The Maryland Emergency Medical Services (EMS) System is a coordinated statewide network that includes volunteer and career EMS clinicians, medical and nursing personnel, communications, transportation systems, trauma and specialty care centers and emergency departments. The Maryland Institute for Emergency Medical Services Systems (MIEMSS) oversees and coordinates all components of the statewide EMS system in accordance with Maryland statute and regulation. This includes planning, operations, evaluation, and research. In addition, MIEMSS provides leadership and medical direction, conducts and supports EMS educational programs, operates and maintains a statewide communications system, designates trauma and specialty centers, licenses and regulates commercial ambulance services, and participates in EMS-related public education and prevention programs.
The statewide EMS system had its origins nearly 50 years ago when plans were developed in the mid-1960s to create a statewide EMS system and to transport serious trauma patients by Maryland State Police helicopter. In the early 1970s, education programs were implemented to train ambulance personnel, standards of emergency care were established, and transportation and communications systems were developed. In 1973, the Governor issued an executive order that established the "Maryland Institute for Emergency Medicine" and a Division of EMS. Both entities were subsequently combined into the Maryland Institute for Emergency Medical Services that consisted of EMS Field Operations, the R Adams Cowley Shock Trauma Center, and the National Study Center.
In 1993, MIEMSS became an independent state agency, governed by an 11-member EMS Board appointed by the Governor. A Statewide EMS Advisory Council (SEMSAC), comprised of representatives from organizations involved in providing emergency care services, was created to advise and assist the EMS Board.
Since becoming an independent state agency in 1993, MIEMSS has worked to formalize, through statute and regulation, the administration, regulation and operation of the statewide EMS system. The EMS Board has statutory oversight authority, while MIEMSS’ Executive Director is statutorily responsible for coordination of all aspects and components of the system. MIEMSS is organized into departments that reflect the structure necessary to coordinate the statewide EMS system (see organizational chart). Additionally, a number of committees are actively involved in various aspects of the statewide system (see list of active committees).
More than half of the prehospital clinicians in Maryland are volunteers operating in public service EMS agencies, while others are employed as career EMS clinicians by public service agencies and/or commercial EMS services (ground and air). Volunteer and career prehospital personnel are certified/licensed by the state and authorized to provide care in accordance with the Maryland Medical Protocols for EMS Providers.
Maryland prehospital clinicians are divided into two areas: basic life support (BLS) and advanced life support (ALS). BLS is provided by state-certified emergency medical dispatchers (EMD), first responders, and emergency medical technicians-basic (EMT-B). ALS, which is available in all jurisdictions, is provided by state-licensed cardiac rescue technicians (CRT), cardiac rescue technicians–intermediate (CRT-I) and emergency medical technicians-paramedic (EMT-P). The CRT-I has completed the equivalent of the national standard curriculum for the Emergency Medical Technician-Intermediate. In 1999, an educational program was established to allow current CRTs to transition to the National Registry EMT-I no later than 2006, by which time all existing CRTs in Maryland will have either completed the update or reverted to EMT-B. No additional CRT courses that did not meet the national standard intermediate curriculum were taught after 1999.
The EMS communication system—one of the first statewide systems in the country—is maintained by MIEMSS and integrates the entire EMS system in Maryland. Through the use of radio and microwave technology, the statewide communication system links ambulances, helicopters, and hospitals and allows communication between system components at anytime. For example, a paramedic on-scene with a patient in Western Maryland can talk directly with a local emergency department physician or, if needed, can obtain medical consultation from a specialty center in Baltimore. All local 9-1-1 centers are staffed with certified emergency medical dispatchers (EMDs) licensed by MIEMSS.
Because of the high volume of EMS calls in certain areas of the state, a communications center at MIEMSS assists with the heavy demand for medical communication. The Emergency Medical Resources Center (EMRC) coordinates medical consultation between medic units and hospital physicians. Medic units requesting a medical consult can call EMRC where operators instruct them to switch over to an available med channel to be patched through to a hospital. While en route to the receiving hospital, prehospital clinicians transmit patient information to an on-line hospital physician. Physicians may direct the prehospital clinician to follow specific medical protocols and give them approval for additional treatment.
Also located within the same communications center is SYSCOM—the System Communication Center. SYSCOM’s operators work with a Maryland State Police Duty Officer to dispatch and coordinate all Maryland State police med-evac missions. The Maryland State Police Aviation Division, with a fleet of 11 helicopters based in seven (7) sections across the state, transports over 5,000 critically injured or ill patients each year.
In Maryland’s EMS system, 85% of patients who are injured are taken to the nearest hospital emergency department. Forty-eight (48) hospitals have emergency departments staffed around the clock and equipped to handle most emergency medical problems. Approximately 15% percent of injured patients are treated at the state’s designated trauma centers that provide advanced medical and surgical services 24 hours a day. Rehabilitation, which completes the spectrum of patient care, starts as early as possible in the recovery process. Many patients who need extended occupational, physical, and speech therapies are transferred to rehabilitation hospitals to continue their recovery.
The EMS system in Maryland works closely with the National Study Center for Trauma and Emergency Medical Systems, the Maryland Highway Safety Office, the Safe Kids Coalition, the American Trauma Society and other organizations to foster and support education and injury prevention activities. EMS services and hospital facilities throughout the state sponsor injury prevention programs, many of which focus on the role of the public in EMS. Other safety awareness programs include geriatric and child abuse prevention, bike safety, poison prevention, and street safety.
Maryland’s EMS system is composed of five regions. Each region has a Regional EMS Advisory Council composed of members who have an interest in EMS. Council responsibilities are defined by regulation, and council meetings typically cover a range of topics, including grants, training, EMS policies/protocols, legislation, and communications. Input from each Regional EMS Advisory Council is provided to the Statewide EMS Advisory Council for recommendation to the EMS Board. MIEMSS has regional administrators in each of Maryland’s five EMS regions who support the councils, facilitate communication and address issues.
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