.

3. The Maryland Virtual Emergency ResponseSystems (MVERS) is a joint project with theMaryland State Police, the MIEMSS OperationalSupport Team, and school partners. The MVERSprogram provides worksheets for gathering infor-mation and the page-builder software on CD-ROM to store and recall the essential data in anorganized format for all aspects of an emergencyresponse. The program will improve and enhancethe communication and coordinated response ofpublic safety, public health, and educational pro-fessionals to critical incidents, both man-made andnatural. Anne Arundel County schools are utiliz-ing the MVERS project through a federalDepartment of Education grant they received.

The Maryland EMSC program received a sec-ond EMSC Regional Symposium grant and willbe jointly coordinating the third Mid-Atlanticeight-state EMSC Regional Symposium withDelaware EMSC, to be held in Rehobeth duringthe fall of 2004. The initial grant period coordinat-ed two eight-state planning meetings. The firstmeeting included the filming of a multi-state pub-lic service announcement based upon the federalEMSC "Right Care When It Counts Campaign."The second meeting was a partnership with theAtlantic EMS Council and facilitated collaborationand knowledge exchange among state directorsand EMSC directors. The Mid-Atlantic EMSCgroup includes Virginia, West Virginia, the Districtof Columbia, Maryland, Delaware, Pennsylvania,New Jersey, and New York.

The federal EMSC research agenda continuesto be implemented through the Chesapeake

Applied Research Network (CARN) of the nation-al Pediatric Emergency Care Applied ResearchNetwork (PECARN). The CARN project is basedat Children’s National Medical Center andthrough partnerships with Johns HopkinsChildren’s Center provide the academic base forthe nodal network in Maryland that have the firstEMS and Emergency Department collaborativeresearch projects within the PECARN project. TheUniversity of Maryland Pediatric EmergencyDepartment has joined the research network thisyear along with Holy Cross Hospital, CalvertMemorial, and Howard County Hospital. TheCARN is establishing data linkage projects and thestructure to apply for and implement pediatricEMS and ED research initiatives.

Maryland EMSC personnel participated onthe following national advisory committees andexpert panels during the past year: (1) The HealthResources and Services Administration’s NationalConsensus Panel on Guidelines for PrehospitalResponse to School Health Emergencies; (2) theCenters for Disease Control’s National Center onEnvironmental Health Work Group on EMSManagement of Asthma Exacerbations; and (3)the Institute of Medicine’s Subcommittees onPediatric Emergency Medicine and Hospital-basedEmergency Care of the Committee on the Futureof Emergency Care in United States HealthSystems. In June 2004, the Maryland EMSCProgram Director was presented with the 2004EMSC National Heroes Award in the state coordi-nator’s category.

During May 2004, EMS for Children’s Daywas celebrated across Maryland through therecognitions of children and youth who havedemonstrated one of the 10 Steps to Take in anEmergency or one of the 10 Ways to be BetterPrepared for an Emergency. On May 17, 2004,First Lady Kendel S. Ehrlich presented eightyoung Marylanders with awards for their actionsthat ensured anther person would receive "TheRight Care When It Counts." Public serviceannouncements and a Maryland EMSC Dayposter are available in English and Spanish to con-tinue the public education message promotinginjury prevention, family preparedness, and appro-priate emergency actions.

The EMSC Program continues to receive aMaryland Department of Transportation HighwaySafety Grant focused on improving the child pas-senger safety resources within Maryland hospitalsand health care professional practices. Maryland’sChild Passenger Safety Law changed on October1, 2003 (with the inclusion of booster seats).

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MIEMSS collaborated with the MarylandHighway Safety Office and the Kids in SafetySeats program at the Maryland Department ofHealth and Mental Hygiene to develop and pro-duce public service announcements, posters, andpress releases to inform the public about theimportance of using booster seats for preschooland early school-age children. The third-year pro-ject has also included the expansion of the website(http://www.miemss.org/EMSCwww/CPSHome.htm)resources to include all the informational packagesdistributed to the hospitals and the occupant pro-tection posters developed jointly with theMIEMSS Public Information & Media Servicesstaff. Three new resources are being developed forthe hospitals to promote current child passengersafety initiatives and health-care provider educa-tion:

1. Child Passenger Safety: Best Practice forHealth Care Facilities (Workbook)

2. Proper Occupant Protection training videofor hospitals

3. Introductory workshops on child passengersafety and children with special needs.

Maryland was awarded a RISK WATCH®Champion Award for 2003- 2005 from theNational Fire Protection Association (NFPA). TheEMSC Program at MIEMSS is the lead agencycoordinating this two-year initiative, along with theOffice of the Maryland State Fire Marshal, theMaryland State Police, and the MarylandDepartment of Education. Other partners in RISKWATCH® include Maryland SAFE KIDS, the Fire Prevention Committee of the Maryland StateFiremen’s Association, the State HighwayAdministration, the Maryland & National CapitalPoison Centers, the Maryland Chapter of theAmerican Trauma Society (ATS), and theMaryland Department of Natural Resources.During the first year of the Champion Award givento Maryland, five communities have placed theRISK WATCH® program into more than 100classrooms during fall 2003 and winter 2004.These communities are Montgomery, PrinceGeorge’s, and Howard counties, special needsschools in Bowie, Maryland, and a parochial schoolin Charles County. During the second year of theChampion project, the RISK WATCH® programwill expand into an additional 100 classrooms inMaryland, with implementation during the entire academic school year. MIEMSS has developed awebsite page for RISK WATCH® and producedposters to increase the access for teachers and par-ent in other counties and school systems. (See

http://www.miemss.org/EMSCwww/RISKWATCH2.htm.)The Maryland State Firemen’s Association provid-ed the funding for a 9-1-1 simulator to be dedicat-ed to RISK WATCH® programs and for eachschool to receive at least four "RISKY BUSI-NESS" boxes that include training equipment andvideos on life-safety skills. RISK WATCH® pro-jects and county programs were presented at boththe September 2003 Mid-Atlantic Life SafetyConference and the March 2004 Public Educationand Injury Prevention Conference.

The EMSC Program staff actively participatesin national, state, and local SAFE KIDS coalitions;the Maryland division of the American TraumaSociety; the Maryland Occupant Task Force; andthe Child Passenger Safety Board coordinated bythe State Highway Administration. This collabora-tion provides a consistent flow of information tothe five regional pediatric committees and thestate PEMAC on injury prevention resources andinitiatives. Through the federal EMSC PartnershipGrant, Special Projects in Injury Prevention con-tinue to be available and awarded through theEMSC program office. The recipients during thefederal FY 2003 grant period are listed on page 8.

FIELD OPERATIONSMission: To provide support in the area of planningand coordination for health and medical prepared-ness for catastrophic events, as well as to providecommunications equipment and maintenance and toprovide communications services to assist in thequality of care provided patients in Maryland’sEMS System.

Communications Engineering ServicesDuring FY 2004, the integration of St. Mary’s

County EMS Services into the Region VEmergency Medical Resource Center (EMRC)was completed. This allows providers to haveaccess to the entire network provided bySYSCOM/EMRC. This project included theinstallation of three new communications sites anddigital microwave links connecting Baltimore tothe St. Mary’s County system.

As part of the partnership to build thestatewide communications infrastructure,MIEMSS Communications coordinated the instal-lation of new towers at Grantsville (GarrettCounty), Stoney Forest (Harford County),Hagerstown (Washington County), and Denton(Caroline County).

New medical base stations were installed atDenton, Hagerstown, Grantsville, Hereford,Kingsville, and Stoney Forest.

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A state-of-the-art hydrogen fuel cell power sys-tem was installed at the MIEMSS tower site at ElkNeck State Forest in Cecil County. This systemprovides up to five days of backup power for thedigital microwave serving Cecil County. A secondsystem was installed in Hancock (WashingtonCounty) at a fiber optic relay site for NetworkMaryland and the infrastructure project. This sys-tem eliminated the need for a backup generatorfor the site.

Three regular Central Alarm AdvisoryCouncil meetings were held around the state—onein Queen Anne’s County in August, one in PrinceGeorge’s County in December, and one inFrederick County in April.

A total of 35 mobile EMS radios were distrib-uted throughout the state. Grant funding in theamount of $377,200 was supplied for the purchaseof cardiac monitor/defibrillators and automatedexternal defibrillators.

MIEMSS Communications processed a totalof 700 service reports for the FY 2004.

EMRC/SYSCOMIn FY 2004, the Emergency Medical Resource

Center (EMRC) handled 151,342 telephone callsand 116,035 radio calls. Of these 267,377 calls,100,893 were communications involving a patientor incidents with multiple patients.

In FY 2004, the System CommunicationsCenter (SYSCOM) handled 60,514 telephone callsand 4,311 radio calls. Of these 64,825 calls, 6,969were related to requests for med-evac helicopters.

EMRC/SYSCOM continued participation inthe National Disaster Medical System (NDMS).Utilizing the Facility Resource EmergencyDatabase (FRED), SYSCOM/EMRC obtainedhospital bed status information for routine quarter-ly reports and in response to specific requestsrelated to the war in Iraq.

The FRED system was also utilized byEMRC/SYSCOM in support of local emergenciesand several drills conducted statewide.

EMS communications operations forFrederick and Saint Mary’s counties were incorpo-rated into the EMRC. The EMRC/SYSCOMoperations center now provides EMS communica-tions for all of Regions III and V and for Ceciland Frederick counties.

Through a cooperative agreement,SYSCOM/EMRC now answers the Maryland Department of Health and Mental Hygiene’s 24-hour Duty Officer Telephone lines for referrals.

Emergency Operations ProgramThe emergency operations program has been

established to support our federal, state, local, andprivate partners in areas of health and medicalpreparedness. Some of the programs activitiesover the past fiscal year included:

• Staffed and coordinated the Governor’sEmergency Management Advisory Council,Health and Medical Committee, which isresponsible for the planning and coordina-tion of all health and medical preparednessactivities in Maryland.

• Managed the Facility Resource EmergencyDatabase (FRED), which continues to beused regularly to alert emergency medicalservices, hospitals, and public health agen-cies and allows for the effective use of avail-able resources during emergency events andexercises.

• During preparation for potential disastersand actual emergency occurrences, aMIEMSS Operational Support Team hasprovided support to federal, state, and localagencies, as well as hospitals, for the coordi-nation of resources. The team has participat-ed in 17 events since January 2004 thatrequired coordination efforts.

• MIEMSS continues to partner with theMaryland Department of Health and MentalHygiene (DHMH) in participating in theStrategic National Stockpile Program. Inaddition, the partners are working to imple-ment the "Chempack" program, whichstrategically pre-places federally ownedcaches of nerve antidote agent in the state.

• Coordinated the distribution of bioterrorismcooperative agreement funding provided byDHMH to local emergency medical servicesoperations to enhance their ability torespond and provide care.

• Provided representation on the Governor’sSenior Homeland Security Group and, whenappropriate, provided risk-based informationto EMS organizations and hospitals.

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HOSPITAL PROGRAMS OFFICEMission: To implement the designation and verifica-tion processes for trauma and specialty referral cen-ters, to provide continuing evaluation of these centersfor compliance with the regulations and standards inCOMAR 30.08 et seq., and to ensure ongoing quali-ty monitoring of the trauma/specialty care system.

The Hospital Programs staff continued tomanage and coordinate quality monitoring activi-ties for the trauma/specialty care system. Keycomponents of the ongoing monitoring activitiesare the trauma registry data analysis, monthlymeetings with the Maryland Trauma and SpecialtyCare Quality Improvement Committee, and case-specific follow-up on consumer complaints. Theoffice coordinated the planning for the FirstEmergency Department Leadership Summit. This Summit was well attended with representation ofover half of the hospitals in Maryland. There wasimportant information exchanged betweenMIEMSS, the trauma and specialty referral cen-ters, and the community hospital emergencydepartments. Contact information was exchanged,and critical issues related to interhospital transfersof injured patients were discussed.

The office staff coordinated the designationprocess for the Neurotrauma Center and the re-verification process for nine trauma centers thatwas completed in December 2003. These process-es involved accepting and reviewing trauma centerapplications, obtaining an out-of-state review team,site visits to each of the centers, writing the reportof findings, and notifying the centers of the reportfindings.

The office staff worked with several membersof the MIEMSS administrative staff to support thework of the Legislative Trauma Funding StudyPanel.

The Hospital Programs Office continued toprovide support to the Maryland Traumatic BrainInjury Demonstration Project. This grant project isbeing coordinated through the MarylandDepartment of Health and Mental Hygiene(DHMH), which is the lead agency for traumaticbrain injury in Maryland. DHMH is collaboratingwith the Mental Hygiene Administration and theBrain Injury Association of Maryland to imple-ment project activities for training and outreachacross the State.

The office was successful in obtaining a$40,000 grant from the Health Resources andServices Administration (HRSA) Trauma-EMSSystems State Planning Grant for a second year.

The purpose of this grant was to evaluate thetriage of seriously injured patients to trauma cen-ters in Maryland. MIEMSS contracted with theNational Study Center to link data from the pre-hospital Maryland Ambulance Information System(MAIS), the trauma registry, and the HealthServices Cost Review Commission (HSCRC) hos-pital discharge data to evaluate access to traumacenters statewide and to determine if the patientswho met the trauma triage protocol criteria weretransferred to the appropriate trauma center. Thedata for this project are currently being collatedand analyzed.

A third year planning grant was submitted toHRSA with a request of $40,000 to purchase out-comes software for the 11 trauma centers to usewith the trauma registry collector software and toevaluate the current collector software and makerecommendations for needed upgrades.

INFORMATION TECHNOLOGYMission: To provide leadership, expertise, and coor-dination in information systems, data management,networking, and application development relating toemergency medical services systems.

Work continued on EMAIS (ElectronicMaryland Ambulance Information System),designed to replace the current paper runsheetwith a computer software application. Currently,commercial, paid, and volunteer EMS providersfill out more than 700,000 paper MAIS runsheetseach year. EMAIS will save money, improve thequality of the data, and shorten the time to submitdata to MIEMSS. After beta testing was complete,a pilot program for EMAIS, designed to work outany additional issues/processes that were not dis-covered during beta testing, was implemented.MIEMSS initiated EMAIS in the first pilot pro-gram jurisdiction (Cecil County) on December 1,2003 and then Washington County on December15, 2003. By April 2004, MIEMSS had expandedthe pilot program to five jurisdictions (Allegany,Dorchester, and Garrett, as well as Cecil andWashington counties). Working closely with thesejurisdictions, MIEMSS was able to correct issuesin EMAIS while implementing enhancementsneeded by the jurisdictions. With all issuesresolved, MIEMSS implemented EMAIS in fullproduction mode on July 1, 2004.

The County Hospital Alert Tracking System(CHATS) tracks six different alert types for thehospitals and jurisdictions of all regions inMaryland. The data help identify emergency

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department overcrowding as it occurs, so thatambulances may be redirected to less crowdedfacilities, as needed. Participating hospitals and thepublic are able to view the status of the hospitalsat all times via the MIEMSS external web page.

MIEMSS continues to use its web-based sys-tem called FRED (Facility Resource EmergencyDatabase). This was developed in response to the9/11 tragedy. During any disaster or emergency,MIEMSS would contact hospitals for a status ofavailable beds. The time for the hospitals torespond would vary, depending on numerous fac-tors, but it could take many hours for all hospitalsto respond. FRED allows MIEMSS to send analert to all hospitals requesting an update on theircurrent status. This includes not only beds, butalso staffing and medications, as well as informa-tion from the local jurisdictions regarding EMSstaffing. FRED will reduce the time it takes to col-lect this data and make the process more efficient.FRED version 2.0 was implemented in April2004. Version 2.0 has many additional featuresthat give tighter control over who gets alerts, howthe alerts are sent, and what data points are col-lected.

MIEMSS began actively pursuing itseGovernment goals in FY 2001 and continued tomake progress in FY 2004:

• CHATS, EMAIS, and FRED are all web-based systems.

• MIEMSS staff can access their email via theMIEMSS web page.

• EMS providers can find copies of the proto-cols online and can access their individualcontinuing education reports.

The Information Technology Department con-tinued optical character recognition (OCR) scan-ning during FY 2004 to convert paper records toelectronic images. By scanning and capturingimages of prehospital care forms, it is possible tolink the electronic images of records to the MAISdatabase. Linking images to database records willmake available for review the text portions of theforms that are not otherwise captured electronical-ly. As of June 2004, MIEMSS has successfullyOCR-scanned over 1,650,000 MAIS forms.

MIEMSS performed a full re-write of theMaryland Prehospital Provider Registry (MPPR)system in FY 2004. The MPPR system tracks allprehospital care EMS providers (currently over31,000) that operate in the State of Maryland. TheMPPR system not only tracks who the providersare, but also tracks their existing continuing educa-tion credits needed for recertification. Providers

can access their continuing education credit statusfrom the MPPR system via the MIEMSS webpage.

MARYLAND CRITICAL INCIDENTSTRESS MANAGEMENT PROGRAM

Mission: To offer psychological support services tofirefighters, emergency medical technicians, police,and other emergency services personnel involved inemergency operations under extreme stress, to mini-mize the impact of job-related stress, and to helpaccelerate recovery of those persons exhibiting symp-toms of severe stress reaction.The Maryland Critical Incident Stress

Management (MCISM) program offers education,defusings, and debriefings conducted by astatewide team of trained volunteers. The teamconsists of volunteer doctoral or master-level psy-chosocial clinicians interested in working withemergency services personnel, and fire/rescue/lawenforcement peer-support persons trained in theprocess. Volunteer regional coordinators areresponsible for specific geographic areas of thestate and serve as the points of contact, throughlocal 9-1-1 centers and SYSCOM, for critical inci-dent stress management.

MEDICAL DIRECTOR’S OFFICEMission: To provide leadership and coordination forstate medical programs, protocols, and quality assur-ance, to liaison with the regional programs andclinical facilities, and to promote creative, respon-sive, and scientifically sound programs for the deliv-ery of medical care to all citizens.The Office of the Medical Director has been

invited to Charles, Calvert, Anne Arundel, andPrince George’s counties to conduct or participatein a SWOT (Strengths Weaknesses, Opportunities,and Threats) to address selective EMS issues toimprove the delivery of prehospital medical care.The Charles County SWOT has been completedwith a signed consensus report to the county exec-

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utives with several of the recommendationsalready being instituted by the county. TheseSWOT analyses have improved the following:internal communications, the availability of ALSservices to the public, established response stan-dards, augmentation of quality medical oversight,and establishment or augmentation of qualityimprovement initiatives.

The Office of the Medical Director and otherMIEMSS staff have provided comprehensive edu-cation on Maryland’s EMS/Trauma system toguests of the U.S. Secretary of State. Health, trau-ma, and political officials from Bosnia, Chile,Egypt, Japan, and Korea visited MIEMSS andseveral designated trauma/specialty referral institu-tions within Maryland. MIEMSS is viewed as aninternationally recognized, quality, comprehensiveEMS/Trauma system.

Throughout FY 2004, the Office of theMedical Director has been working with theOffice of Information Technology on the develop-ment of the Electronic Maryland AmbulanceInformation System (EMAIS). The developmentprocess has included identifying data elements,designing screen layout, producing teaching mate-rials, and working with the vendor to ensure thesuccess of the program. Presentations providing anoverview of the system’s screen layouts and datapoints were conducted in jurisdictions across thestate.

The Tenth Annual Medical DirectorSymposium was conducted with participation bythe many Regional, Jurisdictional, andCommercial Medical Directors, as well as BaseStation Physician Coordinators. Several jurisdic-tions’ comprehensive databases and quality assur-ance/improvement systems were presented, andthe software engines were distributed for referenceand modification to meet each jurisdiction’s needs.

In February 2004, an update to the MarylandMedical Protocols for EMS providers was distrib-uted to the jurisdictions. The new protocols weredeveloped after extensive review by the ProtocolReview Committee. Effective July 1, the new pro-tocols included:

• Modifications to the General Patient Caresection improving pediatric care and imple-mentation of the refinements of the TraumaDecision Tree.

• Allowing the use of the pediatric automatedexternal defibrillator (AED) age to be low-ered to include children ages 1-8.

• Allowing the use of a copy of theEMS/DNR form to be used for purposes of

withdrawing care when indicated by theEMS/DNR protocol.

• Lowering the dose of Haldol for patients 69years of age and older.

• Addition of contraindications to nitroglyc-erin—not to be administered to patients whohave recently taken Viagra, Cialis, orLevitra.

• The Continuous Positive Airway Pressureprogram has been converted from a pilotprogram to a jurisdictional optional pro-gram, with each jurisdiction needing to sub-mit a request for approval to MIEMSS.

The Governor’s Emergency ManagementAdvisory Council (GEMAC) was reconstitutedand provided a new mission and vision to addressgrants, weapons of mass destruction issues, and thestate’s preparedness to manage catastrophicevents. Richard Alcorta, MD was appointed as amember of the GEMAC. The Health and MedicalSubcommittee of GEMAC has been revitalizedwith expansion of membership and the develop-ment of technical advisory groups to bring multi-ple source efforts into a single focus work groupon a topic. The Health and Medical Subcommitteeis chaired by Robert Bass, MD (ExecutiveDirector, MIEMSS) and Arlene Stephenson(Deputy Secretary, Public Health Services,DHMH), with Clay Stamp (MIEMSS) leading thestaffing and management of the committee.

