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Local first responders, aviation medics, work with Shock Trauma Go Team

Feb. 9—CUMBERLAND — An intense, logistically challenging car accident on U.S. Route 220 in Rawlings Monday night took tremendous collaboration and communication among emergency dispatchers, volunteer fire personnel, state police, trauma and hospital experts and highly trained medical aviation crews.

But it was the initial survey of the scene by local first responders who recognized the need to call for more help that got the ball rolling.

Their actions set off a chain of events that hours later culminated with a stabilized patient delivered to R Adams Cowley Shock Trauma Center in Baltimore.

"That's how everything came together on this night and made everything work cohesively," Maryland State Police Cpl. Rick DeVore, supervisor of medevac Trooper 5 in Cumberland, said Wednesday.

"That's the Maryland system at play," he said. "It just worked fantastic that night."

A unique situation

First responders from Allegany County and Mineral County, West Virginia, determined the accident involved "significant physical injuries and prolonged entrapment time," and called for more resources, he said.

"My crew members were on scene," DeVore said of Monday night's accident. "I was listening to the call and I did brief the crews."

Trooper 5 was initially dispatched for a two-vehicle collision, "which turned into a semi-truck trailer versus a motor vehicle," DeVore said.

"The Go Team was also requested pretty quickly," he said and added the team's presence made the situation all the more unique. "Multiple other units were also dispatched for the heavy rescue operations."

Trooper 1, which transported the Go Team, first "took on extra fuel" to make the trip to Mountain Maryland and back to Baltimore.

The team's flight from Baltimore to Rawlings took more than 45 minutes.

"This whole time there were multiple fire and EMS units working with the patient, working on the vehicle extraction, and Trooper 5's crew was on scene assisting with that patient care," DeVore said.

When the Go Team was roughly 10 minutes away, Trooper 5 took off from its initial landing zone because ground crews had difficulty finding a suitable landing spot for Trooper 1 to land with the Go Team.

Prepared to deploy

Dr. Ben Lawner is medical director at Maryland ExpressCare and PHI Air medical EMS liaison for the Go Team at Shock Trauma.

He arrived with the team at Monday's accident.

"When we got there ... the only exposure we had to this patient was part of his right arm and his head," Lawner said.

"He was talking to us fortunately, but ... our information was limited because we couldn't do a full assessment," he said.

"Every call is unique," Lawner said.

"We always train and prepare to deploy for the worst-case scenario," he said.

The team responds to each call with a very similar configuration, standardized set of supplies and protocols.

"That enables us to prepare for stuff we can't know before we get there," Lawner said.

"The emergency medical services system is highly evolved in Maryland," he said. "We empower our clinicians to do lots of things."

For example, volunteer fire companies can provide necessary first response care and provide a patient IV fluids and pain medication.

"What was very unique about this scene was the time it took," Lawner said of the victim being "heavily entrapped."

In most cases, the process to extricate a person from a car can take upward of 45 minutes "in severe cases," he said.

"This evolved over several hours," Lawner said.

"Our goal was to support the on-scene emergency medical services," he said. "We were at all times conferring with the incident command on scene."

The Go Team's strategy included treatment for the patient's pain and injuries sustained in the crash and subsequent problems caused by the lengthy entrapment and exposure to the cold.

After the patient was freed from the wreckage, the Go Team supported his vital functions en route to the trauma center, which took at least an hour.

Treatment included medication to support blood pressure, administration of additional blood products and ventilator management.

"These are things that the Go Team can provide in conjunction with our EMS colleagues," Lawner said. "We were able to support and stabilize (the patient) until arrival at the trauma center."

In-hospital procedures

Dr. Rishi Kundi is director of the Go Team at the Shock Trauma Center.

One of the challenges the team faces at a scene such as Monday's Rawlings accident is that the complexity of the patient's injuries can be obscured by the degree of entrapment, he said.

That's why the Go Team brings initial in-hospital procedures to the scene.

After extrication, the team makes a primary survey of the patient to get a rough idea of the injuries.

That information is then communicated to the surgeons at Shock Trauma.

"Especially with a location that's quite far away, we have just moved the initial steps of the patient's care in the hospital ... up by more than an hour," Kundi said.

The overall process and workflow follows incident command to establish leadership patterns and break a complex scene into workable parts.

"It is constant on-scene communication," he said of everyone at the accident "knowing their roles."

Training for the Go Team is an ongoing effort.

"Aside from the (emergency) calls, that's what we devote most of our energy to, working with the fire rescue squads in the region and the aviation command to train in different scenarios and be prepared for any scenes that we may come across," Kundi said.

The team has trained for incidents including collapsed buildings and swift-water situations, he said.

"We are always happy and eager to participate in the training exercises held by any organization with whom we work," Kundi said.

Blood on board

All Maryland State Police aircraft carry two units of whole blood.

"This was done after a long effort by the MSP working together with the Shock Trauma Center," Kundi said.

"This is, as far as pre-hospital care, absolutely state of the art," he said. "It is far, far ahead of most other places in the country and certainly the world."

Additionally, the Go Team deploys with two units of whole blood, "which means that if a patient is very badly injured and needs blood they can get four units of whole blood before they even (get to) the hospital," Kundi said. "That really is unparalleled in pre-hospital care right now."

It's difficult to overstate the positive effect of early whole blood treatment on an injured patient, he said.

"Literature shows that there is a survival benefit that extends well past the initial resuscitation period," Kundi said. "These patients do better a month out if they get whole blood initially."

Carrying the blood "has been a game changer in our patient care," DeVore said.

EMS providers have said, "please bring your blood directly to the scene," he said.

The ability for two units of blood to circulate in a patient that is critically compromised provides an "extra chance of survival prior to getting them to a facility for the surgery," DeVore said.

Teresa McMinn is a reporter for the Cumberland Times-News. She can be reached at 304-639-2371 or tmcminn@times-news.com.