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Last fall, the Delaware County Emergency Health Services Council in suburban Media drafted a contract which all emergency transport services in and around the county were required to sign if they wanted to continue to operate in the county. By the deadline of August 20th, only one air-ambulance service agreed to the pact -- Sky-Life Care, associated with Brandywine Hospital in Chester County. Neither PennSTAR nor Medevac, the helicopter that services Hahnemann and Jefferson Hospitals, took part in the agreement. Now, Sky-Life Care is the "primary provider" to Delaware County and PennSTAR and Medevac are only called in when Sky-Life Care is unavailable. But PennSTAR's base at the Hospital of the University of Pennsylvania is critical minutes closer to eastern portions of Delaware County than other air-ambulance services. HUP officials said last week that the hospital's proximity makes it a vital part of proper patient care. · The source of contention between PennSTAR, Medevac and Delaware County is a clause in the county's contract which governs where trauma patients are taken. The EHSC contract places that decision in the hands a Medical Command Official within the county, even if PennSTAR is called. HUP officials said that they want the decision to remain where it had been before August 20th, in HUP's hands for calls on PennSTAR. Tim Morgan, the program manager of the trauma center at HUP, said that the hospital is focusing on patient care in the dispute. "We are willing to come to some agreement with Delco that would be best for the patient," Morgan said. "That's what it's all about." Previously, when the helicopter was called by emergency crews in Delaware County, PennSTAR rushed to the scene and reported back to its base to report on the condition of the patient. A standardized Trauma Triage Program was used to make the assessment. Based on that report, a Medical Command Official at HUP decided where a patient should be taken. EHSC officials, however, decided that in certain circumstances patients had been flown to hospitals in Philadelphia, passing up closer centers within Delaware County. Robert Holm, Delaware County's Emergency Medical Service Coordinator, said that he knows of at least one case in which a patient died while traveling to a trauma center that was farther away than necessary. On top of everything else, the Pennsylvania Trauma Foundation rates the ability of trauma centers to care for emergency cases. Such ratings can affect the decisions of emergency personnel as to where they bring trauma cases. HUP is a Level I institution, while the highest rated hospital in Delaware County is Crozer-Chester Medical Center, which is only Level II. The main difference between the two is the heart-lung machines that Level I hospitals have and that Level II hospitals do not. Delaware County's Holm said that the distinction is not critical, citing a Trauma Foundation opinion that the difference between the two levels is not crucial, pointing out that Level II facilities have the capability to keep a patient alive long enough to transfer the person to a Level I center. Holm also said since it is almost impossible to discern in the field which of the two facilities a patient will need, PennSTAR has the tendency bring patients back to its own Level I base. However, HUP's Morgan disputes Holm's charges of any such "rubber band effect." Morgan said PennSTAR does not follow such a policy, adding that they were the first service to institute a practice of choosing a destination hospital on a case-by-case basis. This, Morgan said, has made HUP quite unpopular with the other Level I facilities in the Philadelphia area, because it puts pressure on them to follow suit. "We were the first in the region to break the mold," Morgan said. The situation has caught the attention of the Department of Health in Harrisburg. Kum Ham, director of the Emergency Medical Service Division of the state's Department of Health, said last week that regulation in the division depends on geographic proximity and response time. Therefore, Ham said, "there is no such thing as exclusivity." "We took the position on the Delaware County contract that we do not agree with contracting with a specific air-ambulance service exclusively providing such service to a given region," Ham said. The Health Department division is a regulatory body with the power to enforce its decisions. However Robert Fisher, a Health Department spokesperson, said that the division's stand does not mean that the contract will be voided. He added that meetings are currently being scheduled to decide on the future of Delaware County's emergency transport situation. HUP trauma center head Morgan said that HUP is working to settle the matter without angering Delaware County officials, state officials and patients. "We are probably closer to the Department of Health's position than Delco," Morgan said. "When your house is burning down you don't call a firehouse miles away if you have one just down the road." While EHSC' Holm had no comment on the Health Department opinion, he suggested that a possible solution may to implement the emergency call-up of he helicopters on a rotating basis. For example, one month HUP may be the primary provider then the next Medevac may take its turn.

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