During the last year, several potential disastersoccurred in Maryland, two of them at theBaltimore-Washington International Airport(BWI). The MIEMSS Rapid Response Team(recently re-named the Field Operations SupportTeam [FOST]) responded to BWI for a suspectedradiologic package release and to an arriving flightwith a cluster of passengers reportedly presentingwith toxic signs and symptoms of a possible chem-ical exposure. Both instances were managed effec-tively and protected the citizens from harm. Thesuspicious radiologic packaged was determined tonot be a hazard. The suspected toxic exposureflight was managed by medically screening thepassengers and releasing them after ensuring thatthe single person who was ill previous to boardingthe flight received medical attention.

As part of Maryland’s EMS/Fire disaster pre-paredness, the Office of the Medical Director hasparticipated in numerous national and state plan-ning and educational programs. Maryland’sEMS/Fire and Public Health communities haveconducted multiple disaster exercises to evaluatethe effectiveness of and to improve existing plans.

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The Office of the Medical Director, along withother MIEMSS staff, continues to provide essen-tial resources, expertise, and training to the localEMS/fire services. Special exercise focus has beendirected on preparedness to receive and distributethe federal Strategic National Stockpile (SNS)through the state and local public health deliverysystems.

The Maryland Board of Nursing and theMaryland Board of Physicians have both beenactively training nurse and physician volunteers toaugment their volunteer corps. The Office of theMedical Director has been actively involved in thedelivery of training presentations for both boards—on bioterrorism for the Board of Nursing and onthe principles of incident management systems forthe Board of Physicians. The incident manage-ment presentation, through collaborative workwith Johns Hopkins Public Health, has become aninternet-based distance learning program. Morethan 2,000 nurses and 700 physicians have beentrained through this program which improvesMaryland’s preparedness in the event of a disaster.

POLICY AND PLANNINGMission: To develop effective policies and innovativestrategies to enhance and improve the statewideemergency medical services system.

Yellow Alerts/Emergency DepartmentOvercrowding

MIEMSS continues to monitor statewidealert activity via the County Hospital AlertTracking System (CHATS) and provides monthlysummary and year-end cumulative reports con-taining individual facility alert activity to all hospi-tals. Overall alert activity remains elevated and isparticularly high during the flu and respiratoryseason. In comparison to previous years, 2003-2004 was a very busy season, with record peaks inselected regions of central Maryland. Continuousonline availability of hospital alert activity status isavailable at www.miemss.org/chats.

Increased efforts are underway to address spe-cific emergency department (ED) overcrowdingand hospital capacity issues after recent nationalstudies have indicated that inpatient capacity andprolonged throughput times are the largest reasonfor ED delays. MIEMSS will be partnering withorganizations such as the Maryland HospitalAssociation, the Maryland Health CareCommission, the Maryland Department of Health& Mental Hygiene (DHMH) Office of HealthCare Quality, the American College of Emergency

Physicians, the Maryland State Firemen’sAssociation, and jurisdictional EMS services toaddress best practices that focus on inpatientcapacity and decreasing throughput times, thusshifting the emphasis from the ED to the entirehospital.

Lay Person Automated ExternalDefibrillator Program

The Lay Person Automated ExternalDefibrillator (AED) Program has continued togrow throughout Maryland. Under the "publicaccess defibrillation" program, non-health carefacilities that meet certain requirements are per-mitted to have an AED on site to be used bytrained lay persons in the event of a sudden car-diac arrest until EMS arrives. Currently, there aremore than 375 approved programs in the state. Alist of AED facilities and program information canbe viewed at www.miemss.org/AED.

The AED Task Force dealt with issues relatedto statutory amendments and regulation revisions,as well as strategies for enhanced statewide place-ment of AEDs. The Task Force was also providedwith the 2001-2003 Maryland Out-of-HospitalCardiac Arrest Report from the MIEMSS Officeof Epidemiology. Recommendations based on thereport data will include placement of AEDs inskilled nursing facilities and other high-risk loca-tions identified in the report, such as assisted livingfacilities, rehabilitation centers, and dialysis cen-ters.

MIEMSS, in partnership with EMS servicesin 14 rural jurisdictions in Maryland, includingGarrett, St. Mary’s, Caroline, Dorchester, Kent,Somerset, Talbot, Wicomico, Calvert, Washington,Frederick, Carroll, Harford, and Worcester coun-ties, again obtained funds through the federalOffice of Rural Health Policy’s FY 2003 RuralAccess to Emergency Devices Grant Program.This allowed for the placement of 123 AEDs andnumerous CPR and AED training sessions inEMS, public safety, and layperson sites. A total of203 AEDs have been placed in eligible rural juris-dictions since the first grant funds were awarded in2002. MIEMSS again plans to participate in theRural Access to Emergency Devices GrantProgram in FY 2004.

MIEMSS will again partner with several agen-cies along with the State Advisory Council onHeart Disease and Stroke in a public awarenesscampaign designed to educate citizens on theChain of Survival. The campaign encourages learning CPR, how to use an AED, and develop-

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ing public access defibrillation programs whenappropriate. Last year’s awareness effort waskicked off at a meeting of the State AdvisoryCouncil on Heart Disease and Stroke with aproclamation from Governor Robert Ehrlich, Jr.that declared September 2003 "Partner with Us:Create a Heart Safe Community Month." Thecouncil again plans to request that September2004 be proclaimed "Partner with Us: Create aHeart Safe Community Month."

Geriatric Emergency Medical ServicesAdvisory Committee

As part of an ongoing effort to maintain high-quality emergency medical care, MIEMSS hasidentified a need for geriatric-specific EMS educa-tional programs, evaluation of geriatric emergencyassessment guidelines and treatment protocols,and other relevant geriatric emergency manage-ment issues. In order to incorporate a geriatric-specific component into the Maryland EMSSystem, MIEMSS has established the Geriatric

Emergency Medical Services Advisory Committee(GEMSAC), consisting of members with clinicalknowledge and expertise in geriatric patient care.The committee’s primary responsibilities includethe evaluation of current geriatric assessmentguidelines, recommendations for geriatric-specificprotocol changes, and advisement on EMS geri-atric educational curricula in the future.

The committee meets on a quarterly basis andincludes representation from physicians and nursesspecializing in geriatrics and emergency medicine,EMS providers with geriatric clinical expertise andknowledge, and the Maryland Department ofAging.

Committee member David Chang, PhD andMIEMSS staff John New (Director of QualityManagement) and Lisa Myers (Director ofProgram Development) gave a presentation enti-tled, "Triage of the Elderly Trauma Patient" at the2004 EMS Care conference held at the MaritimeInstitute of Technology. A survey was also distrib-uted to determine possible causes for the under-triage of elderly trauma patients. The presentationis scheduled to be given again at the annualPyramid conference in October 2004.

Do Not Resuscitate ProgramAs part of a working group that was convened

by the Attorney General as a result of Chapter 152(House Bill 770) of the Laws of Maryland 2000, acomprehensively revised EMS/DNR and medicalcare order form was issued in July 2003. The newform is easier for patients and their caregivers toread and use. It is available on the MIEMSS web-site and also available in printed form fromMIEMSS.

Maryland Cardiac Arrest PublicDefibrillation Study

The Maryland Cardiac Arrest PublicDefibrillation Study (M-CAPD) was begun inJanuary 2001 by the Office of Epidemiology. Thisstudy has two main objectives: (1) to determinethe impact of the Facility AED Program; and (2)to identify whether there is a need for the State torequire that AEDs be placed in certain publiclocations. This study is ongoing.

Additional information about the study can befound on the M-CAPD website http://www.miemss.org/m-capd.htm.

2002 Maryland Population Served By EMS System (Ages 21 years and older)

N = 3,755,428

Confirmed Cardiac Arrests considered forResuscitation

N = 9938 (88 per 100,00 population per year)

Non-CardiacEtiology

N =1722 (19.7%)

Note: Incidentswhere the Pt. isconsidered deadon arrival and noresuscitativeefforts are madeor patients thathave valid EMSDo NotResuscitateOrders are notcaptured in thisnumber.

Resuscitations AttemptedN = 8734 (87.9%)

Cardiac / Unknown EtiologyN = 7012 (80.3%)

ARREST WITNESSED (Bystanders n = 2568; EMS n = 640)

N = 3352 (47.8%)

Arrests Not WitnessedN =3660 (52.2%)

Initial RhythmVF

N = 454 (13.5%)

Initial RhythmVT

N = 27(0.8%)

Initial RhythmAED Shockable

N = 218 (6.5%)

Initial RhythmAsystole

N = 666 (19.9%)

Other InitialRhythmN = 1987 (59.3%)

Return of Spontaneous Circulation(ROSC) at ED Arrival

N = 172(24.6%)

No Return ofSpontaneous

Circulation (ROSC) at ED Arrival

N = 2816(84.0%)

Return ofSpontaneous

Circulation (ROSC) atED Arrival

N = 364(13.7%)

ADULT USTEIN TEMPLATE FOR OUT-OF-HOSPITAL CARDIAC ARRESTS, MCASS 2001-2003

Notes: (1) Percentages are calculated by the latest figure derived at each level of the algorithm rather thanthe total number of confirmed cardiac arrests.(2) Individuals less than 21 years of age were excluded early in the algorithm because they are included inthe Pediatric Utstein Template.

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Maryland Cardiac Arrest SurveillanceSystem (M-CASS)

MIEMSS Office of Epidemiology establishedthe Maryland Cardiac Arrest Surveillance System(M-CASS) in January 2001.The surveillance sys-tem has two main objectives: (1) to identify theepidemiology of out-of-hospital sudden cardiacarrest in Maryland; and (2) to evaluate the effec-tiveness of the Maryland EMS System in respond-ing to cardiac arrests. The surveillance system cap-tures all out-of-hospital sudden cardiac arrests thatcontact the 9-1-1 emergency medical system inMaryland. The Utstein Style templates (Adult andPediatric) are applied to the data to evaluate theMaryland System (see algorithm on previouspage). State annual reports for statewide data areavailable upon request.

PUBLIC INFORMATION ANDMEDIA SERVICES

Mission: To contribute to MIEMSS’ vision of elimi-nating preventable death and disability by providingto the public essential information on how to recog-nize an emergency, summon an EMS response, andincorporate injury prevention methods in their dailylives, as well as designing and developing education-al programs for EMS providers through state-of-the-art technology.

The Office of Public Information and MediaServices provides education and information toMaryland’s Emergency Medical Services providersand the general public through training modulesand informative programs. The office develops,designs, and produces programs that are distrib-uted statewide.

The office is responsible for the design andeditorial content of the MIEMSS Annual Report,MIEMSS web page, and the "Maryland EMSNews." The newsletter is sent to 32,000 hospitaland prehospital EMS personnel six times a year.This keeps emergency medical services personnelin touch with local, state, and national EMS issues.Recent topics include updates on infectious dis-eases and geriatric medical issues. These docu-ments are also available on the MIEMSS webpage. This year the annual EMS Week Stars ofLife Awards Ceremony was held in Annapolis atthe State House with the assistance of GovernorEhrlich. In a special ceremony held prior to theStars of Life ceremony, First Lady Kendel Ehrlichassisted with Awards for Children. This was donein recognition of the National EMS for ChildrenDay. Press releases were distributed statewide and

media coverage obtained on the award winners.Press releases were also produced on many EMSrelated issues, including Yellow Alerts and hospitalemergency department overcrowding.

The office provides conference planning, aswell as technical and audiovisual support toMIEMSS-sponsored continuing education pro-grams. These regional and statewide conferencesallow providers to update their certification andlicensure by attending programs. Design and pro-duction of printed, photographic, computer-assist-ed programs, and video materials assist the learn-ing process.

This year the National Highway Traffic SafetyAdministration (NHTSA) conducted a re-assess-ment of the Maryland EMS system. Their initialassessment occurred in 1991. The office staff assist-ed with the production of the briefing documentand PowerPoint presentations.

Several training modules were produced dur-ing the past year. These included "The PrehospitalProtocol Update," "Tracheostomy: Care across theAges," and "Facility Resource EmergencyDatabase (FRED) Training Program." These mod-ules were produced on compact disc and includeprinted materials. The office provided satellitedown-linking and taping of many informationalprograms on infection control andWMD/Bioterrorism issues. Video projects includ-ed the documentation of various disaster drillvideos and several public service announcements(PSAs). PSAs were produced in conjunction withthe NHTSA Region III Office. Law enforcementpersonnel and doctors from the surrounding statescame together to participate in a PSA about thedangers of impaired driving. A major video pro-ject with the Mid-Atlantic EMSC Council high-lighted the top ten emergency situations and howto handle them. Eight states sent representatives tobe a part of these PSAs. Working with theMaryland State Firemen’s Association, office staffproduced the annual convention’s MemorialService eulogies and slide show.

Statewide prevention initiatives were devel-oped through partnerships with other state andlocal government agencies. This year, the interna-tional World Health Day focused on motor vehiclecrashes and the need for prevention. A press eventand special Grand Rounds were held at the RAdams Cowley Shock Trauma Center with multi-ple partners. Participation on the OccupantProtection Task Force, the Motorcycle Safety TaskForce, the Pedestrian Safety Task Force, theImpaired Drivers Coalition, and the R Adams

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Cowley Shock Trauma Center PreventionCommittee allowed these teams to work collabora-tively on multiple projects. Membership on theState Highway’s Diversity in Traffic SafetyProgram raised the need for diversity in publiceducation efforts. Print and broadcast projectswere produced in both Spanish and English.Projects were completed with representation ofMaryland’s growing diverse population.

QUALITY MANAGEMENTMission: To support MIEMSS and the EMS commu-nity in their continuous quality improvement initia-tives and commitment to a customer-based way ofdoing business. Successfully accomplishing this is notsimply dependent upon recognizing that the ultimatecustomer is a patient in need of timely, proficient, andcompassionate care, but understanding and improvingthe processes that maintain a well functioning EMSsystem for the delivery of quality medical care.

MIEMSS initiated its quality managementimplementation through the development of aJuran-based program. Over the years MIEMSShas taken advantage of state supported resources,particularly those offered through the ContinuousQuality Improvement and Managing for Resultsprograms, in its efforts to improve upon its ser-vices and customer relationships.

Managing for Results (MFR)For the past six years, covering two different

gubernatorial administrations, MIEMSS, like allState agencies, is required to submit a Managingfor Results plan along with its fiscal year budgetrequests to the Maryland Department of Budgetand Management. Initiated in 1997, this phased-inplanning process began with the submission ofMIEMSS Vision, Mission, and Principles state-ment through a customer-focus strategic planningprocess. MIEMSS has again met those require-ments; these include re-evaluation of key goals,subsequent objectives and strategies, developmentof associate action plans, and establishment andmonitoring of performance indicators.

MIEMSS has identified two strategic goalsand seven associated objectives. Three objectivesare outcome oriented, while the remaining fourare quality-based indicators. Each objective includ-ed performance indicators, which will help bothsystem and jurisdictional quality management ini-tiatives in establishing benchmarks for future quali-ty control and quality improvement efforts.

KEY GOALS AND OBJECTIVES

Goal 1. Provide high quality medical care to indi-viduals receiving emergency medical services.

Objective 1.1 Maryland will maintain its trau-ma patient care performance above the nationalnorm at a 95% or higher statistical level of confi-dence.

Objective 1.2 By 2005, maintain an overallinpatient complication rate of 10% or less forMaryland trauma centers.

Objective 1.3 Achieve 20% witnessed suddencardiac arrest resuscitation upon emergency depart-ment (ED) arrival in 70% of jurisdictions by 2003.

Goal 2. Maintain a well-functioning emergencymedical services system.

Objective 2.1 By 2003, all jurisdictions will usea uniform set of quality indicators for prioritizedemergency medical dispatch (EMD) services.

Objective 2.2 Before 2003, x% of jurisdictionswill achieve or exceed 90% compliance with pre-hospital provider standards of care per the"Maryland Medical Protocols."

Objective 2.3 Maintain an EMS response inci-dent location to hospital base station communica-tion at a successful completion rate of 95% or better.

Objective 2.4 Maintain at least an 85% rate forseriously injured patients transported to a designat-ed trauma center in Maryland.

Team EMSAn innovative approach to Quality

Management education and application in the realworld of EMS management was developed in con-junction with the MIEMSS Region V administra-tion. Implemented in 1996 and updated to presentstandards, MIEMSS staff and a cadre of volunteerpresenters from the EMS community present waysfor company and jurisdictional managers to planfor, measure, maintain, and improve quality ser-vices. Techniques taught range from brainstormingto data analysis interpretation and include topicsfrom quality improvement team creation to meet-ing quality assurance standards established understate law. Jurisdictions and Regional EMSAdvisory Councils have utilized this training forplanning purposes, and more than 100 providers

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have attended workshops at Pyramid and EMSCare on a variety of subjects from indicator devel-opment to data interpretation.

EMS Surveillance MeasuresMIEMSS has established several EMS system

surveillance priorities based upon routine datareview, customer requests, and research outcomes.Hospital yellow alert demand is monitored dailyon a regional basis to keep individual hospitalsupdated on system response. This monitoring(especially in the winter months) and individualhospital resolution to high ED service demandhelped keep this vital service available system-wide. The maintenance of a plentiful, diverse, andstable EMS work force was addressed this yearbased on local and national experiences. An EMSprovider survey has been developed in concertwith the Maryland EMS community in an attemptto identify the key factors to be addressed jointly.A joint research effort in the area of geriatric trau-ma triage led to the identification of differences intransport decisions system-wide. Education strate-gies are underway through a variety of means toaddress root causes.

Data ConfidentialityMIEMSS maintains or has access to eight

confidential databases used in ensuring qualityEMS care delivery. The Data Access and ResearchCommittee (DARC) was formed to ensure that alldata and information requests were expedited effi-ciently and accurately, while ensuring patient andprovider confidentiality at all times. Since January2000, over 900 requests have been tracked andfacilitated. Profiles of requestor, types, format, andcontent are reviewed at the end of each year sothat MIEMSS’ routine, non-confidential reportsare modified to better meet the most commonneeds of data requestors.

REGIONAL PROGRAMSMission: To provide a liaison between theMIEMSS Central Office and the local EMSagencies, manage MIEMSS programs at thelocal level, work closely with the local govern-mental entities, training centers, emergencymedical services/fire providers, and staff theRegional EMS Advisory Councils.

Region IThe MIEMSS Region I Office was involved in

the prioritization and implementation of grantsinvolving: $88,486 for bioterrorism projects to 14

departments; $40,000 for Matching and HardshipGrants for the purchase of automated externaldefibrillators (AEDs) and monitor defibrillators for8 departments; submission of a $75,000 BystanderCare Program to the Department of HighwaySafety (in conjunction with Jennifer Dreese of theFrostburg Safe Communities Program); prioritiza-tion and implementation of 4 Highway SafetyGrants for communications scene safety, extrica-tion, medical equipment, and training; and theimplementation of the second year Rural AEDProject in Garrett County. The total amount for allof these projects affecting 9 companies in theRegion was $80,800.

The highlight of training activities for Region Iwas the presentation of the second annualMiltenberger Emergency Services Seminar. Held inMarch at Allegany College of Maryland, the pro-gram had over 100 participants and providedworkshops for nursing, EMS, and fire personnel.The keynote program focused on the I-68Memorial Day Weekend Crash of 2002 and thelessons learned from the multi-vehicle crash thatinvolved over 90 vehicles and was the worst high-way crash in Maryland history. Other trainingactivities included coordination of FacilityResource Emergency Database (FRED) trainingfor hospitals and 9-1-1 operators; funding for aCRT-Bridge program; and two video conferencesbetween the R Adams Cowley Shock TraumaCenter and the Western Maryland Health System.

Quality assurance and quality improvementcontinue to be a major emphasis for the Region. Inaddition to the tracking of specific quality indica-tors (response times, intubation success rates, trau-ma patients to trauma centers, ALS coverage) andthe formalization of a medical review committeechaired by Dr. William May and staffed by BillHardy, the office was involved at the state levelwith the organization of a QA/QI officers summitat a special workshop at EMS Care entitled"Conducting an Internal Investigation."

EMAIS was implemented in the Region dur-ing this fiscal year. The Regional Office’s involve-ment in this included the setting-up and coordina-tion of the training for 600+ EMS providers; con-tact with ALLCONET and GCNET to obtaininternet access for fire and rescue; and the identifi-cation and necessary paperwork for EMAIS super-visors and administrators. In addition, a specialtraining program was put together for the supervi-sors, administrators, and train-the-trainers. Thetraining itself was provided by Eric Chaney andKathy Paez from MIEMSS.

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For EMAIS to be successful, the CommunityAccess Project (the provision of computers for allhospital emergency departments, EMS companies,and select First Response fire departments fundedthrough a Federal grant) was implemented. Theoffice delivered 40 computer systems to the Regionfrom Baltimore and oversaw their delivery to all ofthe EMS services and Regional hospitals. Formalinventory paperwork and arrangements for accep-tance of equipment by jurisdiction EMS organiza-tions were also completed.

Ambulance inspections were conducted in thefall of 2003. In Allegany County 26 ambulanceswere inspected and in Garrett County 6 ambu-lances were inspected. Also, there were 10 firstresponse units (two ALS, eight BLS) examined.Looking to the future, the Region I Office hasbegun to initiate the updating of the Seal ofExcellence standards for the state.

Efforts were conducted in the Region forresponse preparation to weapons of mass destruc-tion (WMD) incidents. The Regional Office partici-pated with Allegany and Garrett counties’ HealthDepartments and Emergency Management Officesin updating their disaster plans. In addition, aWMD Summit was held by the Region I EMSAdvisory Council in April, serving as a forum forpublic safety agencies, health departments, andhospitals to share information on planning effortsand equipment purchased.

