EMS ExpressCare

Through partnerships with Petroleum Helicopters International (PHI) and American Medical Response (AMR), the University of Maryland operates a busy critical care and interfacility transport service. ExpressCare is comprised of critical care personnel, specialty care paramedics, transport nurses, and communication staff. A primary mission of ExpressCare is to provide safe and effective transport for patients requiring a higher or more sophisticated level of in-hospital care. ExpressCare crews are capable of the following specialty transports:

• Extracorporeal membrane oxygenation (ECMO)
• Neonatal interfacility
• Critical care / blood product administration / advanced modes of ventilation
• Intra-aortic balloon pumps

Residents and students are encouraged to ride a long with transport crews and observe a shift in the communications center. Helicopter ride-alongs are limited to the winter months when the EC-135 twin engine helicopter can accomodate additional observers. The most common crew configuration consists of a registered transport nurse (RN) and specialty care paramedic (NRP). Crews are tasked with the transport of critically ill and injured patients across the spectrum of age and acuity. Critical care transport exists to bring the definitive and specialty care resource of the University of Maryland Medical Center to the patient's bedside. 

Resident Rotation in Critical Care Transport

Goal:                      

The resident assigned to the Maryland ExpressCare (MEC) EMS rotation will become familiar with interfacility critical care transport operations. The resident will interact with specialty transport crews and learn about how the standard of hospital based care is maintained throughout transport.

Objectives:           

• Understand how the scope of critical care transport (CCT)  practice differs from typical prehospital operations
• Define the capabilities of CCT crews and discuss the specifics of training and education
• Discuss how EMTALA factors into decisions about the level of transport care
• Describe how patients in need of interfacility transport are matched to the appropriate level of transport care (BLS, ALS, CCT, flight)

Rotation description:

Residents assigned to rotations with MEC will check in with the CCT crew at the University of Maryland Medical Center. Residents will serve as members of the critical care transport team. Residency policies about dress code and attendance shall remain in effect for the duration of the MEC block.

• Resident physicians will observe critical care crews and function under the auspices of the lead transport RN and MEC clinical guidelines
• Residents will bring their own PPE (gloves, goggles, mask) the rotation. Additional supplies will be available to the resident in order to maintain a safe transport environment
• Residents will report to the lead transport RN and participate in the formulation of a transport care plan. Procedures and patient care related activities will be performed at the discretion of the transport RN
• Examples of acceptable resident-performed procedures include: patient assessment, intravenous access, needle decompression, application of monitor leads, 12 lead electrocardiograph interpretation, and other tasks identified as appropriate by the transport crew
• Senior residents who have completed base station training can serve as surrogate medical control physicians (upon request of the MEC crew) and can provide input on adjustments to the transport care plan. Advice or medical control provided by the senior resident physician will be in accordance with existing MEC clinical guidelines and documented on the prehospital / interhospital electronic medical record
• The final authority for transport related decisions rests with the lead transport RN responsible for execution of the transport care plan

ExpressCare Contact Information
 

Leigha McGuin, RN, BSN
Assistant Manager, Maryland ExpressCare

Michael McCabe, NRP
Base Manager, PHI Air Medical (ExpressCare 1)

Benjamin Lawner, DO, MS, EMT-P
Medical Director, Maryland ExpressCare Critical Care Transport 

Alexander Torres, DO, MBA
Assistant Medical Director, Maryland ExpressCare

Kevin Pearl, MD
Assistant Medical Director, Maryland ExpressCare

University of Maryland ExpressCare Official Website