Efforts in the communications area in theRegion focused on a first meeting of the 9-1-1 cen-ters and hospitals in Garrett, Allegany, andWashington counties to discuss the establishment ofa Western Maryland EMRC (Emergency MedicalResource Center). Also in the communicationsarea, new consoles were provided by MIEMSS tothe Regional hospitals; assistance was provided ingaining Garrett County Commissioners’ approvalto build a 350-foot tower at the new highwaygarage in Grantsville; and radios were alsoobtained for seven ambulance services.

Region IIRichard A. Mettetal retired in February 2004 as

the Region II EMS Administrator with over 18years of dedicated service to the EMS communitiesof Frederick and Washington counties. During EMSWeek in May 2004, Mr. Mettetal was presented theLeon W. Hayes Award for Excellence in EMS atthe Maryland EMS Stars of Life Awards ceremonyheld in Annapolis. He was highly committed to andsupported the county governments, hospitals, fireand EMS providers throughout Region II. Mr.Mettetal was part of the implementation, modifica-tion, and evaluation of the quality assurance andimprovement program, 12-lead EKG program, spe-cial response team, emergency medical servicesmedical dispatch system, EMS conferences, andmany other programs. In May 2004, Richard"Rick" C. Meighen was appointed the new RegionII EMS Administrator. Mr. Meighen worked inRegion V as its Associate Administrator for over tenyears. With his many years of experience andexpertise in EMS management and as a fieldprovider, the Region II EMS communities ofFrederick and Washington counties have extendedtheir congratulations to Rick and are looking for-ward to working with him.

The Region II Office continues to be veryactive in the region’s Quality Assurance andQuality Improvement programs and participates inall of the Jurisdictional Medical Review Committeemeetings. A Regional Medical Review Committeehas been established within the Regional EMSAdvisory Council to discuss issues or initiatives thatcould affect or benefit the entire region.

The Region II Office has coordinated and willbe doing the inspection for 84 EMS response vehi-cles, including both ALS and BLS ambulances,EMS, engines, and special units, and ALS "chasecars." Both jurisdictions in Region II have adoptedthe MIEMSS/Maryland State Firemen’sAssociation’s Voluntary Ambulance InspectionProgram as the standard for their annual inspectionof vehicles providing EMS services.

The Region II Administrator has been activelyinvolved in disaster preparation at the local, region-al, and state levels. The concept of interagencycooperation and communication, principles of con-tinuous quality improvement, have been integratedinto the design of mass casualty exercises so thateach is evaluated, and the resulting data are used tofurther increase response capability and improveoperations. Templates for drill organization and pre-sentation have been developed that will allow localand regional groups to utilize proven processes and

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evaluation tools. A package that includes flowcharts, victim and provider accountability, andother management and training tools, as well asloaner vests, has been made available throughoutthe state. The office also provided support to theHagerstown Community College for a multi-disci-plinary drill involving their EMT-Paramedic stu-dents, their nursing students, and theirAdministration of Justice students. A mock emer-gency department overseen by Dr. Steve Kotch, theWashington County Jurisdictional Medical Director,utilized the nursing students to evaluate/treat the"patients" that were provided prehospital care bythe EMT-P students. The justice students investigat-ed the "crime scene" which was a simulated

weapons of massdestruction explo-sion.

The MIEMSSRegion II Office staffcontinues to providesupport to the newlydeveloped Maryland VirtualEmergency Response System(MVERS). This system pro-vides an electronic plan that allowsquick and easy access to information inorder to expedite a response to a critical situation.MVERS has been developed and managed cooper-atively between MIEMSS, the Maryland StatePolice (MSP), and the Maryland EmergencyManagement Agency (MEMA). The Region IIAdministrator, along with other MIEMSS staff andrepresentatives from the three participating agen-cies, continue to make presentations to organiza-tions interested in implementing the program.Training has been provided to organizations thatneed assistance in collecting specific data, conduct-ing walk-throughs of facilities, taking digital images,and constructing the final plan for storage on a CD.The Maryland State Police has received PatriotFunds to provide support for the implementation ofMVERS. The funds have been utilized to assistwith gathering the electronic data, purchasing pho-tographic equipment, and establishing a team ofprogrammers to assist interested agencies with theprocess. While MIEMSS through its EMS-C pro-gram will focus on implementing MVERS in

schools, the program and training will be madeavailable to any agency/organization upon request.

Both the Frederick Memorial Hospital and theWashington County Hospital have conducted drillsthroughout the year to plan for weapons of massdestruction (WMD) events (involving HAZMATand decontamination of patients), as well as theirroutine annual mass casualty management drills.

The Region II Office continues to provide theadministrative support to the region for the annualHighway Safety Office Grant Program as well asthe MIEMSS Matching and Hardship GrantProgram for the acquisition of monitor-defibrillatorsand automated external defibrillators (AEDs). Every

EMS, fire, and rescue company in RegionII was provided with the appropriateinstruction packets and applications.Region II was successful in having ninegrants approved. A total of one monitor-defibrillator and 12 AEDs were obtainedthrough the MIEMSS Matching and

Hardship Grant process. Through theMaryland Department of Health andMental Hygiene, Office of HealthPreparedness, this office provided

instruction packets andapplications to every EMS,fire, and rescue companyin Region II for the

Bioterrorism Sub Grants.Through this Bioterrorism

Sub Grant the region wasapproved for five grants for equip-

ment such as Mark 1 kits, patient treatment andtriage items, and communications equipment.

Hagerstown Community College has been verysuccessful teaching EMS training curriculums, bothALS and BLS certification courses as well as severalother medical/EMS related ancillary programs tobenefit the EMS students. The MIEMSS Region IIAdministrator also serves on the EMS CurriculumAdvisory Board of the Hagerstown CommunityCollege. The Frederick County Department of Fireand Rescue Services has applied to become an ALSEducation Program. This office provides administra-tive support and materials to these programs asrequested.

Region II this year administered certificationexaminations to 7 First Responder Basic classes and9 EMT-B classes. In addition, 12 EMT-P, 29 EMT-B, 6 FR-B, and 5 CRT individual examinationswere administered in the Region II Office.

This office identified the training sites and rec-ommended the appropriate jurisdictional and

Garrett II III

IVV

I Allegany Washington

Frederick

Montgomery

CarrollHarford

BaltimoreCounty

BaltimoreCity

Cecil

KentHoward

AnneArundel

Queen Anne’s

Caroline

Talbot

Calvert

Prince George’s

Charles

DorchesterSt. Mary’s

Wicomico

Worcester

Somerset

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regional individuals, including health departments,9-1-1 centers and adjoining out-of-state hospitals toundergo training in the Facility ResourceEmergency Database 2.0 (FRED) Program which isbeing implemented statewide by MIEMSS.

The Region II Office provided reference mate-rials and accurate information to our key EMS offi-cials, the Mid-Maryland EMS Advisory Council(MMEMSAC), and to the emergency services com-munity pertaining to the construction of the contro-versial emergency communications tower onLamb’s Knoll, the second highest point on the his-toric South Mountain in Washington County. TheRegion II Office also coordinated several meetingsheld in the region between state communicationspersonnel and regional/jurisdictional EMS officialsand county government officials. As a result ofthese meetings, Lamb’s Knoll tower has beenapproved by the Federal CommunicationsCommission and construction will begin in July2004 with a completion date in September 2004.

This office worked with our Region II EMSjurisdictions to qualify appropriate areas and com-munities in this region to receive AEDs at no costunder the Rural Access to Emergency Devices(RAED) Federal Grant Program being managed viaMIEMSS. This grant has been very beneficial inproviding to the citizens in these areas access to theAED. Fifteen AEDs have been distributed to theHancock and Emmitsburg areas.

Region II’s Washington County was one of thefirst counties in the state to implement theElectronic Maryland Ambulance InformationSystem (EMAIS) as a pilot program. The Rural Community Access Grant provided 18 computersfor Washington County. The computers wereplaced in all EMS services, Washington CountyHospital, and Frederick Memorial Hospital toimplement the EMAIS program. The computerswill also be used for monitoring FRED and theCounty Hospital Alert Tracking System (CHATS).In July 2004, EMAIS will be implemented officiallyin Washington Count—it will no longer be a pilotprogram.

Region IIIThe Region III Office continued its expansion

of the Facility Resource Emergency Database(FRED) by releasing FRED Version 2.0 in April2004. FRED is an internet-based communicationsystem designed to alert all components of theState’s EMS system and catalog resources availablefor response to a large-scale incident. Theseenhancements in FRED 2.0 include regional alert-

ing capabilities, text paging of key individuals, moreflexibility of databases, and more organized infor-mation pages. Throughout the year, the number ofinstitutions participating with FRED increasedsteadily, as did user response during its use in vari-ous exercises and real-time events such asHurricane Isabel and the funeral of PresidentRonald Reagan.

FRED played a major role in the HarborBASEII exercise. Conducted in June, this exercise strivedto test the new Strategic National Stockpile (SNS)Plan. The SNS is the federal stock of medicationsthat can be deployed to any area of the country.The challenge is to repackage this from one centralreceiving point to the areas of the state in need.Although the exercise was conducted by the statehealth officials, Baltimore City Health Departmentled all the Region III hospitals in a full functionalrole. Clinics were established and "antibiotics" wereactually distributed to emergency response person-nel and the general public. The Region III Officealso cooperated with the National Study Center forTrauma and EMS in conducting the Local AreaDefense exercise. This was an exercise that testedthe University of Maryland at Baltimore (UMB)campus capabilities to respond to an on-campusemergency. The MIEMSS building (on the UMBcampus) was evacuated due to a bomb that wasdefused while EMRC tested its ability to moveoperations to the back–up communication center.

The Region III EMS Advisory Council contin-ued to face the recurring problem of hospital over-loads. Record yellow alert usage was again experi-enced during the winter illness season. A workinggroup was established to begin to investigate astudy of potential policy changes that could effectimprovement. Literature has been reviewed andavailable data are being cataloged. It is hoped thatthe group will return recommendations back to thefull Council by September.

The Region III Medical Director was due forreappointment in July 2004. As Dr. Kevin Seamanhad successfully filled the role for the last fouryears, the Council voted to recommend Dr. Seamanfor reappointment. This will allow the Council timeto revise their current Medical Director recruitmentand appointment procedures to more closely reflectTitle 30 regulations. An Associate Medical Directorwill be selected to assist Dr. Seaman and increasephysician involvement with the Council and theRegion.

As part of their ongoing commitment to educa-tion, the Emergency Education Council of RegionIII conducted EMS Care 2004, at the Maritime

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Institute of Technology and Graduate Studies onApril 22–25. Approximately 200 registrants attend-ed this year’s conference whose theme was"Covering All the Bases." Participants from variousparts of the State enjoyed seminars on topics rang-ing from self-defense to advanced respiratory man-agement. Pre-conference seminars were also offeredto cover topics specific to geriatrics, pediatrics, andquality management. The Emergency EducationCouncil of Region III continues to meet quarterlyto improve the quality and efficiency of trainingefforts throughout the Region.

Funding was received through Maryland’sEMS for Children Program to conduct an EMSMoulage course in Region III. Seventeen partici-pants from various parts of the Region participatedin the course and will be used to expand the State’scurrent cadre of moulage experts who assist inlocal, regional, and statewide disaster exercises.

As a result of the Regional EMS AdvisoryCouncil’s prioritization of issues to be investigatedin a quality improvement format, the QualityImprovement Managers Committee continued towork on evaluating current field practices regardingpatient refusals and unrecognized esophageal intu-bations. In 2004, the Committee, chaired by Dr.Christina Johns, concentrated primarily on thepatient refusal process, identifying potential datasources and areas for improvement in the process.

Testing and ambulance inspections also contin-ued throughout the year with the Region III Officeconducting 85 written exams and over 50 vehicleinspections.

Region IVThe Region IV Office continues to coordinate

and support the medical review committees withinthe region’s nine counties concerning the develop-ment of emergency medical services quality assur-ance and quality improvement programs. The med-ical directors, jurisdictional representatives, andEMS organizations have been actively supportingthis initiative to include intubation audits, continu-ous positive airway pressure, and cardiac arrestsand intervention.

Wor-Wic Community College formallyreceived its designation as an advanced life support(ALS) training center by MIEMSS. The firstEmergency Medical Technician-Paramedic classgraduated May 2004. The college offers two ALSprogram choices—an Associate of Applied Sciencesand a Certificate of Proficiency. Both programs fol-low the national certification and state protocolstandards, which allow graduates to take the nation-

al and State of Maryland certification examinations.The Region IV Office continues to partner with

the MIEMSS Information and TechnologyDepartment and the State Medical Director’s Officewith the implementation of the electronic MarylandAmbulance Information System (EMAIS).Currently, Cecil and Dorchester counties are opera-tional with the EMAIS. The next regional jurisdic-tion to be trained is Somerset County. The educa-tion component of EMAIS in Somerset County willbegin in September 2004.

The Region IV EMS Advisory Council priori-tized 10 requests for Maryland Department ofTransportation Highway Safety Grants. In addition,matching grants from MIEMSS assisted with theplacement of monitor/defibrillators and automatedexternal defibrillators (AEDs) in EMS departmentsthroughout the region. Seven counties within theregion were eligible for funding and participated inthe Rural Access AED program which placed addi-tional AEDs in the region.

The Education Committee of the Region IVEMS Advisory Council prioritized and coordinatedthe distribution of training funds for initial trainingof ALS providers, as well as recertification trainingfor ALS and BLS providers.

The Region IV Office worked closely with theregion’s health departments, hospitals, and offices ofemergency management in the education and train-ing of designated managers relevant to the imple-mentation of the Facility Resource EmergencyDatabase (FRED) project. It coordinated with theregion’s health departments in the development ofa regional bioterrorism training program, and alsoparticipated in a bioterrorism drill at WashingtonCollege in Chestertown, Maryland.

The MIEMSS Region IV administratorsinspected 22 prehospital emergency response vehi-cles, including advanced and basic life supportambulances, chase cars, and first responder units.

The Region IV Office staff assisted in planningand staffing two regional conferences. TheWinterfest 2004 EMS Seminar was held January 31and February 1, 2004, at Tilghman Island.

Region VPyramid 2003, the fourteenth Tri-County EMS

Conference, was conducted in conjunction with theEmergency Education Council of Region V, Inc.Held at the Holiday Inn and Conference Center,Solomon’s, Maryland, the September conferencehad 200 registrants. Skill workshops were conduct-ed on such topics as EMAIS, patient restraint, trau-matic brain injury scenarios, and new medical

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devices. Plenary sessions were presented on theFinzel Crash, traumatic brain injury, and the EMSrole in caring for victims of domestic violence andsexual assault. Both ends of the age continuum wereaddressed through pediatric and geriatric generalsessions as well as BLS Pediatric Education forPrehospital Providers (PEPP) and BLS GeriatricEducation for Emergency Medical Services(GEMS). Pre-conferences on Quality AssuranceOfficer Training and Advanced MoulageTechniques rounded out the program.

Region V continues to support a variety of edu-cation and prevention activities through the RegionV EMS Advisory Council, county fire and rescueassociations, and the EMS for Children RISKWATCH initiative. Charles County parochialschools, public schools in Prince George’s andMontgomery counties (including special needsschools in Prince George’s County), participated inthe National Fire Protection Association (NFPA)Risk Watch Programs as part of the State ChampionGrant. The Region V Risk Watch for Children withSpecial Needs project was the first such project inthe nation and was recognized in the NFPA "AppleCorps" newsletter.

The Region V EMS Advisory Council hasstrongly supported the development of QualityCouncils in each county and supported qualitymanagement education and implementation. Datamanagement tools for quality improvement weredeveloped by the Prince George’s County Fire/EMS Department Bureau of AEMS and have beenmade available statewide. Charles County recentlyused the Strengths, Weaknesses, Opportunities, andThreats (SWOT) process to revamp their EMS sys-tem. The Region V Administrator and State EMSMedical Director staffed that process.

Bioterrorism/WMD planning has been a majorfocal point of efforts throughout the Region.Hospitals and health care facilities in PrinceGeorge’s County have entered into a Memorandumof Understanding (MOU) to cover resource sharingduring emergencies. Goals include a region-wideMOU for FY 2005. A variety of tabletop exercisesand drills have been conducted throughout theRegion and a Bioterrorism/WMD Forum, toinclude EMS, Emergency Management, Hospitals,and Health Departments, is planned for July.

The Region V Administrator continues to offerprograms in Geriatric Assessment as requested.

STATE OFFICE OF COMMERCIALAMBULANCE LICENSING AND REGULATION

Mission: To provide leadership and direction regard-ing the commercial (private) ambulance industry inMaryland to protect the health, safety, and welfareof persons utilizing these services. This includes thedevelopment and modification of statewide require-ments for commercial ambulance services and vehi-cles and the uniform and equitable regulation of thecommercial ambulance industry throughoutMaryland.

Operating statistics:131 BLS vehicles licensed116 ALS vehicles licensed7 neonatal vehicles licensed31 ground ambulance services licensed4 air ambulance services licensed57 temporary upgrades authorized20 complaints received and investigated243 routine compliance inspections performed

Number of commercial ambulance transports:Total ground ambulance transports: 191,115

BLS 167,000ALS 23,000Neonatal 1,115

Total commercial air transports: 3,600

The commercial ambulance market continuedits contraction during FY 2004, SOCALR’s 11thyear of operation. The year was marked by theunexpected exit of a large ambulance service inSeptember 2003. The resulting reorganization sawthe total number of commercial ambulancesreduced 3.8%, from 264 overall to 254. While theBLS category was hardest hit, falling from 144 to131, ALS ambulances increased slightly in numberfrom 112 to 116. Neonatal units fell slightly fromthe eight licensed in FY 2003 to seven in FY 2004.

SOCALR invested considerable effort in lead-ership, particularly in exposing commercial ser-vices to the use of Quality Assurance/QualityImprovement measures. This included identifyingand implementing QA/QI practices. SOCALRimplemented a feedback loop by adopting thereporting structure used by jurisdictional opera-tional programs.

SOCALR also continued to carry out the sys-tem-wide strategy of striving for optimal functionand reducing death and disability. Two importantregulatory steps were carried out during FY 2004.First, the Specialty Care Transport (SCT) regula-tions were approved by the EMS Board. This was

25

achieved with extensive consultation from thecommercial services. These regulations will pro-vide the framework for more timely access totransport by expanding the scope of practice forspecially-prepared EMT-Ps. Next, progress contin-ued on promulgating air ambulance regulations.

SOCALR also made significant progress on itsgoal of integrating commercial services into disas-ter response. Supported by many within the com-mercial sector, SOCALR facilitated participationin two drills and three real events during FY 2004.These events included aiding Baltimore City EMSin evacuating a skilled nursing facility duringHurricane Isabel, and organizing for hospital evac-uations during a fire at Dorchester GeneralHospital and the Fairfield Waterfront ordnanceevent. Although neither of these resulted in anevacuation, the commercial sector immediatelyaligned itself to provide needed resources to theincident commanders.

SOCALR also enlisted as a community part-ner with Sheppard Pratt Hospital to facilitate train-ing in psychological trauma resulting from disas-ters. This training will greatly improve the effec-tiveness with which commercial services respondwhen called upon. It will be provided free ofcharge to commercial providers, assisting the ser-vices in meeting their continuing educationrequirements. Rene Fechter, BA, NREMT-P,SOCALR’s Associate Director, provided signifi-cant expertise in the curriculum design to ensurethat the program met the needs of EMS providers.

Measurement and analysis also emerged asareas of progress during FY 2004. We implement-ed a database to track results from compliancechecks, which allowed us to aggregate data anddraw some conclusions about the efficacy of ourinspections. For example, SOCALR performed243 compliance inspections during the year. Ofthese, 45% resulted in serious findings.Furthermore, 18% of the 243 were temporarilyplaced out of service so that the condition couldbe corrected.

These rates were significantly higher (at 95%confidence) than the historic averages of 14% and6.3% respectively. We consider this to be a special

cause variance for two reasons. First, we imple-mented an acceptance sampling scheme thatresulted in all of our services being visited ratherthan relying upon random compliance checks.This resulted in a more representative group thanin years past. Next, we focused considerable atten-tion on oxygen storage to improve the safety ofthis aspect of interfacility transport. This campaignresulted from the need for primary injury preven-tion activities in the prehospital and interfacilityarenas. The installation repairs resulting from thiscampaign inflated the non-compliance statistics;now that these issues have been addressed, weexpect the rate of non-compliance findings toreturn to their historic levels.

The reporting structure for QA/QI statisticsyielded some promising findings. Of special noteare the increasing rates of reporting and the pre-ponderance of documentation findings. The tablebelow presents the categories accounting for themost findings. While the samples are too small todraw any significant conclusions, we believe theyare nonetheless representative of the distribution.They also demonstrate the commercial services’ongoing critical review of their activities.

In the year to come, we look forward to con-tinuing our efforts to carry out our goals under theEMS Plan. For example, we will continue effortsto ensure that interfacility transport is carried outefficiently, effectively, and in accordance with pro-tocols. This will include the implementation of theSCT program, as well as participation with theInter-Hospital Transport Subcommittee of theMaryland Health Care Commission’s committeeon interventional cardiology. We will also refinethe process by which commercial services respondto emergencies when requested by public safetyjurisdictions. Chief among these efforts will beaddressing questions of liability and reimburse-ment. Next, we will build upon our oxygen safetycampaign to address behaviors among commercialEMS providers (for example, safety restraint usageand heavy item storage). Finally, we will continueto champion the ongoing critical review of thecommercial services’ activities and efforts toimprove the quality of service.

Period reporting

10/1–12/31/031/1–3/31/04

Companiesreporting

814

Documentationissues

153 (82.7%)155 (81.2%)

Transport issues

14 (7.6%)9 (4.7%)

Protocol variances7 (3.8%)3 (1.6%)

Injured patients need treatment at the hospitalbest staffed and equipped to meet their specialneeds. Maryland's system of care ensures thatpatients promptly get to the most appropriate hos-pital in an effort to decrease morbidity and mortali-ty. (For differences in standards in the levels of trau-ma centers, see the Trauma Center Categorizationchart on the next page.)

The trauma and specialty referral centers withinthe Maryland EMS System are:

TRAUMA CENTERSPrimary Adult Resource Center

R Adams Cowley Shock Trauma Center/University of Maryland Medical System, Baltimore City

Level I Trauma CenterThe Johns Hopkins Hospital Adult Trauma

Center, Baltimore City

Level II Trauma CentersThe Johns Hopkins Bayview Medical Center,

Baltimore CityPrince George's Hospital Center, CheverlySinai Hospital of Baltimore, Baltimore CitySuburban Hospital, Bethesda

Level III Trauma CentersWashington County Hospital, HagerstownWestern Maryland Health System,

Memorial Hospital, CumberlandPeninsula Regional Medical Center, Salisbury

SPECIALTY REFERRAL CENTERSBurns

Baltimore Regional Burn Center/The Johns Hopkins Bayview Medical Center, Baltimore City

Burn Center/Washington Hospital Center, Washington, DC

Eye TraumaWilmer Eye Institute’s Emergency Service/The

Johns Hopkins Hospital, Baltimore City

Hand/Upper Extremity TraumaThe Curtis National Hand Center /UnionMemorial Hospital, Baltimore City

Hyperbaric MedicineHyperbaric Medicine Center/R Adams Cowley

Shock Trauma Center/University of Maryland Medical System, Baltimore City

Neurotrauma (Head and Spinal Cord Injuries)Neurotrauma Center/R Adams Cowley Shock

Trauma Center/University of Maryland Medical System, Baltimore City

Pediatric TraumaPediatric Trauma Center/The Johns Hopkins

Children’s Center, Baltimore CityPediatric Trauma Center/Children's National

Medical Center, Washington, DCPerinatal Referral Centers

Anne Arundel Medical CenterFranklin Square Hospital CenterGreater Baltimore Medical CenterHoly Cross HospitalHoward County General HospitalJohns Hopkins Bayview Medical CenterJohns Hopkins HospitalMercy Medical CenterPrince George’s Hospital CenterSt. Agnes Health CareSt. Joseph Medical CenterShady Grove Adventist HospitalSinai Hospital of BaltimoreUniversity of Maryland Medical System

Poison Consultation CenterMaryland Poison Center/University of

Maryland School of Pharmacy, Baltimore City

MARYLAND TRAUMA & SPECIALTY REFERRAL CENTERS

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Primary Adult Resource CenterR Adams Cowley Shock Trauma CenterUniversity of Maryland Medical System

Located in Baltimore City, the R Adams CowleyShock Trauma Center, which serves as the state’sPrimary Adult Resource Center (PARC), reportedreceiving 5,829 trauma patients from June 2003 toMay 2004, according to the Maryland AdultTrauma Registry. (See pages 42 to 47 for patientdata in various categories.) Thomas M. Scalea,MD, FACS, FCCM, serves as the Physician-in-Chief for the Program in Trauma, and RobbiHartsock, RN, MSN, CRNP, as the Trauma NurseCoordinator.

Shock Trauma Center staff were very active inprehospital EMS educational activities. Tours weregiven to 59 groups. Case reviews open to prehos-pital care providers were held quarterly. Therewere 101 EMS providers who participated in ALSSkills Labs that were offered 10 times. In theObservation Program, 194 EMS providersobserved in the Trauma Resuscitation Unit, and 56EMS providers in Critical Care. In addition, 61on-site clinical programs were held at firehouses,training academies, and EMS conferences.The Research Program at the Shock TraumaCenter is an integrated multi-disciplinary programthat seeks to answer important questions concern-ing issues that affect trauma patients. The R

Adams Cowley Shock Trauma Center researchersparticipate in large national and internationalmulti-institutional projects, and are conductingprojects funded by the National Institutes ofHealth. A Research Education Program continuesfor residents and fellows who rotate through ShockTrauma.

In the area of clinical research, the R AdamsCowley Shock Trauma Center:

• Tested a novel device capable of measuringblood flow to the brain without the need to drill ahole in the skull. The Brain Acoustic Monitor(BAM) has shown promise in the early identifica-tion of patients with brain trauma, which maygreatly facilitate triage and transport decisions andrevolutionize care of the patient with traumaticbrain injury.

• Served as a test-bed for new technology,becoming one of the first facilities in the world toevaluate the Statscan, a new low-dose, digital X-ray system that can take images of the entire bodyin 13 seconds.

• Participated in an ongoing study seeking toidentify biological markers of sepsis in a patient’sblood and to validate their ability to detect sepsis24 hours or more prior to the onset of clinicalsymptoms.

• Collaborated with the Department ofPathology to help the University of Maryland,Baltimore became a national center in theTransfusion Medicine/Hemostasis ResearchNetwork funded by the National Heart Lung and

Trauma Center Categorization

Differences in Standards Based on Physician Availability and Dedicated Resources PARC Level I Level II Level IIIAttending surgeon who is fellowship-trained and is in the hospital at all times X

Dedicated facilities (Resuscitation Unit, Operating Room, and Intensive Care Unit) 24 hours X

Facilities (Resuscitation Unit, Operating Room, and Intensive Care Unit) available at all times X X X X

Trauma Surgeon available in the hospital at all times X X

On-call Trauma Surgeon available within 30 minutes of call X

Anesthesiologist in the hospital at all times and dedicated to trauma care X

Anesthesiologist in the hospital at all times but shared with other services X X

On-call Anesthesiologist with CRNA who is in the hospital X

Orthopedic Surgeon in the hospital at all times and dedicated to trauma care X

Orthopedic Surgeon in the hospital at all times but shared with other services X

On-call Orthopedic Surgeon available within 30 minutes of call X X

Neurosurgeon in the hospital at all times and dedicated to trauma care X

Neurosurgeon in the hospital at all times but shared with other services X

On-call Neurosurgeon available within 30 minutes of call X X

Fellowship-trained/board-certified surgical director of the Intensive Care Unit X X

Physician with privileges in critical care on duty in the Intensive Care Unit 24 hrs/day X X X

Comprehensive Trauma Research Program X X

Education—Fellowship Training in Trauma X

Surgical Residency Program X X

Outreach Professional Education X X X

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Blood Institute. The designation will facilitate thestudy of methods designed to reduce RBC transfu-sions, control hemorrhage, and reduce mortality intrauma patients.

The Shock Trauma Center provides the lead-ership for the American Trauma Society,Maryland Division through its president, RobbiHartsock, RN. Active in all regions in Maryland,the American Trauma Society has sponsored andparticipated in safety fairs, fire department andhospital open houses, conferences, and conven-tions and has distributed safety literature to thou-sands of Maryland’s adults and children over thelast year.

The Shock Trauma Center ViolenceIntervention Program (VIP) is designed to identifyprofiles of patients who are repeat victims of vio-lence in an effort to intervene and disrupt thecycle of violence. The program includes a multi-disciplinary approach that combines parole andprobation, surgeons, social workers, psychiatrists,nurses, epidemiologists, and physicians who plancare for these patients.

The Shock Trauma Center also hosted in the"Mentoring Male Teens in the Hood" program.Forty males, ages 8-18 years old, visited ShockTrauma to interact with role models from theSTC/VIP staff, tour the facility, and participate insmall group sessions to reinforce the importance ofstaying away from a life of crime. The purpose ofthis program is to teach young boys to be honest,respectful, and to model positive behavior. As part of the community outreach initiative,Shock Trauma also held a "Minds of the Future"program four times this year with 454 high-schoolstudents participating.

The High Risk Adolescent Trauma PreventionProgram (HRATPP) is an educational programdesigned to provide information on the conse-quences of drinking, taking drugs, and driving sothat the participants can make informed decisionsabout these high-risk behaviors.

The on-site high-risk teen program at theShock Trauma Center is provided to four counties:Cecil, Anne Arundel, Frederick, and Howardcounties. A total of 365 teens participated fromthose counties. Other counties sent an additional10 teens and special requests for 3 other high-riskgroups allowed another 28 teens to participate,bringing the high-risk teen total attendees to 393.Three on-site programs were conducted for stu-dents who were members of Students AgainstDestructive Decisions (SADD).

The teen outreach program goes to the high-risk teens. Mountain Manor Residential TreatmentCenter, Harford County, Howard County, andSykesville Shelter are included in the group. Atotal of 368 teens participated in these classes.

Fifteen high-school assemblies were provided,reaching 12,000 students. The assemblies werevery well received. Three health classes weretaught to an additional 65 students.

A similar on-site program is provided to adultDWI offenders, with 328 participating in this pro-gram during FY 2004.

The prevention staff attended six health/safetyfairs reaching thousands of Marylanders. The staffalso coordinated a 3-D event on the University ofBaltimore campus during December 2003 for 3-DMonth (National Drinking, Driving, DruggedCampaign). The staff has also participated in vari-ous committees and task forces that focus ondrunk driving issues.

Positive Alternatives to Dangerous andDestructive Decisions (PADDD) is a 501C3 pre-vention organization that was developed byTrauma Nurses Debbie Yohn and Laurel Stiff. InFY 2004, PADDD was awarded a grant from theMaryland Highway Safety Office. In conjunctionwith the R Adams Cowley Shock Trauma Center,the organization has implemented the followingprograms in the State of Maryland reaching 598participants who were court ordered and 5,188who were part of special presentations. HowardCounty had 993 participants who attended theprogram at the courthouse in Ellicott City. TheHoward County Sheriffs Department and PADDDstaff administer the program. In Harford County,where the classes are held at the UpperChesapeake Health Center, 581 court-ordered par-ticipants and over 100 guests attended. The com-pany also presented an educational seminar forthe drivers and staff at Comcast Cable for 20 par-ticipants. PADDD gave a presentation to the mili-tary for a total of 2,186 soldiers in Edgewood andAberdeen Proving Grounds. Baltimore Countyhad four PADDD business seminars with 189 par-ticipants. The Maryland Highway Safety Officeheld two presentations for a total of 47 partici-pants. Carroll County had one business presenta-tion at Tevis Oil Company with a total of 45 truckdrivers. PADDD also participated at the annualFiremen’s Convention in Ocean City with 5,000attendees. The PADDD program reached morethan 10,000 Maryland residents with a message ofinjury prevention this year.

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Level IThe Johns Hopkins Hospital, AdultTrauma Center

Located in Baltimore City, the Johns HopkinsHospital Adult Trauma Center reported receiving2,296 trauma patients from June 2003 to May2004, according to the Maryland Adult TraumaRegistry. (See pages 42 to 47 for patient data invarious categories.) Edward Cornwell III, MD,FACS, FCCM, serves as Director of the JohnsHopkins Hospital Adult Trauma Service, and KathyNoll, MSN, RN, is the Trauma NurseCoordinator/Program Manager.

The Johns Hopkins Hospital Adult TraumaCenter, housed in the "#1 Hospital in America"according to the U.S. News & World Report,receives more than 2000 adult trauma patients peryear. In 1998, the Adult Trauma Service imple-mented a 24-hour a day in-house trauma attendingsurgeon commitment, and has quickly demonstrat-ed improved survival, triage time, and length ofstay among critically injured patients (Archives ofSurgery, 2003). The service has successfully recruit-ed two additional full-time trauma surgeons,Doctors David Efron and Elliott Haut.

The Johns Hopkins Hospital Division of AdultTrauma has a strong commitment to trauma pre-vention, particularly in the area of youth violence.During the past fiscal year, the Division of AdultTrauma continued its involvement in severalimportant trauma prevention endeavors. TheHopkins Injury Prevention and CommunityOutreach Collaborative (HIPCOC), which wasestablished by Dr. Cornwell in 2000, is a multi-dis-ciplinary group of clinicians, hospitals, and com-munity affairs professionals, public health profes-sionals, and members of the community, who areinterested in pursuing violence prevention througheducational and outreach activities. During thispast fiscal year, HIPCOC continued to conductseveral ongoing prevention programs, including:the dissemination of videos aimed at adolescentsby depicting the true consequences of gun vio-lence; hospital tours to visit the survivors of inter-personal violence; and slide presentations byhealth care professionals graphically demonstrat-ing the anatomic damage that results from inter-personal violence. The results of this program withthe first 90 youths (presented at the AmericanTrauma Society meeting in May 2004), demon-strated a decreased likelihood toward conflict andaggression that was quantifiable. In addition, as

part of the HIPCOC initiative, and with a grantfrom the American Trauma Society, the Divisionof Adult Trauma completed a "readiness tochange" study for injured patients ages 15 to 24who have positive toxicology screens for drugs oralcohol. The results of this study were presented asa poster at the annual meeting of the AmericanAssociation for the Surgery of Trauma (AAST) inSeptember 2003.

As part of his many trauma prevention activi-ties, Dr. Cornwell continued his membership onthe Board of the American Trauma Society(national and state), and the New SongCommunity Learning Center in the Sandtownneighborhood of West Baltimore. Dr. Cornwellalso works with the Fort Worthington PoliceAthletic League (PAL) center.

During the past fiscal year, the Division ofAdult Trauma continued to be actively involvedwithin the trauma community at both the state andnational levels. Doctor Cornwell is the Chairmanof TraumaNet through November 2004. TheDivision of Adult Trauma also continues to pro-vide educational and community outreach andparticipates in numerous grand rounds presenta-tions. The Division also provides educationalofferings to diverse groups, including area schoolchildren, college students, EMS personnel, traumaclinicians, church congregations, and rotary clubs.Within the hospital, the Adult Trauma EducationCommittee continued to present quarterly traumacontinuing education seminars for nurses, techni-cians, ancillary staff, and EMS personnel.

Level IIJohns Hopkins Bayview Medical CenterTrauma Center

Located in Baltimore City, the Trauma Center atthe Johns Hopkins Bayview Medical Center received1,250 trauma patients from June 2003 to May2004, according to the Maryland Adult TraumaRegistry. (See pages 42 to 47 for patient data invarious categories.) Paul Freeswick, MD, FACS,serves as the center’s Director, with Robert Dice,RN, MS as Trauma Coordinator and BarbaraWard, RN, MS as the Nursing ClinicalCoordinator of Trauma, Burn, and SurgicalIntensive Care.

The Trauma Center at the Johns HopkinsBayview Medical Center ( JHBMC) provides com-prehensive care to all trauma/burn patients,including direct injury treatment along with psy-

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chosocial and physical/rehabilitative focuses. InFY 2004, the center registered 1,250 patients inthe Maryland Adult Trauma Registry with out-comes data securely in the upper levels of whatwould be expected from any center dedicated tothe treatment of trauma victims.

The JHBMC Trauma division has recentlyattained successful redesignation as a Level II cen-ter. While we take pride in our achievement, werealize that while some areas are exceedinglystrong, other areas, which are adequate, can be sig-nificantly enhanced. To this end, trauma teammembers and the hospital administrators haverededicated resources and made personal commit-ments to these areas.

We have revamped our reviews of cases whichtrigger audit filters. We now ask subspecialistsfrom our own institutions (that is, neurosurgeons,orthopedic surgeons, plastic and reconstructivesurgeons), as well as independent outside consul-tants, to contribute to the review of these cases.Additionally, the JHBMC has allocated significantresources for physician and nursing continuingeducation, which is well above what has been bud-geted in the past.

JHBMC trauma bypass guidelines have beencompletely rewritten to only allow the medicalcenter to go on trauma bypass when the TraumaDirector or his designee (in the event the TraumaDirector is not available) has been apprised of thesituation and approved its utilization. Additionally,incremental increases of surgical, anesthesia, andburn physicians will allow the institution to fullyserve its injured patients and limit bypass events.

JHBMC continues to focus on its communitycommitment via its burn education and outreachprograms in schools. Additionally, theTrauma/Burn services have and will continue withcase presentations to the EMS and first respondersto allow for our better understanding of what isnecessary to optimize care from injury to dis-charge. These presentations have been met withmuch enthusiasm by all. Some issues raised atthese sessions have led to JHBMC changes andimprovements to our initial intake and triage ofinjured patients. The equipment lockers in thetrauma bays were redesigned and updated.Additionally, an audit form filled out by an inde-pendent third party critiquing the resucitation forreview and improvement has been implemented.

The Trauma Service at JHBMC recognizes therole an aging population has in the evolution oftrauma. Given that on the JHBMC campus is aworld-class center for the diagnosis and treatment

of the geriatric patient (the JHB Care Center), theTrauma Service and our gerontologists have com-bined forces to address the special needs of theelderly trauma patient. This allows for formal (forexample, hip fracture service) medical oversightby the Geriatrics and Trauma services to provideoptimum care to this frail population.

In summary, the JHBMC Trauma Service is amulti-disciplinary unit dedicated to our traumapatients of all ages and the community as a whole.We continue to strive to continually assess andimprove our services to the city of Baltimore andits surrounding communities.

Level IIPrince George’s Hospital Center

Located in Cheverly, the Trauma Center at PrinceGeorge’s Hospital Center continues to grow.According to the Maryland Adult Trauma Registry,Prince George’s Hospital Center received 2,636trauma patients from June 2003 to May 2004.(See pages 42 to 47 for patient data in various cat-egories.) This is an 11% increase in trauma patientvolumes from the previous year. In July 2003,Carnell Cooper, MD, joined the Prince George’sHospital Center as the Medical Director, TraumaServices. Philip R. Militello, MD, has continued toserve in the capacity of the Assistant TraumaDirector. Melissa E. Meyers, RN, BSN joinedPrince George’s Trauma Service in September 2003as the Trauma Program Manager. Sandra Waak,RN, CEN continues in the role of the AssistantDepartment Manager for the Trauma Service.The Prince George’s Hospital Center (PGHC)

continues to serve as the primary adult trauma cen-ter for the counties of Prince George’s, Calvert,Charles, St. Mary’s, and southern Anne Arundel,as well as parts of Montgomery and Howard coun-ties and the eastern part of Washington, DC.Approximately 30 percent of last year’s traumapatients arrived via helicopter. Three flight agen-cies routinely use the rooftop helipad: theMaryland State Police, United States Park Police,and MedStar.

Because of its unique proximity to Washington,DC, PGHC is also a designated trauma center forthe White House Medical Team, as well asOperation Capitol. Renovations to the ground-level helipad have been made in order to accom-modate the larger helicopters from the military,should the need arise.

Prince George’s Hospital Center maintainstheir affiliation with the R Adams Cowley ShockTrauma Center in Baltimore which regularly

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rotates a team of senior trauma fellows throughPGHC as part of their fellowship training. Thisserves to enhance their clinical experiences andprovides PGHC with additional resources for itsgrowing trauma program.

The Trauma Service continues to expand withnew programs being instituted. In the past year, anew high-speed CT scanner has been installed. Theinstallation of the new CT scanner not only servesas a reliable backup scanner, providing a more effi-cient trauma workup, but also has contributed tothe significant decrease in trauma fly-by hours thatPGHC has experienced in the past several years.Patient disposition rounds are conducted on a dailybasis. These rounds are multi-disciplinary. Theynot only ensure a standard of care for the traumapatient but also contribute to decreasing traumapatient hospital lengths of stay. Another programreinstituted in the past year is the Trauma GrandRounds/M&M conferences that are held on a regu-lar monthly basis. These conferences not onlyserve as an exercise in quality management butalso provide physician, nursing, and ancillary staffwith trauma continuing education opportunities toensure current standards of trauma care.

PGHC is actively involved in violence inter-vention/prevention initiatives. This past year,Prince George’s Hospital Center provided interven-tions for troubled teenagers on the nationallyviewed Judge Hatchett Show. This is the third yearthat PGHC has participated in this program.Prince George’s Trauma Service also participatedin the media kickoff for NBC-4’s "Safe and Secure"campaign featuring pedestrian safety with emphasison the impaired pedestrian. The Trauma Centeralso actively participates in hosting the "Reality"program with the Prince George’s County JuvenileJustice System.

In an effort to improve relationships and com-munications with prehospital care providers, theTrauma Service has been visiting the Region VEMS squad houses and regularly attending councilmeetings. These visits also serve to address andimprove prehospital quality of care issues.

Level IISinai Hospital Trauma Center

Located in Baltimore City, Sinai Hospital TraumaCenter reported receiving 1,513 trauma patientsfrom June 2003 to May 2004, according to theMaryland Adult Trauma Registry. (See pages 42 to47 for patient data in various categories.) TomGenuit, MD, serves as the Trauma Director.The Trauma Division’s ongoing commitment

to injury prevention was demonstrated by activeinvolvement in community outreach and traumaprevention endeavors. Continued efforts to reducegeriatric injury resulted in the presentation ofongoing fall and injury prevention activities. Inconjunction with the Lifebridge CommunityHealth Education Department, the TraumaDivision presented the American Trauma Society’sTraumaroo injury prevention programs to childrenat local elementary schools and health fairs. Sinai’sFamily Violence Program continued its efforts tobreak the cycle of violence by providing counsel-ing, resources, referrals, and training of health careproviders.

Performance Improvement activities enhancedthe care provided to the trauma patient. Focusedmulti-disciplinary performance improvement ini-tiatives resulted in the reduction in complicationrates, enhancement of triage and transfer process-es, and development of improved trauma docu-mentation records.

Emergency medicine and trauma staff wereactively engaged in EMS educational activities.Continuing education courses and case reviewswere offered to the EMS community. In addition,preceptorship of paramedics was provided inSinai’s ER7.

Level IISuburban Hospital

Located in Bethesda, the Suburban HospitalTrauma Center cared for 1,312 trauma patientsfrom June 2003 to May 2004, according to theMaryland Adult Trauma Registry. (See pages 42 to 47 for patient data in various categories.)Daniel Powers, MD, FACS, serves as the Medical Director of Suburban Hospital’s Trauma Services and Anne Kuzas, RN, as itsTrauma Nurse Coordinator/Program Manager.

Ongoing enhancements have been applied tothe Picture Archiving and Communication System(PACS) system that was instituted last fiscal year. Asfurther technological advances became availablethis year, such as web-based software upgrades toimprove remote access for our medical staff in addi-tion to wireless access to PACS for radiology imagereviews for case review conferences, enhancementshave been made to the system. A second imagereader station was also added to the trauma bay.

The trauma center’s bypass hours during thisfiscal year have continued to remain below thethreshold that were set when the trauma bypass pol-icy was developed and implemented. Each event

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continues to be evaluated on a daily basis for policycompliance as well as the identification of addition-al opportunities for improvement. The ability tomaintain ongoing improvement enables Suburban’sTrauma Center to be more available to serve thetrauma care needs of citizens within its immediatecommunity and serve as a backup trauma center asneeded within the statewide trauma system.

The Medical Director of Trauma Services andthe Trauma Nurse Coordinator/Program Managercontinue to actively participate in the MarylandEMS System through memberships in theTraumaNet, the MIEMSS Trauma QualityImprovement Committee, the Region V EMSAdvisory Council, the Statewide EMS AdvisoryCouncil, and the Maryland Division of theAmerican Trauma Society. Suburban is an institu-tional member of the American Trauma Society.Suburban staff continue to participate in communi-ty partnerships to educate the public in the sur-rounding community about "pedestrian safety,"child-related safety issues, and "drinking, drug, anddriving" awareness. Suburban sponsored a commu-nity-wide event on October 11, 2003 to kick off theopening of our new Pediatric Center (including apediatric emergency department, as well as inpa-tient beds). More than 500 parents and their chil-dren attended this educational event.

Suburban Hospital continues to provide traumatraining for the registered nurses and corpsman atBethesda Naval Hospital. This affiliation was estab-lished prior to the deployment of the USS Comfortto the Middle East in FY 2003. This trauma pro-gram includes didactic and clinical trauma compo-nents based on the Maryland Trauma NursingOrientation Core Curriculum.

Two four-hour seminars, "Update on CriticalIssues in Trauma," were held in the fall and spring.These seminars were offered free of charge to thetrauma care community within the regional area,including medical and hospital staff and the EMScommunity. Emergency department nurses provid-ed an injury prevention program, ENCARE(Emergency Nurses Cancel Alcohol-Related

Emergencies), as well as alcohol poisoning lecturesin community high schools.

Renovations have been underway sinceJanuary, 2004 to expand our critical care bedcapacity. Once this expansion has been completed,it will improve Trauma/ED patient flow which willresult in a decrease in our diversion time.

Level IIIPeninsula Regional Medical CenterTrauma Center

Located in Salisbury, the Peninsula RegionalMedical Center (PRMC) Trauma Center received773 trauma patients from June 2003 to May 2004,according to the Maryland Adult Trauma Registry.(See pages 42 to 47 for patient data in various cat-egories.) Un Y. Chin, MD, serves as the TraumaDirector, and Lisa Hohl, RN, BSN as the TraumaNurse Coordinator.

Under the direction of Dr. Un Y. Chin,Peninsula Regional Medical Center successfullyapplied for and received re-designation as a LevelIII trauma center effective November 19, 2003 for aperiod of five years.

Peninsula Regional Medical Center continuesto coordinate and participate in community-basedinjury prevention initiatives. Initiatives addressingthe impact of driving under the influence of alcoholand/or drugs were presented at area high schoolsduring their pre-prom celebrations. Educationthrough the Emergency Nurses Association EN-CARE program, demonstration with fatal visionglasses, and the reenactment of a motor vehiclecrash were different methods used to portray thesafety message. Other injury prevention efforts con-tinue with the Maryland Division of the AmericanTrauma Society, SAFEKIDS Lower ShoreCoalition, the Worcester and Wicomico HighwayAdvisory Committees, and the Ocean CityPedestrian Task Force.

Peninsula Regional Medical Center continuesto assist in planning, coordinating, and sponsoringseveral educational conferences:

• The Trauma Office continues to coordinateand sponsor the annual "Topics in Trauma" confer-ence, with topics ranging from prehospital care toadvanced inpatient trauma care.

• The Education Department joined forces withthe AACN Delmarva Chapter to sponsor and coor-dinate the Critical Care/Medical-SurgicalConference. Current healthcare trends and issuesthat challenge nurses today were addressed by

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offering a variety of topics designed to advance pro-fessional practice.

• Peninsula Regional Medical Center continuesto work collaboratively with WorWic CommunityCollege in providing continuing education for pre-hospital providers, as well as curriculum manage-ment and coordination of EMT programs. Ongoingwork has progressed for establishing course workfor an EMT-B to EMT-I program. This addition tothe EMT program will expedite certification ofemergency medical technicians on the intermediatelevel to provide ALS care.

Peninsula Regional Medical Center hasimproved communication with area prehospitalproviders by implementing a quarterly newsletter.The newsletter addresses current issues in prehospi-tal care, educational opportunities, and specialannouncements. It is distributed to prehospitalproviders throughout the Lower Shore ofMaryland, Sussex County in Delaware, andAccomack County in Virginia.

Peninsula Regional Medical Center has contin-ued to improve its radiographic capabilities with thepurchase of a 16 Pro CT scanner. The new scannerwill have the ability to provide a thorax to toe scanin 10 seconds with thinner slices for improved diag-nostic capability. This scanner is expected to beoperational by August 2004.

Level IIIWashington County Health SystemsTrauma Center

Located in Hagerstown, the Washington CountyHealth Systems Trauma Center reported receiving845 trauma patients from June 2003 through May2004, according to the Maryland Adult TraumaRegistry. (See pages 42 to 47 for patient data invarious categories.) Karl P. Riggle, MD, FACS isthe Director of Trauma Services, Marc E. Kross,MD, PhD, FACS is Surgeon-in-Chief of TraumaServices, and Joan Fortney, RN, BSN is theManager of Trauma Services.

During the past fiscal year, the Trauma Centerat Washington County Hospital has provided trau-ma services to residents of Washington andFrederick counties, Southern Pennsylvania, andthe Eastern Panhandle of West Virginia. As spe-cialties such as neurosurgery decrease in the sur-rounding areas, transfers to the Trauma Center fortreatment of complex injuries are increasing.

Throughout the year, the Trauma Center staffhas been active in community education events.

They have participated in community health fairs,served as speakers about safety issues, and partici-pated in Prom Promise. Trauma Center represen-tatives have also been working with communitymembers to plan the annual Citizen’s EmergencyPreparedness Day. An indoor Bike Safety Rodeowas held during December in cooperation withSAFE KIDS and other local community agencies.

The staff of the Trauma Center continues toprovide trauma-related education to physiciansand other staff members on a regular basis. TheTrauma Center collaborated with HagerstownCommunity College to present two multi-discipli-nary trauma conferences for trauma providers.Plans are already in progress to continue this semi-annual event in upcoming years. Trauma Centerrepresentatives have also presented case studies toarea EMS providers on an "as requested" basis.

To celebrate the outstanding contributions anddedication of the trauma center staff throughoutthe hospital, the Trauma Service organized TraumaTeam Recognition Day. A crashed vehicle was dis-played in front of the hospital during EMS week,concluding with a vehicle extrication demonstra-tion by a local EMS agency. Members of the trau-ma team were invited to a reception. Displaysabout trauma services and motor vehicle safetywere set up in the hospital lobby. Employees andstaff learned about the multi-disciplinary approachto providing trauma services.

The Trauma Center underwent successfulLevel III redesignation by the MIEMSS. The hos-pital and staff of the Trauma Center look forwardto continuing to provide trauma care to residentsof the tri-state area.

Level IIIWestern Maryland Health System—Memorial Trauma Center

Located in Cumberland, the Western MarylandTrauma Center received 599 patients from June2003 to May 2004, according to the MarylandAdult Trauma Registry. (See pages 42 to 47 forpatient data in various categories.) Juan Arrisueno,MD, serves as the Trauma Director and SheriTroutman, RN, is the Trauma Nurse Coordinator.

With nearly 70 percent of its trauma cases attrib-utable to motor vehicle and motorcycle crashes, theWestern Maryland Health System (WMHS)—Memorial Trauma Center focuses much of its com-munity injury prevention efforts on traffic safety.

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WMHS works cooperatively with the AlleganyCounty Health Department, local law enforcementagencies, and other area organizations to promotechild passenger safety issues and conduct safety seatchecks at various locations in the community. Theirefforts also include programs on bicycle safety andan "On the Road Again" program that is providedto prison inmates prior to their release.

In addition, radio ads are aired in conjunctionwith major holidays to promote traffic safety andother related holiday safety issues. As part of thiscampaign, the Trauma Nurse Coordinator does livebroadcast interviews about these topics on themorning talk shows on local radio stations.

Staff from the WMHS—Memorial TraumaCenter also participate in the School Safety Council,which brings together the Allegany County Boardof Education, law enforcement agencies, theAllegany County Health Department, and theAllegany County Emergency Operations Center toeffect a safer school environment.

Continuing education is another importantcomponent. The telemedicine link between theUniversity of Maryland Shock Trauma Center andthe WMHS—Memorial Trauma Center enablesphysicians, nurses, EMS personnel, and otherhealthcare providers to participate in classesthroughout the year. Staff members also participat-ed in the Miltenberger Emergency ServicesSeminar, now held annually in Allegany Countyand named in memory of Fred Miltenberger, MD,a long-time advocate for Maryland’s trauma net-work. This program offers a variety of topics relatedto trauma and emergency case, including a special-ized track for nurses.

Staff from the WMHS—Memorial TraumaCenter worked with Maryland State Police Trooper5’s team to provide education on helicopter safetyto staff in the Emergency Department, ICU, andother areas. The class provided training for safelyloading and unloading patients, as well as preparingpatients for transport.

Baltimore Regional Burn CenterJohns Hopkins Bayview Medical Center

The Baltimore Regional Burn Center manages morethan 300 patients a year. For every inpatient, thereare approximately 4 patients seen as outpatientsthroughout the state. The outpatient burn clinicaverages about 1600 visits a year. Robert J. Spence,MD, FACS is the Director of the Burn Center.During FY 2004, the Baltimore Regional Burn

Center (BRBC) treated 389 inpatients, of whomapproximately one-quarter were children. During

this time period, the trend toward increased outpa-tient care continues, and outpatient visits wereincreased to approximately 1600. Patients wereadmitted from Baltimore City and 22 counties inMaryland, as well as from the states of Delaware,Pennsylvania, Virginia, and West Virginia. (Seecharts on pages 34-35 for other statistics.)

During the past fiscal year, the Burn Centeradded a community outreach nurse, who focuseson both adult and child burn prevention, as wellas other topics of interest. She also provides classesof interest within the institution.

The Wound Care Team has proven to beessential to quality inpatient care. It has recentlystarted to attend the outpatient burn clinic sessionsand has been extremely helpful.

During the year, the Burn Center continues itscommitment to professional and community edu-cation. The Center commits to many hours ofspeaking and teaching to the community, as wellas providing educational and clinical opportunitiesfor physicians, nurses, nurse practitioners, physi-cian assistants, burn technicians, and paramedicstudents. It is a well respected clinical site forEMT-I and EMT-P students. Last fiscal year, morethan 1,000 hours of clinical time were provided forthe paramedic students.

The Metropolitan Fire Fighters Fund contin-ues its support with the Burn Center, helping withboth patient needs and professional education.

The Burn Center at the WashingtonHospital Center

The Burn Center at the Washington HospitalCenter is located in the District of Columbia andserves as the adult regional burn center for theDistrict, southern Maryland, and northern Virginia.Marion Jordan, MD, is the Director.

The Burn Center features a 7-bed intensive careunit with a dedicated operating room and recoveryroom, a 13-bed intermediate/rehab care unit, andthe Skin Bank for Burn Injuries. Between 275 and300 adult burn patients are admitted each year.

ADMISSIONS TO BALTIMORE REGIONAL BURNCENTER BY MODE OF TRANSPORT (FY 2004)

_______________________________________________________________________Arrival Mode Patients_______________________________________________________________________

EMS ground 140

EMS aeromedical 69

Commercial, ground 83

Commercial, aeromedical 26

Personal transportation 63

Not recorded 8_______________________________________________________________________

Total 389

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Reconstructive surgery and rehabilitation areavailable for patients in the post-acute and convales-cent phases, regardless of where they received treat-ment for their acute burns.

Patients with minor burns that do not requirehospitalization are provided with outpatient woundcare and rehabilitation through the Burn CenterClinic.

The Curtis National Hand CenterAt Union Memorial Hospital

The Curtis National Hand Center at UnionMemorial Hospital serves as the state’s referral cen-ter for specialized care of injuries to the hand, wrist,and elbow, including significant elbow trauma andinjuries requiring microsurgical reconstruction.Thomas J. Graham, MD, is the Director.

The Curtis National Hand Center is known asone of the country’s most advanced resources forthe care of patients with elbow, forearm, wrist, andhand trauma. Having received the congressionaldesignation as The National Hand Center in 1994,the Center remains one of the world’s premierfacilities for the study of hand surgery and thetraining of orthopaedic, plastic, and general sur-geons in the field of upper extremity surgery.Thomas J. Graham, MD is the Director of theCurtis National Hand Center and the Chief of the

Union Memorial Hospital Division of HandSurgery, as well as the Vice-Chairman ofOrthopaedics at Union Memorial, and is anAssociate Professor of both Orthopaedic andPlastic Surgery at Johns Hopkins University.

The Curtis National Hand Center remainscommitted to handling acute injuries and provid-ing reconstructive surgery after trauma. The focuson complex hand, wrist, and elbow injuries haslong been part of the well-developed Marylandtrauma care system, since the Center’s founder,Dr. Raymond M. Curtis, collaborated with Dr. RAdams Cowley and others during the inception ofShock Trauma and the Maryland EMS System.

The Center’s expertise in complex bone andsoft tissue trauma is supplemented by advancedmicrosurgery skills. The handling of fractures,challenging soft tissue coverage problems, andamputations continues to be the major focus of theHand Surgery Service at Union Memorial.

The Curtis National Hand Center is one of thelargest training centers for hand surgery. TheCenter’s relationships with Johns HopkinsHospital, Georgetown University, Walter ReedArmy Medical Center, and Union MemorialHospital continue to provide extraordinary train-ing because of the volume and variety of thepathology. The surgeons of the National HandCenter have contributed some of the most impor-tant publications concerning the care of theinjured hand and upper extremity, and continue tolecture worldwide about the topic of hand trauma.

Continuing research projects, funded by bothinternal and external sources, look at a wide rangeof pertinent questions, including those in micro-surgery, surgery of the peripheral nerve, bone, softtissue problems, and reconstruction after signifi-cant trauma. Collaborations with the region’s sci-entists and other investigators promote currentthinking and new development in this vital area.

Among other upcoming projects is the physi-cal reorganization of the trauma intake facility tointroduce even better processes for the injuredpatient. The value of the association of The CurtisNational Hand Center and MIEMSS is clear andstrong. Maryland maintains the nation’s premiernetwork of institutions and physicians for traumacare in part because of the unique capabilities andavailability of the specialty trauma centers. One ofthe country’s most important resources in the careof hand and upper extremity trauma is also one ofthe critical components in Maryland’s strong net-work of advanced trauma centers.

ADMISSIONS TO BALTIMORE REGIONAL BURNCENTER BY INJURY TYPE (FY 2004)

___________________________________________________________________Injury Type Patients___________________________________________________________________

Flame 188

Scald 118

Electrical 24

Contact 13

Chemical 11

TENS 16

Sunburn 1

Radiation 1

Not recorded 5___________________________________________________________________

BALTIMORE REGIONAL BURN CENTERSTATISTICAL SUMMARY (FY 2004)

__________________________________________________________

Admissions 389

• Adults 310 (79.9%)

• Children 79 (20.3%)

Average Age 35.68 years

Average Total Burn Surface Area 8.22%

Average Length of Stay 8.99 days

Inhalation Injury 61 (15.7%)

Mortality 16 (4.11%)__________________________________________________________

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Hyperbaric Medicine CenterR Adams Cowley Shock Trauma Center

The Hyperbaric Medicine Center of the R AdamsCowley Shock Trauma Center of the University ofMaryland Medical System is the statewide referralcenter for victims of diving accidents, carbon monox-ide poisoning, smoke inhalation, and gas gangrene.It is the only multi-place chamber in Maryland, andis capable of accommodating 10 stretcher patients or23 seated patients simultaneously. The center is ableto provide treatment around the clock, 365 days ayear. Robert Rosenthal, MD, is the Director of theHyperbaric Medicine Center.

During FY 2004, the types of emergent casestreated included: carbon monoxidepoisoning/smoke inhalation; arterial gasembolism; decompression sickness (the bends),clostridial myonecrosis; group A beta hemolyticstrep fasciitis/myositis; necrotizing fasciitis; com-promised skin grafts and flaps; crush injuries; andexceptional blood loss anemia.

The types of non-emergent cases treatedincluded: non-healing diabetic extremity wounds;refractory osteomyelitis; osteoradionecrosis; andradiation cystitis/enteritis.

All treatments are supervised by speciallytrained hyperbaric physicians; direct patient con-tact is administered by critical care nurse "tenders"who provide patient care in the chamber duringall "dives." Because of the chamber’s uniquedesign and staffing, even the most critically illpatients can receive hyperbaric treatments withoutany interruption of care.

Physician and nursing members of theHyperbaric Medicine Center actively lecture onhyperbaric medical education at regional andnational levels and to local and regional EMSproviders.

Researchers from the Department ofHyperbaric Medicine, in collaboration with theDepartment of Anesthesiology, are actively contin-uing pre-clinical investigations exploring the neu-roprotective effects of hyperbaric oxygen followingcardiac arrest and brain injury. Additionally,departmental researchers, in collaboration with theDivision of Plastic Surgery, are exploring the abili-ty of hyperbaric oxygen to promote the "accep-tance" of tissue flaps following surgery or trauma.

Maryland Eye Trauma SystemThe Wilmer Eye Institute at JohnsHopkins

The Eye Trauma Center at the Wilmer Eye Institute(WEI), Johns Hopkins Hospital is the firststatewide eye trauma center in the nation. The mainobjectives of the eye trauma center are to provideoptimal clinical management of severe ocularinjuries, to conduct research into the natural historyof eye trauma, to develop new treatments for oculartrauma, and to initiate and support eye trauma pre-vention activities. Dr. Michael P. Grant, MD, PhD,is the new Director of the Center; the AssociateDirector for FY 2005 is Robert A. Equi, MD.

The Wilmer Emergency Room (WER) logged5,723 patient visits in FY 2004; 159 serious eyeinjuries, some requiring emergency surgical treat-ment, were reported to the U.S. Eye InjuryRegistry.

The Maryland Society for Sight is working topass statewide legislation requiring children towear a batting helmet with a protective face shieldand soft-core baseballs when participating in orga-nized baseball games. Dr. Stuart R. Dankner, WEIfaculty and Chairman of the Society’s Eye SafetyCommittee, presented testimony on the eye safetybill to the General Assembly in 2004, but the leg-islation did not pass. The Society will reintroducethe bill to the General Assembly in 2005. John A. Hurson, Chairman of the Health andGovernment Operations Committee of theMaryland House of Delegates, wrote a letter onthe Society’s behalf to Secretary Nelson J. Sabatini,requesting that the Office of Injury Preventionwithin the Maryland Department of Health andMental Hygiene collect materials on injury pre-vention, specifically eye injuries in sports, and pro-vide the materials to the injury prevention coordi-nators in the local health departments. The Societyis also working to get an eye safety law passed onthe county level. Councilman Ken Ulman, fromthe Howard County Council, has been contactedrequesting his assistance in passing an eye safetylaw in Howard County.

The WER physicians and nurses continue tobe active participants in the Johns HopkinsDisaster Plan, Operation Red: Chemical Plan forthe treatment of chemical eye burns.

WEI developed the MIEMSS QualityImprovement Indicators of Care for OcularTrauma. Data collection will commence in FY2005 to monitor compliance with indicators.

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Community service consisted of disseminationof information before the July 4th holiday onFireworks and Eye Injury Prevention from theU.S. Eye Injury Registry. Dr. Grant was inter-viewed for radio broadcast and television (airedtwice) on the topic. Martha Conlon, RN andCindy Henry, RN manned an eye care and injuryprevention booth during a health fair at St. Francisof Assisi Parish Church last October. Ann Roberts,RN presented eye injury prevention to students atHarford County Middle School.

During FY 2004, the WEI faculty and RNstaff (mainly the faculty of the OculoplasticDivision, Dr. N.I. Iliff, Director) were involved in14 presentations and publications on ocular trau-ma. Dr. Morton F. Goldberg, Chairman Emeritus,presented Sickle Cell Hyphema for the BarnesInaugural Lecture at the annual meeting of theOphthalmic Section of the National MedicalAssociation. Dr. Daniel C. Garibaldi and Dr.Joseph B. Harlan conducted a study on theDetection of Retinal Hemorrhages by Non-Ophthalmologists in Cases of Presumed ShakenBaby Syndrome (SBS) which represented the firstprospective trial of its kind to characterize the sen-sitivity and specificity of non-ophthalmologists fordetecting retinal findings of presumed SBS. Itdemonstrates that non-ophthalmologists may,using standard exam techniques, successfully docu-ment retinal findings in presumed Shaken BabySyndrome. However, there is a need to enhancethe sensitivity and specificity of non-ophthalmolo-gists’ exams for the detection of retinal hemor-rhages using current examination modalities.

Neurotrauma CenterR Adams Cowley Shock Trauma Center

The Neurotrauma Center at the R Adams CowleyShock Trauma Center, University of MarylandMedical System, provides comprehensive manage-ment for patients with brain, spinal cord, andspinal-column-related injuries. Bizhan Aarabi, MD,is the Director of the Neurotrauma Center.

More than 253 neurosurgical procedures wereperformed for a variety of acute complex head andspinal cord injuries. Patients with epiduralhematomas, intracerebral hematomas, subduralhematomas, and subarachnoid hemorrhagesreceived care based on the latest treatment proto-cols. The Neurotrauma Center also provided state-of-the-art care for patients with complex spinal col-umn injuries.

Pediatric Trauma Center at the JohnsHopkins Children’s Center

In FY 2004, 962 children (ages newborn to 14years) were treated at the Pediatric Trauma Centerat the Johns Hopkins Children’s Center, located inBaltimore City. Paul Colombani, MD, is theDirector, and Susan Ziegfeld, MSN, CCRN,CRNP, serves as the Trauma Nurse Coordinator.

Located in the Johns Hopkins Hospital (listedas one of the "Best of the Best" hospitals in the U.S.News & World Reports Rankings for the past 14years), the Pediatric Trauma Service (PTS) at theJohns Hopkins Hospital Children’s Center is aLevel I pediatric trauma facility for the state ofMaryland. The PTS is an advocate in the care ofcritically ill and injured children and is activelyinvolved in the prevention of pediatric injuries atthe local, state, and national levels. The PTS inte-grates patient care with ongoing basic scienceresearch. The Pediatric Surgery Laboratory, underthe direction of Antonio DeMalo, PhD, investigatesmolecular mechanisms involved in the response toinjury. In addition, the laboratory studies con-founding factors that modify the response to injury,such as genetics, diet, sex, and age. The laboratoryis actively engaged in the training of future acade-mic pediatric surgeons, basic scientists, and med-ical and graduate students. In addition, the PTSconducts ongoing clinical research and collaborateswith other departments and the community to pro-vide childhood injury prevention activities. Paul M.Colombani, MD, FACS, FAAP, is the Children'sSurgeon-in-Charge at Johns Hopkins and theDirector of the PTS. He serves on TraumaNet.

Susan Ziegfeld, MSN, CCRN, CRNP, TraumaNurse Coordinator, serves on TraumaNet, theMaryland Trauma and Specialty Care Quality

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Improvement Committee, and the MarylandTrauma Registry, Education and Injury PreventionCommittee. She is serving as Course Director forthe Advanced Trauma Care for Nurses, in collabo-ration with the Air Force and R Adams CowleyShock Trauma Center, to train nurses in AdvancedTrauma Life Support. She also spearheaded a pro-ject funded by the Johns Hopkins Children’sCenter Telethon to distribute stuffed animals,specifically bloodhound puppies, to children thatpresent to the trauma bay. Regardless of the child’sage, this can be a comfort to him/her. Furthermore,the stuffed puppies, named "Stitches" by localjunior high school students, will serve as education-al tools. The puppies have a Velcro open stomach.If the child has an injury, the child will place astuffed replica of the injured organ/bone into thepuppy with a fact sheet regarding the injury. Thepuppy will serve two purposes: to comfort the childduring a frightening experience and provide theneeded prevention and post-injury education forthe child and family.

Vinita Misra Knight, MPH, CSTR, PediatricTrauma Program Coordinator, serves on theMaryland Trauma and Specialty Care QualityImprovement Committee, the Maryland TraumaRegistry, Education and Injury PreventionCommittee, and the Pediatric QualityImprovement Committee of the Maryland EMSQuality Leadership Council. Ms. Knight is activelyinvolved in several research initiatives, includingtraumatic brain injury studies and pedestrianinjuries. Four manuscripts, on topics ranging fromphysical child abuse to renal and spine injury, havebeen published or accepted for publication.

Mary Pasquariello, CSTR, Pediatric TraumaData Coordinator, oversees all aspects of data col-lection and management. Both Ms. Knight and Ms.Pasquariello are certified as car safety seat techni-cians and certified by the American TraumaSociety as Specialists in Trauma Registry.

The Pediatric Trauma Service welcomed twonew members to its team. Stacey Nash, RN, BSNserves as Performance Improvement Coordinator.In her new role, she will be coordinating monthlypediatric trauma morbidity and mortality confer-ences and initiating trauma-related performanceimprovement projects in the Johns HopkinsChildren’s Center. In addition, she will be servingas a liaison between the EMS community and thePTS. Rose Stinebert recently joined the PTS as theProgram Coordinator for Hopkins Outreach forPediatric Education (HOPE). The HOPE programhas continued to provide quality educational pro-

grams for all prehospital providers and hasexpanded to offering approximately 20 classesannually. Approximately 500 participants havecompleted the PALS course during the past year.

All members of the PTS actively participate inprehospital provider follow-up and education. InMay 2004, the PTS spearheaded a multi-depart-mental EMS appreciation program which distrib-uted thank-you gifts, such as stethoscopes and giftcertificates for local restaurants, to over 50 prehos-pital providers.

Through collaboration with the AmericanTrauma Society, the PTS has received funding forcar seats, bicycle helmets, and elbow/knee pads. All members of the service distribute these prod-ucts free of charge to families and reinforce aninjury prevention message.

The PTS received funding from the RobertWood Johnson Foundation in November 2002 forJohns Hopkins Hospital to become the 27th localsite of the Injury Free Coalition for Kids (IFCK).IFCK is a national network of community-basedhospitals and community advocates, focused on theprevention and reduction of injuries to children.Mahseeyahu Ben Selassie, MSW, MPH, serves asthe Project Administrator. The BaltimoreCoalition’s program gathered information andinput from community residents on injuries to chil-dren in their neighborhoods and is currently con-ducting its first Parent Safety Leadership Group,which trains parents and caregivers in various areasof injury prevention, such as smoke detector instal-lation, poison prevention, CPR, and First Aid. Theaim of the program is to train parents, residents,neighbors, and caregivers to become safety leadersand advocates for safety in their communities.

Pediatric Trauma CenterChildren’s National Medical Center

In FY 2004, Children’s National Medical Center,as a pediatric specialty referral center, treated 914children with multiple trauma and burns who wereresidents of Maryland or who were injured inMaryland. Martin R. Eichelberger, MD, is theDirector of Emergency Trauma-Burn Services, andMaureen Deehan, RN, CPNP is the Trauma-BurnCoordinator.

The Children’s National Medical Center(CNMC) was re-verified by the American Collegeof Surgeons in July 2004 as a Level I PediatricTrauma Center. CNMC serves the pediatric com-munity of Region V, which includes Montgomery,Prince George’s, Calvert, Charles, and St. Mary’s

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counties, by caring for children with multiple trau-ma and burns.

CNMC provides pediatric emergency andtrauma education to physicians, nurses, and pre-hospital providers. The EMT-B course is offeredtwice a year. Thirteen courses in PediatricAdvanced Life Support (PALS) are offered annual-ly. Four courses in the Pediatric Education forPrehospital Professionals (PEPP) are presentedannually. The Center for Prehospital Pediatrics hasproduced a regional report on the state of EMSCin the Mid-Atlantic Region. The Trauma NurseCore Curriculum (TNCC) is offered five times peryear. Advances in Pediatric Emergency Medicine isalso offered annually to community physicians.

Since its inception in 1987, the National SAFEKIDS Campaign (NSKC), a subsidiary of CNMC,has contributed to the decrease of childhood fatali-ties by: 7% from motor crashes, 40% from drown-ing, 69% from non-helmeted bike riders, and 63%from residential fires. The campaign interacts withmore than 600 state and local SAFE KIDS coali-tions in 50 states and 2 jurisdictions and 16 foreigncountries to bring the prevention of unintentionalinjury to the grassroots level. In addition, theNSKC provides critical safety devices to those whocannot afford them, advocates for new andstronger safety legislation, and conducts primaryresearch to identify who is most affected by injuryand why (www.safekids.org).

CNMC houses the Emergency MedicalServices for Children (EMSC) National ResourceCenter and supports programs that enhance thequality of medical and trauma care those childrenreceive. Since 1984, EMSC has provided 87 newand continuing grantees with resources and techni-cal assistance. The EMSC National ResourceCenter also supports the Federal program withmany activities, including the Partnership forChildren stakeholder committee (comprised ofmore than 30 representatives from national organi-zations, federal agencies, and grantees), the annualgrantee meeting, and preparation of special reports.EMSC joined the American College of EmergencyPhysicians for another successful national obser-vance of EMS Week (May 16-22), including a spe-cial EMSC Day. During these challenging times,the EMSC initiative is focused on an increasingnational awareness of the need to have an emer-gency response system that is fully prepared toaddress children's needs during catastrophic emer-gencies (www.ems-c.org).

CNMC is part of the Crash Injury Researchand Engineering Network (CIREN), funded by theNational Highway Traffic Safety

Administration/USDOT. It is the only pediatriccenter of ten centers nationwide investigating thebio-mechanics of vehicle crashes and the anatomicand physiologic impact on children. This informa-tion is used by pediatric professional organizations,child restraint manufacturers, and other child pas-senger safety groups to design prevention pro-grams, make technological improvements torestraints and vehicles, and develop advocacy andpolicy recommendations (www-nrd.nhtsa.dot.gov/depart-ments/nrd-50/ciren/CIREN.html).

CNMC is one of 40 pediatric centers partici-pating in the Partnership for Development andDissemination of Outcome Measures for InjuredChildren: A Multi-Center Study of Burn InjuryAssessment and Outcomes, coordinated by theAmerican Pediatric Surgical Association (APSA).The objective is to obtain patient-based clinicaldata that allow for a comparison among burn treat-ments used in current practice. The data includeclinical assessment and management; patient para-meters of pain and anxiety, appearance, behavior,and parental issues such as expectations and stress.The data will be analyzed to determine which clini-cal management strategies appear to optimize out-come. Currently, Children's is the leading pediatricuser of TransCyteTM, a bio-engineered skin equiv-alent, on partial thickness burns, which hasreduced inpatient length of stay from 2 weeks to 2days (www.eapsa.org).

Perinatal Referral CentersTo date, MIEMSS has designated a total of 14

Perinatal Referral Centers. (See page 26 for a com-plete list of perinatal centers.) MIEMSS hasworked closely with the Department of Health andMental Hygiene (DHMH) regarding perinatal cen-ters in Maryland. DHMH provides grant funds tosupport a full-time staff member to coordinate theperinatal programs at MIEMSS.

Poison Consultation Center MarylandPoison Center

The Maryland Poison Center (MPC) is a certifiedregional poison center that provides emergency poi-son information by telephone 24 hours a day to thegeneral public and health professionals in the state.A division of the University of Maryland School ofPharmacy, MPC is designated by the MarylandDepartment of Health and Mental Hygiene as aregional poison center for Maryland. MPC alsoserves as a consultation center for MIEMSS. BruceD. Anderson, PharmD, DABAT, is Director ofOperations, and Suzanne Doyon, MD, ACMT, isMedical Director.

In Calendar Year 2003, the Maryland PoisonCenter (MPC) received 61,179 calls. While 35,156of these calls involved a human exposure, 2,175involved animal exposures, and the remaining23,848 were requests for information where noexposure occurred. The majority of poison expo-sures (54.3%) involved children under the age ofsix. Although the incidence of poisoning is greaterin children, most severe poisonings and poisoningdeaths occur in adolescents and adults.

Seventy-five percent of the cases reported tothe MPC were managed at a non-health care facil-ity site, such as the home, school, or workplace.Safely managing these patients at the site of theexposure saves millions of dollars in unnecessaryhealth care costs. It also allows more efficient andeffective use of limited health care resources.

All of the poison specialists who work in theMPC are pharmacists and nurses, and arerequired to be certified as specialists in poisoninformation by the American Association ofPoison Control Centers. Managing at least 2,000human-exposure-poisoning cases and passing anational certification examination are required tobecome a certified specialist. Specialists must re-test every seven years to maintain their status.

The Maryland Poison Center continues tobenefit from the Poison Control CenterEnhancement and Awareness Act that was signedinto federal law in February 2000 to help stabilizethe funding of poison centers and to assist in poi-son prevention education. Over 300,000 pieces ofeducational materials were distributed at programsand health fairs and by mail to families in everyMaryland county and Baltimore City. Forty-sixprograms for schools, parent groups, workplaces,and other community organizations were conduct-ed throughout Maryland in 2003, reaching over17,000 people with poison prevention education.

The MPC is also involved in making sure thathealth care providers know how to best managepoisoned patients. Over 900 EMS providers, nurs-es, physicians, physician assistants, and pharma-cists attended professional education programsprovided by the MPC. The MPC also serves as atraining site for a variety of health professionals,hosting over 100 EMT-P and EMT-I students, 12emergency medicine residents, 50 pharmacy stu-dents, and several other residents and fellows in2003. "Toxalert" and "Toxtidbits" are newsletterswritten and published by the staff of the MPC.Both are mailed, faxed, or emailed to over 3500health care providers, healthcare facilities, organi-zations, and others. "Toxalert" and "Toxtidbits" are

also posted on the MPC’s website at www.mdpoi-son.com.

The MPC works closely with state and nation-al agencies to monitor for possible chemical andbiologic weapons exposures. The MPC’s data col-lection system allows data to be submitted in nearreal-time to a nationwide poison center surveil-lance system to detect outbreaks. MPC facultycontinue to work with the Maryland Departmentof Health and Mental Hygiene and the MarylandState Board of Pharmacy to develop and imple-ment bioterrorism response training programs forpharmacists throughout the state. Over 500 phar-macists have been trained to respond should therebe a biologic agent release.

Research on the management of poisonedpatients is critical to improving patient care.During the past calendar year, the faculty of theMPC have been engaged in several research pro-jects and have published and presented the resultsof this research in 13 journals and/or scientificmeetings. Topics included the evaluation of toxici-ty following exposures to new anticonvulsants,pediatric methylphenidate exposures, adverseevents associated with dietary supplements,methylphenidate abuse, dry chemical fire extin-guisher inhalation, and poison center manage-ment.

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Cause of Poisoning (CY 2003)Circumstance Number of Patients Percentage__________________________________________________________

Unintentional 29,026 82.6Intentional 5,180 14.7Other & Unknown 950 2.7

__________________________________________________________TOTAL 35,156 100.0

Medical Outcome (CY 2003)Medical Outcome Number of Patients Percentage__________________________________________________________

No Effect/Minor Effect 32,404 92.2Moderate Effect 1,313 3.7Major Effect 118 0.3Death 24 0.1Other & Unknown 1,297 3.7__________________________________________________________

TOTAL 35,156 100.0NOTE: The medical outcome is assessed, based on the inherent toxicity ofthe agent and the severity of the clinical manifestations.

Location of Exposure by Region (CY 2003)Region Number of Exposures Percentage__________________________________________________________

Region I (Garrett, Allegany) 744 2.1

Region II (Washington, Frederick) 2,661 7.6

Region III (Carroll, Howard, Harford,Anne Arundel, Baltimore County, Baltimore City) 21,552 61.3

Region IV (Cecil, Kent, Queen Anne’s, Talbot, Caroline, Dorchester,Wicomico, Worcester) 3,331 9.5

Region V (Montgomery, Prince George’sCharles, Calvert, St. Mary’s) 5,735 16.3

UnknownCounty/Other state 1,133 3.2

__________________________________________________________TOTAL 35,156 100.0

REHABILITATION

The vision of MIEMSS is the elimination ofpreventable deaths and disabilities due to suddenillness or injury though an integrated system ofprevention, intervention, and rehabilitation. Thisintegrated system is known as the trauma carecontinuum. Rehabilitation is the cornerstone of"post-trauma" care. It is the phase of emergency

care that enables the individual to return to a max-imum level of function and, in most cases, toreturn as a productive member of society.

In Maryland we are fortunate to have anextensive number of rehabilitation providers totreat patients who have experienced neurotrauma,multi-trauma, and orthopedic injuries in varioustreatment settings. The trauma centers providetransitional (subacute) care or have transfer agree-ments with rehabilitation hospitals to provide thisspecialized care. Rehabilitation services are pro-vided in hospitals, acute inpatient rehabilitationhospitals, long-term care facilities, home care, out-patient services, and community-based rehabilita-tion programs. During FY 2004, trauma centers inMaryland referred 1,326 trauma patients ages 15and over to inpatient rehabilitation services. Theten rehabilitation facilities receiving the mostpatients are listed on this page.

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TOP TEN DESTINATIONS OF TRAUMAPATIENTS 15 & OVER WHO WENT TO

INPATIENT REHABILITATION FACILITIES:(JUNE 2003 TO MAY 2004)

Source: Maryland Adult Trauma Registry____________________________________________________________________Rehabilitation Center Number

of Patients ____________________________________________________________________

Genesis Long-Term Care Facilities 31

Good Samaritan Hospital of Maryland 16

Johns Hopkins Comprehensive Geriatric Center 22

Kernan Hospital 341

Kessler Adventist Rehabilitation Facilities 21

Laurel Regional Hospital–Rehabilitation 16

Maryland General Hospital 58

NRH Regional Rehabilitation @ Irving Street, DC 17

Peninsula Regional Medical Center, Transitional Care Unit 23

Washington County Health System, ComprehensiveInpatient Rehab Services 52

____________________________________________________________________

Note: Total patients ages 15 and over who went to a rehabilitation center = 1,326

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MARYLAND TRAUMA STATISTICS

ADULT TRAUMA

GENDER OF PATIENTS:PRIMARY ADMISSIONS

ONLY(June 2003 to May 2004)Source: Maryland Adult Trauma Registry

Male71.4%

Female28.6%

Note: “Primary Admissions” refers to allthose treated and released from theemergency department within 6 hours ofemeregency department arrival.

LEGEND CODEThe Johns Hopkins Bayview Medical Center BVMCJohns Hopkins Medical System JHHPeninsula Regional Medical Center PENPrince George’s Hospital Center PGHR Adams Cowley Shock Trauma Center STCSinai Hospital of Baltimore SHSuburban Hospital SUBWashington County Hospital Association WCHWestern Maryland Health System– WMHS

Cumberland Memorial Trauma Center

TOTAL CASES REPORTED BY TRAUMA CENTERS(3-YEAR COMPARISON)

Source: Maryland Adult Trauma Registry___________________________________________________________________________________________________

June 2001 to June 2002 to June 2003 toTrauma Center May 2002 May 2003 May 2004 ___________________________________________________________________________________________________The Johns Hopkins Bayview Medical Center 1,318 1,182 1,250Johns Hopkins Medical System 1,976 2,101 2,296 Peninsula Regional Medical Center 854 846 773Prince George's Hospital Center 2,512 2,364 2,636R Adams Cowley Shock Trauma Center 6,138 6,037 5,829Sinai Hospital of Baltimore 775 1,062 1,513Suburban Hospital 1,253 1,370 1,312 Washington County Hospital Association 699 487 845Western Maryland Health System—

Cumberland Memorial Trauma Center 489 560 599___________________________________________________________________________________________________TOTAL 16,014 16,009 17,053

___________________________________________________________________________________________________Note: Washington County Hospital Association did not receive trauma patients from June 1, 2002 through

October 1, 2002.

AGE DISTRIBUTION OF PATIENTS:PATIENTS TREATED AT BOTH PEDIATRIC AND ADULT

TRAUMA CENTERS (3-YEAR COMPARISON)Source: Maryland Trauma Registry

___________________________________________________________________________________________________ June 2001 to June 2002 to June 2003 to

Age Range May 2002 May 2003 May 2004 ___________________________________________________________________________________________________Under 1 year 170 172 1611 to 4 years 542 636 616 5 to 9 years 567 629 63810 to 14 years 857 831 88615 to 24 years 4,734 4,714 4,95325 to 44 years 6,296 6,184 6,45545 to 64 years 2,960 3,155 3,532 65 + years 1,529 1,568 1,661

Unknown 35 17 27___________________________________________________________________________________________________TOTAL 17,690 17,906 18,929

___________________________________________________________________________________________________Note: Washington County Hospital Association did not receive trauma patients from June 1, 2002 through

October 1, 2002.

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RESIDENCE OF PATIENTS BY COUNTY:SCENE ORIGIN CASES ONLY (JUNE 2003 TO MAY 2004)

Source: Maryland Adult Trauma Registry______________________________________________________________County of Residence Number______________________________________________________________

Allegany County 213Anne Arundel County 796Baltimore County 2,164Calvert County 150Caroline County 73Carroll County 369Cecil County 149Charles County 212Dorchester County 68Frederick County 292Garrett County 33Harford County 399Howard County 282Kent County 51Montgomery County 1,121Prince George's County 1,727Queen Anne's County 104St. Mary’s County 141Somerset County 47Talbot County 50Washington County 363Wicomico County 232Worcester County 95Baltimore City 4,293Virginia 324West Virginia 298Pennsylvania 364Washington, DC 358Delaware 205Other 338Not Indicated 64______________________________________________________________

TOTAL 15,375______________________________________________________________Note: Scene origin cases represent 90.2% of the total trauma cases

treated statewide.

OCCURRENCE OF INJURY BY COUNTY:SCENE ORIGIN CASES ONLY (JUNE 2003 TO MAY 2004)

Source: Maryland Adult Trauma Registry_________________________________________________________________County of Injury Number_________________________________________________________________

Allegany County 268Anne Arundel County 857Baltimore County 2,066Calvert County 105Caroline County 69Carroll County 359Cecil County 204Charles County 201Dorchester County 86Frederick County 334Garrett County 44Harford County 409Howard County 379Kent County 61Montgomery County 1,288Prince George's County 1,784Queen Anne's County 116St. Mary's County 134Somerset County 56Talbot County 61Washington County 442Wicomico County 225Worcester County 129Baltimore City 4,460Virginia 49West Virginia 257Pennsylvania 122Washington, DC 155Delaware 119Other 2Not Indicated 534

TOTAL 15,375_________________________________________________________________Note: Scene origin cases represent 90.2% of the total trauma cases treated

statewide.

PATIENTS WITH PROTECTIVE DEVICES AT TIMEOF TRAUMA INCIDENT:

PRIMARY ADMISSIONS ONLY (3-YEAR COMPARISON)

Source: Maryland Adult Trauma Registry________________________________________________________________________Protective Device June 2001 to June 2002 to June 2003 to

May 2002 May 2003 May 2004________________________________________________________________________None 31.1% 28.1% 27.4%Seatbelt 37.5% 38.2% 36.6%Airbag & Seatbelt 11.5% 14.5% 15.2%Airbag Only 3.0% 2.8% 3.3%Infant/Child Seat 0.2% 0.1% 0.1%Protective Helmet 8.2% 8.1% 8.8%Padding/Protective Clothing 0.1% 0.0% 0.1%Other Protective Device 0.4% 0.2% 0.1%Unknown 8.0% 8.0% 8.4%________________________________________________________________________TOTAL 100.0% 100.0% 100.0%________________________________________________________________________

Note: Washington County Hosptial Association did not receive trauma patientsfrom June 1, 2002 through October 1, 2002. Patients were involved in motorvehicle, motorcycle, bicycle, and sports-related incidents only. “PrimaryAdmissions” refers to all patients except those treated and released from theemergency department within 6 hours of emergency department arrival.

44

EMERGENCY DEPARTMENTARRIVALS BY DAY OF WEEK:PRIMARY ADMISSIONS ONLY

(June 2003 to May 2004)Source: Maryland Adult Trauma Registry

Note: “Primary Admissions” refers to allpatients except those treated and releasedfrom the emergency department within 6hours of emergency department arrival.

Sunday 16.5%

Monday 13.1%

Tuesday 12.6%

Wednesday 12.6%

Thursday 13.0%

Friday 14.4%

Saturday 17.8%

AGE DISTRIBUTION OFPATIENTS: PRIMARYADMISSIONS ONLY

(June 2003 to May 2004)Source: Maryland Adult Trauma Registry

Unknown0.2%

1– 4 Yrs.0.4%

45-64 Yrs.

21.5%

65+Yrs.11.5%

5–14 Yrs.1.8%

Note: “Primary Admissions” refers to allpatients except those treated and releasedfrom the emergency department within 6hours of emergency department arrival.Only pediatric patients that were treatedat adult trauma centers are included inthis table. For patients treated at pediatrictrauma centers, see pediatric trauma centertables and graphs.

Under 1-Yr.0.1%

15-24 Yrs.

26.8%25-44 Yrs.

37.7%

EMERGENCY DEPARTMENTARRIVALS BY TIME OF DAY:

PRIMARY ADMISSIONS ONLY(June 2003 to May 2004)Source: Maryland Adult Trauma Registry

0:00–5:5922.2%

6:00–11:5917.4%

12:00–17:5929.0%

18:00–23:5931.4%

Note: “Primary Admissions” refers to allpatients except those treated and releasedfrom the emergency department within 6hours of emergency department arrival.

MODE OF PATIENT TRANSPORT TO TRAUMA CENTERS (JUNE 2003 TO MAY 2004)Source: Maryland Adult Trauma Registry

______________________________________________________________________________________________________________________________________________________Modality Type BVMC JHH PEN PGH SH STC SUB WCH WMHS TOTAL______________________________________________________________________________________________________________________________________________________

Gound Ambulance 92.2% 82.3% 63.7% 59.6% 91.6% 55.3% 78.3% 66.9% 68.0% 68.7%

Helicopter 0.2% 1.6% 30.0% 35.8% 0.0% 43.5% 18.6% 22.3% 25.3% 25.4%

Other 7.6% 16.1% 6.3% 4.6% 8.4% 1.2% 3.1% 10.8% 6.7% 5.9%______________________________________________________________________________________________________________________________________________________

TOTAL 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%______________________________________________________________________________________________________________________________________________________

ORIGIN OF PATIENT TRANSPORT TO TRAUMA CENTERS (JUNE 2003 TO MAY 2004)Source: Maryland Adult Trauma Registry

_______________________________________________________________________________________________________________________________________________________Origin Type BVMC JHH PEN PGH SH STC SUB WCH WMHS TOTAL_______________________________________________________________________________________________________________________________________________________

Scene of Injury 98.1% 81.7% 96.7% 98.6% 95.9% 85.2% 94.1% 90.6% 94.8% 90.5%

Hospital Transfer 0.5% 3.2% 3.3% 0.8% 1.1% 14.8% 3.3% 5.0% 4.4% 6.5%

Other 1.4% 15.1% 0.0% 0.6% 3.0% 0.0% 2.6% 4.4% 0.8% 3.0%______________________________________________________________________________________________________________________________________________________

TOTAL 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%_______________________________________________________________________________________________________________________________________________________

45

NUMBER OF INJURIES BY AGE(3-YEAR COMPARISON)

Source: Maryland Adult Trauma Registry__________________________________________________________________________

June 2001 to June 2002 to June 2003 toAge May 2002 May 2003 May 2004__________________________________________________________________________Under 1 year 24 19 231 to 4 years 89 63 745 to 14 years 405 349 38815 to 24 years 4,679 4,655 4,89325 to 44 years 6,296 6,183 6,45545 to 64 years 2,960 3,155 3,53265+ years 1,529 1,568 1,661Unknown 32 17 27 __________________________________________________________________________

TOTAL 16,014 16,009 17,053__________________________________________________________________________Note: Washington County Hospital Association did not receive trauma patients from

June 1, 2002 through October 1, 2002. Only pediatric patients that weretreated at adult trauma centers are included in this table. For patients treatedat the pediatric trauma centers, see pediatric trauma center tables and graphs.

NUMBER OF DEATHS BY AGE (3-YEAR COMPARISON)

Source: Maryland Adult Trauma Registry__________________________________________________________________________

June 2001 to June 2002 to June 2003 toAge May 2002 May 2003 May 2004__________________________________________________________________________Under 1 year 2 1 11 to 4 years 4 0 15 to 14 years 8 11 1415 to 24 years 153 159 16425 to 44 years 194 175 18545 to 64 years 104 112 11365+ years 155 173 165Unknown 14 8 9 __________________________________________________________________________

TOTAL 634 639 652__________________________________________________________________________Deaths Overall as a Percentage of the TotalInjuries Treated 4.0% 4.0% 3.8%__________________________________________________________________________

Note: Washington County Hospital Association did not receive trauma patients fromJune 1, 2002 through October 1, 2002. Only pediatric patients that weretreated at adult trauma centers are included in this table. For patients treatedat the pediatric trauma centers, see pediatric trauma center tables and graphs.

NUMBER OF INJURIES AND DEATHS BY AGE(JUNE 2003 TO MAY 2004)

Source: Maryland Adult Trauma Registry______________________________________________________________________________

Number of Injured Patients Number of DeathsMaryland Maryland

Age Total Residents Total Residents______________________________________________________________________________

Under 1 year 23 20 1 11 to 4 years 74 62 1 15 to 14 years 388 337 14 13 15 to 24 years 4,893 4,294 164 13625 to 44 years 6,455 5,597 185 15445 to 64 years 3,532 3,058 113 9565+ years 1,661 1,460 165 154Unknown 27 17 9 4 ______________________________________________________________________________

TOTAL 17,053 14,845 652 558______________________________________________________________________________Note: Only pediatric patients that were treated at adult trauma centers are included in this

table. For patients treated at the pediatric trauma centers, see pediatric trauma centertables and graphs.

ETIOLOGY OF INJURIES TO PATIENTS:PRIMARY ADMISSIONS ONLY

(3-YEAR COMPARISON)Source: Maryland Adult Trauma Registry

__________________________________________________________________________ June 2001 to June 2002 to June 2003 to

Etiology May 2002 May 2003 May 2004 __________________________________________________________________________Motor Vehicle Crash 42.1% 40.8% 40.5%Motorcycle Crash 4.6% 4.4% 4.9%Pedestrian Incident 5.9% 5.7% 5.8%Fall 17.6% 17.9% 18.9%Gunshot Wound 7.7% 8.0% 7.8%Stab Wound 7.3% 8.1% 7.4%Other 14.8% 15.1% 14.7%__________________________________________________________________________

TOTAL 100.0% 100.0% 100.0%__________________________________________________________________________Note: Washington County Hospital Association did not receive trauma patients from

June 1, 2002 through October 1, 2002. “Primary Admissions” refers to allpatients except those treated and released from the emergency department within6 hours of emergency department arrival.

BLOOD ALCOHOL CONTENT OF PATIENTS BY INJURY TYPE: PRIMARY ADMISSIONS ONLY (JUNE 2003 TO MAY 2004)

Source: Maryland Adult Trauma Registry__________________________________________________________________________________________________

Motor Vehicle Blood Alcohol Content Crash Assault Fall Other Total __________________________________________________________________________________________________ Negative 46.9% 31.1% 37.1% 37.9% 41.0%Positive 20.1% 29.7% 13.6% 9.6% 20.0%Undetermined 33.0% 39.2% 49.3% 52.5% 39.0%__________________________________________________________________________________________________

TOTAL 100.0% 100.0% 100.0% 100.0% 100.0%__________________________________________________________________________________________________ Note: “Primary Admissions” refers to all patients except those treated and released from the emergency department

within 6 hours of emergency department arrival.

46

INJURY TYPE DISTRIBUTIONOF PATIENTS: PRIMARY

ADMISSIONS ONLY(June 2003 to May 2004)Source: Maryland Adult Trauma Registry

Penetrating Injuries 16.3%

BluntInjuries 83.7%

Note: “Primary Admissions” refers to allpatients except those treated and releasedfrom the emergency department within 6hours of emergency department arrival.

ETIOLOGY DISTRIBUTION FOR PATIENTSWITH BLUNT INJURIES:

PRIMARY ADMISSIONS ONLY (JUNE 2003 TO MAY 2004)

Source: Maryland Adult Trauma Registry_____________________________________________________________________Etiology Percentage_____________________________________________________________________

Motor Vehicle Crash 48.8%Motorcycle Crash 5.9%Pedestrian Incident 6.9%Fall 22.5%Other 15.3%Unknown 0.6%_____________________________________________________________________

TOTAL 100.0%_____________________________________________________________________Note: “Primary Admissions” refers to all patients except those treated and

released from the emergency department within 6 hours of emergencydepartment arrival.

ETIOLOGY DISTRIBUTION FOR PATIENTSWITH PENETRATING INJURIES:PRIMARY ADMISSIONS ONLY (JUNE 2003 TO MAY 2004)

Source: Maryland Adult Trauma Registry_________________________________________________________________Etiology Percentage_________________________________________________________________

Motor Vehicle Crash 0.1%Gunshot Wound 48.3%Stabbing 45.6%Fall 0.9%Other 4.6%Unknown 0.5%_________________________________________________________________

TOTAL 100.0%_________________________________________________________________Note: “Primary Admissions” refers to all patients except those treated and

released from the emergency department within 6 hours of emergencydepartment arrival.

ETIOLOGY OF INJURIES BY AGES OF PATIENTS: PRIMARY ADMISSIONS ONLY (JUNE 2003 TO MAY 2004)

Source: Maryland Adult Trauma Registry_______________________________________________________________________________________________________________________________________________________

Motor Vehicle Gunshot StabAge Crash Motorcycle Pedestrian Fall Wound Wound Other Total_______________________________________________________________________________________________________________________________________________________Under 1 year 0.0% 0.0% 0.0% 0.3% 0.0% 0.0% 0.2% 0.1%1 to 4 years 0.2% 0.0% 0.6% 0.7% 0.2% 0.0% 0.4% 0.4%5 to 14 years 1.4% 0.8% 4.8% 1.5% 0.6% 0.9% 3.1% 1.8%15 to 24 years 31.6% 20.1% 18.9% 9.8% 48.4% 43.0% 22.1% 26.9%25 to 44 years 36.5% 55.0% 37.5% 26.5% 40.7% 43.7% 44.8% 37.6%45 to 64 years 20.3% 21.9% 28.8% 29.7% 8.4% 11.3% 23.7% 21.5%65+ years 9.9% 2.2% 9.1% 31.5% 1.0% 1.0% 5.4% 11.5%Unknown 0.1% 0.0% 0.3% 0.0% 0.7% 0.1% 0.3% 0.2%_______________________________________________________________________________________________________________________________________________________

TOTAL 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%_______________________________________________________________________________________________________________________________________________________Note: “Primary Admissions” refers to all patients except those treated and released from the emergency department within 6 hours of emergency department arrival. Only

pediatric patients that were treated at adult trauma centers are included in this table. For patients treated at the pediatric trauma centers, see pediatric trauma centertables and graphs.

47

FINAL DISPOSITION OF PATIENTS:PRIMARY ADMISSIONS ONLY

(3-YEAR COMPARISON)Source: Maryland Adult Trauma Registry

_________________________________________________________________Final Disposition June 2001 to June 2002 to June 2003 to

May 2002 May 2003 May 2004_________________________________________________________________Inpatient Rehab Facility 9.3% 9.4% 10.7%Skilled Nursing Facility 1.9% 1.6% 1.7%Residential Facility 1.2% 1.3% 1.0%Specialty Referral Center 2.7% 3.5% 3.8%Home with Services 4.4% 4.3% 3.2%Home 70.7% 70.0% 69.9%Acute Care Hospital 2.4% 2.4% 2.0%Against Medical Advice 1.7% 1.6% 2.0%Morgue/Died 5.2% 5.4% 5.3%Other 0.5% 0.5% 0.4%_________________________________________________________________

TOTAL 100.0% 100.0% 100.0%_________________________________________________________________

Note: Washington County Hospital Association did not receive traumapatients from June 1, 2002 through October 1, 2002. “PrimaryAdmissions” refers to all patients except those treated and releasedfrom the emergency department within 6 hours of emergencydepartment arrival.

INJURY SEVERITY SCORES OF PATIENTS WITHPENETRATING INJURIES: PRIMARY

ADMISSIONS ONLY (3-YEAR COMPARISON)Source: Maryland Adult Trauma Registry

__________________________________________________________________________ June 2001 to June 2002 to June 2003 to

ISS May 2002 May 2003 May 2004__________________________________________________________________________1 to 12 73.8% 71.5% 74.5%13 to 19 10.4% 12.5% 10.9%20 to 35 11.5% 12.6% 10.7%36 to 75 4.3% 3.4% 3.9%__________________________________________________________________________

TOTAL 100.0% 100.0% 100.0%__________________________________________________________________________Note: Washington County Hospital Association did not receive trauma patients from

June 1, 2002 through October 1, 2002. “Primary Admissions” refers to allpatients except those treated and released from the emergency department within6 hours of emergency department arrival.

INJURY SEVERITY SCORE (ISS) BY INJURY TYPE: PRIMARY ADMISSIONS

ONLY (JUNE 2003 TO MAY 2004)Source: Maryland Adult Trauma Registry

________________________________________________________________________ISS Blunt Penetrating Total ________________________________________________________________________1 to 12 68.1% 74.5% 69.2%

13 to 19 17.2% 10.9% 16.1%20 to 35 12.2% 10.7% 12.0%36 to 75 2.5% 3.9% 2.7%________________________________________________________________________

TOTAL 100.0% 100.0% 100.0%________________________________________________________________________Note: “Primary Admissions” refers to all patients except those treated and released

from the emergency department within 6 hours of emergency departmentarrival.

INJURY SEVERITY SCORES OF PATIENTS WITHBLUNT INJURIES: PRIMARY ADMISSIONS ONLY

(3-YEAR COMPARISON)Source: Maryland Adult Trauma Registry

__________________________________________________________________________ June 2001 to June 2002 to June 2003 to

ISS May 2002 May 2003 May 2004__________________________________________________________________________1 to 12 70.0% 70.1% 68.1%13 to 19 15.7% 15.6% 17.2%20 to 35 11.7% 11.8% 12.2%36 to 75 2.6% 2.5% 2.5%__________________________________________________________________________

TOTAL 100.0% 100.0% 100.0%__________________________________________________________________________Note: Washington County Hospital Association did not receive trauma patients from

June 1, 2002 through October 1, 2002. “Primary Admissions” refers to allpatients except those treated and released from the emergency department within6 hours of emergency department arrival.

INJURY SEVERITY SCORES OF PATIENTS WITHEITHER BLUNT OR PENETRATING INJURIES:

PRIMARY ADMISSIONS ONLY (3-YEAR COMPARISON)

Source: Maryland Adult Trauma Registry__________________________________________________________________________

June 2001 to June 2002 to June 2003 toISS May 2002 May 2003 May 2004__________________________________________________________________________1 to 12 70.6% 70.3% 69.2%13 to 19 14.9% 15.1% 16.1%20 to 35 11.6% 11.9% 12.0%36 to 75 2.9% 2.7% 2.7%__________________________________________________________________________

TOTAL 100.0% 100.0% 100.0%__________________________________________________________________________Note: Washington County Hospital Association did not receive trauma patients from

June 1, 2002 through October 1, 2002. “Primary Admissions” refers to allpatients except those treated and released from the emergency department within6 hours of emergency department arrival.

48

EMERGENCY DEPARTMENTARRIVALS BY DAY OF WEEK:

CHILDREN TREATED ATPEDIATRIC TRAUMA CENTERS

(June 2003 to May 2004)

Sunday 17.0%

Monday 13.2%

Tuesday 12.8%

Wednesday 13.0%

Thursday 11.4%

Friday 13.4%

Saturday 19.2

Note: For children who were treatedat adult trauma centers, see MarylandAdult Trauma Report. Children’sNational Medical Center data includepatients residing in Maryland and/orinjured in Maryland.

18:00–23:5941.8%

00:00–5:5911.8%

06:00–11:5910.0%

12:00–17:5936.4%

Note: For children that were treated atadult trauma centers, see MarylandAdult Trauma Report. Children’sNational Medical Center data includepatients residing in Maryland and/orinjured in Maryland.

EMERGENCY DEPARTMENTARRIVALS BY TIME OF DAY:

CHILDREN TREATED ATPEDIATRIC TRAUMA CENTERS

(June 2003 to May 2004)

MARYLAND PEDIATRIC TRAUMA STATISTICS

OCCURRENCE OF INJURY BY COUNTY:SCENE ORIGIN CASES ONLY Children Treated at Pediatric Trauma

Centers ( June 2003 to May 2004)_________________________________________________________________County of Injury Number_________________________________________________________________

Anne Arundel County 71Baltimore County 148Calvert County 17Caroline County 9Carroll County 34Cecil County 27Charles County 25Dorchester County 4Frederick County 30Harford County 47Howard County 23Kent County 11Montgomery County 111Prince George's County 222Queen Anne's County 16St. Mary's County 23Talbot County 2Washington County 4Baltimore City 228Virginia 1West Virginia 1Washington, DC 17Not Indicated 163_________________________________________________________________

TOTAL 1,234_________________________________________________________________Notes: For children who were treated at adult trauma centers, see

Maryland Adult Trauma Report. Children’s National Medical Center data include patients residing in Maryland and/orinjured in Maryland. Scene origin cases represent 65.8% of thetotal cases treated at pediatric trauma centers.

LEGEND CODEChildren’s National Medical Center CNMCJohns Hopkins Pediatric Trauma Center JHP

TOTAL CASES AT PEDIATRIC TRAUMA CENTERS (3-YEAR COMPARISON)

_______________________________________________________________________________ June 2001 to June 2002 to June 2003 to

Trauma Center May 2002 May 2003 May 2004 _______________________________________________________________________________CNMC 864 919 914 JHP 812 978 962 _______________________________________________________________________________

TOTAL 1,676 1,897 1,876 _______________________________________________________________________________Note: For children who were treated at adult trauma centers, see Maryland Adult Trauma

Report. Children’s National Medical Center data include patients residing in Marylandand/or injured in Maryland.

GENDER PROFILE:CHILDREN TREATED AT

PEDIATRIC TRAUMA CENTERS(June 2003 to May 2004)

Male62.3%

Female37.7%

Note: For children who were treatedat adult trauma centers, see MarylandAdult Trauma Report. Children’sNational Medical Center data includepatients residing in Maryland and/orinjured in Maryland.

49

OUTCOME PROFILE:CHILDREN TREATED AT

PEDIATRIC TRAUMA CENTERS(June 2003 to May 2004)

Died 1.7%

Lived98.3%

Note: For children who were treatedat adult trauma centers, see MarylandAdult Trauma Report. Children’sNational Medical Center data includepatients residing in Maryland and/orinjured in Maryland.

MODE OF PATIENT TRANSPORT BY CENTERChildren Treated at Pediatric Trauma

Centers (June 2003 to May 2004)___________________________________________________________________Modality Type CNMC JHP Total___________________________________________________________________

Ground Ambulance 32.1% 56.2% 44.8%

Helicopter 26.4% 35.0% 31.0%

Other 41.5% 8.8% 24.2%___________________________________________________________________TOTAL 100.0% 100.0% 100.0%___________________________________________________________________

Note: For children who were treated at adult trauma centers, see MarylandAdult Trauma Report. Children’s National Medical Center data includepatients residing in Maryland and/or injured in Maryland.

ORIGIN OF PATIENT TRANSPORT BY CENTERChildren Treated at Pediatric Trauma

Centers (June 2003 to May 2004)_____________________________________________________________________Origin CNMC JHP Total_____________________________________________________________________

Scene of Injury 54.3% 76.8% 65.8%

Hospital Transfer 40.7% 20.0% 30.1%

Other 5.0% 3.2% 4.1%_____________________________________________________________________TOTAL 100.0% 100.0% 100.0%_____________________________________________________________________

Note: For children who were treated at adult trauma centers, see Maryland AdultTrauma Report. Children’s National Medical Center data include patientsresiding in Maryland and/or injured in Maryland.

ETIOLOGY OF INJURIES BY AGES Children Treated at Pediatric Trauma Centers (June 2003 to May 2004)

_______________________________________________________________________________________________________________________________________________________Motor Vehicle Gunshot Stab

Age Crash Motorcycle Pedestrian Fall Wound Wound* Other Total_______________________________________________________________________________________________________________________________________________________Under 1 year 2.5% 0.0% 0.4% 12.2% 0.0% 5.9% 9.2% 7.4%1 to 4 years 18.7% 7.7% 18.7% 37.4% 11.1% 14.7% 33.7% 29.0%5 to 9 years 36.0% 23.0% 40.9% 24.6% 14.8% 11.8% 19.9% 26.7%10 to 14 years 41.4% 66.7% 39.6% 23.8% 63.0% 67.6% 31.0% 33.7%15+ years 1.4% 2.6% 0.4% 2.0% 11.1% 0.0% 6.2% 3.2%_______________________________________________________________________________________________________________________________________________________

TOTAL 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%_______________________________________________________________________________________________________________________________________________________Notes: For children who were treated at adult trauma centers, see Maryland Adult Trauma Report. Children’s National Medical Center data include patients

residing in Maryland and/or injured in Maryland.*Stab wounds include both intentional and unintentional piercings and punctures.

FINAL DISPOSITION OF PATIENTSChildren Treated at Pediatric Trauma

Centers (3-Year Comparison)_________________________________________________________________Final Disposition June 2001 to June 2002 to June 2003 to

May 2002 May 2003 May 2004_________________________________________________________________Inpatient Rehab Facility 1.7% 1.7% 1.4%Skilled Nursing Facility 0.0% 0.1% 0.0%Residential Facility 0.1% 0.2% 1.0%Specialty Referral Center 0.6% 0.6% 0.7%Home with Services 2.5% 1.4% 2.3%Home 92.1% 92.1% 92.0%Acute Care Hospital 0.4% 1.1% 0.1%Against Medical Advice 0.1% 0.1% 0.0%Morgue/Died 2.0% 1.7% 1.7%Foster Care 0.3% 0.8% 0.7%Other 0.2% 0.2% 0.1%_________________________________________________________________

TOTAL 100.0% 100.0% 100.0%_________________________________________________________________

Note: For children who were treated at adult trauma centers, see MarylandAdult Trauma Report. Children’s National Medical Center datainclude patients residing in Maryland and/or injured in Maryland.

50

INJURY TYPEChildren Treated at Pediatric Trauma Centers

(3-Year Comparison)__________________________________________________________________________

June 2001 to June 2002 to June 2003 toInjury Type May 2002 May 2003 May 2004__________________________________________________________________________Blunt 80.3% 77.8% 80.9%Penetrating 2.8% 3.0% 2.6%Burn 6.0% 6.6% 7.0%Near Drowning 1.6% 1.5% 1.7%Hanging 0.1% 0.2% 0.1%Inhalation 0.7% 1.0% 0.5% Ingestion 7.2% 7.9% 5.8%Crush 0.1% 0.0% 0.1%Snake Bite/Spider Bite 0.1% 0.3% 0.1% Animal Bite/Human Bite 1.0% 1.4% 0.7% Other 0.1% 0.3% 0.5% __________________________________________________________________________

TOTAL 100.0% 100.0% 100.0%__________________________________________________________________________Note: For children who were treated at adult trauma centers, see Maryland Adult

Trauma Report. Children’s National Medical Center data include patientsresiding in Maryland and/or injured in Maryland.

NUMBER OF INJURIES BY AGEChildren Treated at Pediatric Trauma Centers

(3-Year Comparison)__________________________________________________________________________

June 2001 to June 2002 to June 2003 toAge May 2002 May 2003 May 2004__________________________________________________________________________Under 1 year 146 153 1381 to 4 years 453 573 5425 to 9 years 450 540 50110 to 14 years 569 571 63515+ years 55 60 60Unknown 3 0 0 __________________________________________________________________________

TOTAL 1,676 1,897 1,876__________________________________________________________________________Note: For children that were treated at adult trauma centers, see Maryland Adult

Trauma Report. Children’s National Medical Center data include patientsresiding in Maryland and/or injured in Maryland.

NUMBER OF DEATHS BY AGEChildren Treated at Pediatric Trauma Centers

(3-Year Comparison)__________________________________________________________________________

June 2001 to June 2002 to June 2003 toAge May 2002 May 2003 May 2004__________________________________________________________________________Under 1 year 3 6 31 to 4 years 15 11 135 to 9 years 6 9 1010 to 14 years 9 6 615+ years 0 1 0Unknown 1 0 0 __________________________________________________________________________

TOTAL 34 33 32__________________________________________________________________________Note: For children that were treated at adult trauma centers, see Maryland Adult

Trauma Report. Children’s National Medical Center data include patientsresiding in Maryland and/or injured in Maryland.

MECHANISM OF INJURYChildren Treated at Pediatric Trauma Centers

(3-Year Comparison)__________________________________________________________________________

June 2001 to June 2002 to June 2003 toMechanism May 2002 May 2003 May 2004__________________________________________________________________________Motor Vehicle Crash 21.6% 19.8% 18.9%Motorcycle Crash 1.5% 1.0% 2.1%Pedestrian Incident 10.7% 8.7% 12.1%Gunshot Wound 1.4% 1.3% 1.4%Stabbing* 1.5% 1.6% 1.8%Fall 28.7% 30.4% 29.9%Other 34.6% 37.2% 33.8% __________________________________________________________________________

TOTAL 100.0% 100.0% 100.0%__________________________________________________________________________Note: For children who were treated at adult trauma centers, see Maryland Adult

Trauma Report. Children’s National Medical Center data include patientsresiding in Maryland and/or injured in Maryland.

*Stab wounds include both intentional and unintentional piercings and punctures.

NUMBER OF INJURIES AND DEATHS BY AGEChildren Treated at Pediatric Trauma Centers

(June 2003 to May 2004)__________________________________________________________________________

Number of Injured Patients Number of DeathsMaryland Maryland

Age Total Residents Total Residents__________________________________________________________________________

Under 1 year 138 136 3 31 to 4 years 542 526 13 125 to 9 years 501 478 10 10 10 to 14 years 635 610 6 515+ years 60 60 0 0__________________________________________________________________________

TOTAL 1,876 1,810 32 30__________________________________________________________________________Note: For children who were treated at adult trauma centers, see Maryland Adult

Trauma Report. Children’s National Medical Center data include patientsresiding in Maryland and/or injured in Maryland.

51

RESIDENCE OF PATIENTS BY COUNTY:SCENE ORIGIN CASES ONLY Children Treated at Pediatric Trauma

Centers ( June 2003 to May 2004)_________________________________________________________________County of Residence Number_________________________________________________________________

Anne Arundel County 84Baltimore County 151Calvert County 18Caroline County 8Carroll County 43Cecil County 25Charles County 30Dorchester County 5Frederick County 23Harford County 56Howard County 24Kent County 8Montgomery County 130Prince George's County 261Queen Anne's County 16St. Mary's County 18Talbot County 2Washington County 8Wicomico County 2Baltimore City 272Virginia 5West Virginia 1Pennsylvania 8Washington, DC 8Delaware 3Other 23Not Indicated 2_________________________________________________________________

TOTAL 1,234_________________________________________________________________Notes: For children who were treated at adult trauma centers, see

Maryland Adult Trauma Report. Children’s National Medical Center data include patients residing in Maryland and/orinjured in Maryland. Scene origin cases represent 65.8% of thetotal cases treated at pediatric trauma centers.

CHILDREN WITH PROTECTIVE DEVICES AT TIMEOF TRAUMA INCIDENT: CHILDREN TREATED AT

PEDIATRIC TRAUMA CENTERS (3-YEAR COMPARISON)

________________________________________________________________________Protective Device June 2001 to June 2002 to June 2003 to

May 2002 May 2003 May 2004________________________________________________________________________None 33.6% 37.8% 35.7%Seatbelt 18.9% 18.5% 18.6%Airbag & Seatbelt 1.7% 0.8% 2.4%Airbag Only 0.4% 0.6% 0.4%Infant/Child Seat 11.3% 9.7% 8.7%Protective Helmet 6.9% 7.7% 7.9%Padding/Protective Clothing 0.2% 0.2% 0.2%Other Protective Device 0.0% 0.2% 0.4%Unknown 27.0% 24.5% 25.7%________________________________________________________________________TOTAL 100.0% 100.0% 100.0%________________________________________________________________________

Note: Children were involved in motor vehicle, motorcycle, bicycle, and sports-relatedincidents only. For children who were treated at adult trauma centers, seeMaryland Adult Trauma Report. Children’s National Medical Center datainclude patients residing in Maryland and/or injured in Maryland.

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The National Study Center for Trauma andEmergency Medical Systems (NSC), at theUniversity of Maryland School of Medicine, is theprimary research center of the Maryland EMSSystem. The NSC collaborates with federal agencies,academic institutes, and governmental groups onprojects focusing on injury epidemiology, injury pre-vention, and improvements in the prehospital andinhospital delivery and coordination of trauma care.Colin F. Mackenzie, MD, is the Director.

During FY 2004, the National Study Centerfor Trauma and Emergency Medical Systems(NSC) added two new faculty members, both ofwhom have appointments in the Department ofEpidemiology and Preventive Medicine, as well astwo full-time research staff members to supportrecent project awards.

The NSC is a leading participant in two multi-center studies of injuries sustained in vehicularcrashes, the Crash Injury Research andEngineering Network (CIREN) and the CrashOutcomes Data Evaluation System (CODES) DataNetwork. To date, 345 patients have been enrolledinto the CIREN study, a multi-center collabora-tion of ten trauma centers. Recent NSC initiativesin CIREN have involved analyses of six-monthand one-year post-injury interview data. Theresults of an examination of the causes and out-comes of mild traumatic brain injury in theCIREN project were presented at the annualmeeting of the Association for the Advancement ofAutomotive Medicine in Lisbon, Portugal. NSCresearchers traveled to Vienna, Austria to presentCIREN findings related to functional outcomesamong a cohort of motor vehicle crash survivorsat the 7th World Conference on Injury Preventionand Safety Promotion. More recently, a manu-script documenting the unexpected physical andpsychosocial outcomes occurring among CIRENpatients who sustain a lower extremity injury hasbeen accepted for publication by the Journal ofTrauma.

As part of the CIREN project, the NSC hasalso been requested by the National HighwayTraffic Safety Administration (NHTSA) to ascer-tain economic costs and long-term outcomes asso-ciated with lower extremity injuries. Findings fromthis project, which include an analysis of compre-

hensive CIREN interview data and estimates ofcosts attributable to specific fracture types, willsoon be published as a NHTSA-sponsored report.

The NSC is also part of the CODES data net-work that provides data to NHTSA and other par-ties with an interest in highway safety. During FY2004, an analysis of CODES data conducted atthe NSC was used to describe crash characteristicsamong injured pedestrians in an Accident Analysis &Prevention publication entitled "Pedestrian injuriesand vehicle type in Maryland, 1995–1999." TheCODES project also provided the means for aninvestigation of injuries occurring due to vehiclemismatch, which was presented at the WorldInjury Conference in Vienna.

The NSC is in the second year of a three-yearcontract from the U.S. Army to study mild trau-matic brain injury and long-term outcomes inShock Trauma patients with blunt trauma injuries.Patients are given a battery of tests, including anelectronic balance test and various neuropsycho-logical and cognitive measures, by a multi-discipli-nary team. Follow-up tests are administered andanalyses conducted to determine which, if any,baseline measures predict those with persistentphysical, cognitive, and behavioral problems. Suchmeasures, if identified, may be useful to the Armyin field settings where decisions related to post-injury deployment must be made.

NSC investigators are focusing on motorcyclesafety as well. Currently, the NSC is in the secondyear of a NHTSA-awarded project to characterizethe population of motorcycle operators and to dis-tinguish factors unique to those who have experi-enced motorcycle crashes. Approximately 300motorcyclists admitted to the Shock TraumaCenter will be interviewed with regard to their rid-ing training and experiences, with a special focuson those over 40 years of age. Analysis is alsounderway to investigate the impact of motorcyclesafety classes offered by the Motor VehicleAdministration. Additionally, the NSC is partici-pating in a Statewide Motorcycle Safety Coalitionin an effort to reduce motorcycle injuries and fatal-ities through an interdisciplinary approach.

In July 2003 the NSC was awarded a grantfrom the National Institute for Occupational Safetyand Health to conduct a three-year surveillance ofwork-related injuries in Maryland. Trauma nurse

CHARLES McC.MATHIAS, JR., NATIONALSTUDYCENTERFOR TRAUMA AND EMERGENCY MEDICAL SYSTEMS

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coordinators from all nine adult trauma centershave agreed to participate by identifying work-related injury patients treated in their institution.In addition, in-depth interviews of patients withknown occupational injuries will be conducted atthe R Adams Cowley Shock Trauma Center. Thisinformation will be linked with other data sourcesto provide an overall description of occupationalinjuries in Maryland. Through this effort we hopeto determine means of decreasing work-relatedinjuries throughout the state.

Preliminary results of a study assessing motorvehicle crash culpability relative to alcohol andother drug use by injured drivers are being draftedby NSC staff for submission to the funding agency.The two-year project, which is funded by theRobert Wood Johnson Foundation’s SubstanceAbuse Policy Research Program and ends in earlyFY 2005, addresses the association of driver culpa-bility with blood alcohol concentration and posi-tive toxicology test results for cocaine, marijuana,and opiates over a five-year period.

Data analysis is currently underway for 497subjects enrolled in a clinical trial of brief interven-tion for trauma patients identified as being alcoholdependent. This trial, funded by the NationalInstitute of Alcohol and Alcohol Abuse, seeks todetermine if a personalized brief intervention willresult in decreased drinking and consequences(including injury episodes) from alcohol abuse.

During FY 2004, NSC researchers publishedrevisions to the annual "Crash and Injury FactBook," which has been developed with supportfrom the Maryland Department of Transportation.As part of this project, the incidence and severityof motor vehicle-related injuries are being docu-mented statewide. Individual fact books pertainingto each county were also produced in an effort todisseminate regional traffic information. Thesedata are available on the NSC web site(http://nsc.umaryland.edu).

In September the NSC published the first edi-tion of a bi-monthly newsletter entitled InjuryWatch. The two-page fact sheet was created to pro-vide legislators and researchers with news briefsrelated to injury prevention as well as shortdescriptions of ongoing NSC projects.

The results of study of airbag data, entitled

"Driver Deaths in Frontal Crashes: Comparisonsof Older and Newer Airbag Designs," was invitedfor presentation at the Blue Ribbon Panel forEvaluation of Depowered and Advanced Airbagsheld in Washington, D.C. Using data obtainedfrom a project previously funded by the RobertWood Johnson Foundation, NSC researchers trav-eled to the World Injury Conference in Vienna topresent findings of a study describing risk factorsfor suicide among a cohort of former traumapatients.

The Human Factors & Technology (HF&T)Group of the Department of Anesthesiology isworking collaboratively with NSC on several pro-jects funded by the National Institutes of Health,the Department of Defense, and the NationalScience Foundation. These collaborating projectsinvestigate potential uses of several types oftelecommunication technologies in field and trans-port care. For example, one project is the integra-tion of wireless mobile communication compo-nents into a system that provides reliable androbust transmission of multimedia diagnostic infor-mation from ambulance crews to receiving physi-cians, logistical control centers, and other experts.In another project, digital ambulances in theExpressCare ambulance system are being used toautomate the transmission of global positioningsystem data and the arrival time of the ambulancesat the University of Maryland Hospital. These dig-ital ambulances are also utilized for cardiacpatients transferred for cardiac catheterization.The potential benefits for this proof of concepttrial are that drug therapy can be initiated oradjusted en route. The catheterization team,whether it is at night or daytime, can be bettercoordinated and prepared for patient arrival.Several applications of such field- and transport-based audio, video, and data access are being con-sidered, including mass casualty scene command,en-route diagnosis of acute stroke, and decisionsregarding transport of trauma and seizure patients.Currently, the HF&T researchers are developingvideo-based protocols in collaboration with NASAto assist in space-based medical emergencyresponse.

The NSC led the collaborative effort fundedby the U.S. Army Telemedicine and Advanced

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Technology Research Center (TATRC) betweenthe University of Maryland campus, BaltimoreCity, State, and military groups to develop amodel for Local Area Defense (LAD). A tabletopexercise was conducted in February 2004 and theLAD Demonstration followed in March 2004.During the LAD Demonstration, inter-operabilityof communication technologies and psychologicaland trauma "casualty" triage were tested. A mobilewireless telecommunication platform developedby UM and Northrop Grumman researchers wasused to transmit video imaging to NATO head-quarters and the University of Regensberg,Germany. A team of disaster management expertsevaluated the images and the LAD Demonstrationremotely using these ISDN transmitted images inreal-time.

In three clinical projects, the NSC is the leadorganization in conjunction with the ShockTrauma Center in investigation of respectively,

Best Practices or Chest Tube Insertion (Agency forHealthcare Research and Quality [AHRQ] fund-ed), Comparison of Succinylcholine andRocuronium for rapid sequence intubation(Organon funded), and a randomized trial of ahemoglobin-based O2 carrier ("blood substitute")in comparison to red cells for major orthopedicsurgery (Biopure funded).

The NSC Board of Advisors met twice thisyear to review current programs and provide guid-ance to the NSC Director about current and futureinitiatives of mutual interest, such as collaborationwith State, Baltimore City, and University ofMaryland initiatives in homeland defense andpublic health including injury surveillance.

GOVERNOR OF MARYLANDRobert L. Ehrlich, Jr.

LIEUTENANT GOVERNORMichael S. Steele

MARYLAND EMS BOARD

Donald L. DeVries, Jr., Esq.ChairpersonPartner, Goodell, DeVries, Leech and Gray Attorneys at Law

Willie C. Blair, MD, FACSAssociate Professor of Surgery, Prince George’s CountyHospital Center

Victor A. BroccolinoPresident and CEO, Howard County General Hospital, Inc.

Dorothy W. Dyott, RNDigestive Health Associates, Easton

John R. FrazierStaff Chief, Baltimore City Fire Department

John M. MurphyPublic at Large (county population less than 175,000)

Nelson SabatiniSecretary of Maryland Department of Health & MentalHygiene

Roger C. Simonds, Sr.Ex officio (SEMSAC Chairperson)

J. Andrew Sumner, MDEmergency Medical Services Physician

Donald E. Wilson, MDDean and Professor of Medicine, University of MarylandSchool of Medicine

Richard L. YingerPast President, Maryland State Firemen’s Association

STATEWIDE EMS ADVISORY COUNCIL

Roger C. Simonds, Sr.ChairpersonRepresenting EMS Region III Advisory Council

John W. Ashworth IIIRepresenting R Adams Cowley Shock Trauma Center

Wendell G. BaxterRepresenting Volunteer Field Providers

Capt. Barry A. ConteeRepresenting Maryland Metropolitan Fire Chiefs

George B. Delaplaine, Jr.Representing EMS Region II Advisory Council

Steven T. EdwardsRepresenting Maryland Fire & Rescue Institute

Jeffrey L. Fillmore, MDRepresenting EMS Regional Medical Directors

Richard P. Franklin, MDRepresenting American College of Surgeons, MarylandChapter

Wade Gaasch, MDRepresenting Medical and Chirurgical Faculty of Maryland

Denise GrahamRepresenting the General Public

Kathleen D. GroteRepresenting MD/DC International Association of Firefighters

Murray A. Kalish, MDRepresenting MD/DC Society of Anesthesiologists

Steven J. KesnerRepresenting General Public (County population of less than 175,000)

Zeina Khouri, RNRepresenting American Association of Critical Care Nurses,Maryland Chapter (Chesapeake Bay)

Bernard KomanRepresenting Maryland Commercial Ambulance Services

Anne Marie Kuzas, RNRepresenting Maryland Trauma Network

Maj. James E. HockRepresenting Maryland State Police Aviation Division

Ronald D. LippsRepresenting Highway Safety Division, Maryland Departmentof Transportation

Colin F. Mackenzie, MDRepresenting National Study Center for Trauma andEmergency Medical Systems

Kenneth MayRepresenting EMS Region I Advisory Council

James SchuelenRepresenting the Maryland Hospital Association

Mary Alice Vanhoy, RNRepresenting Maryland Emergency Nurses Association

Allen R. Walker, MDRepresenting American Academy of Pediatrics, MarylandChapter

Margaret Elaine WeddingRepresenting EMS Region V Advisory Council

Charles W. WillsRepresenting Maryland State Firemen’s Association

Craig ColemanMIEMSS SEMSAC Liaison

VacantEMS Region IV Advisory CouncilBoard of Physician Quality AssuranceState Emergency Numbers Board (9-1-1)American College of Emergency Physicians, Maryland Chapter

MARYLAND INSTITUTE FOR EMERGENCY MEDICALSERVICES SYSTEMS

Robert R. Bass, MD, FACEPExecutive Director

653 W. Pratt StreetBaltimore, MD 21201-1536410-706-5074Website: http://www.miemss.org