Maryland ExpressCare Celebrates 30 Years of Providing Lifesaving Critical Care for Marylanders

What started as a service linking non-affiliated hospital physicians with expertise at the University of Maryland Medical Center (UMMC) has grown three decades later into a thriving service encompassing a 24/7 call center, a fleet of ambulances and contracted medical helicopters providing time-sensitive critical care to sick and injured Marylanders. Over its 30 years, Maryland ExpressCare has treated and transported more than 125,000 critically ill patients from across the state.

In the summer of 1993, UMMC launched ONE CALL, a service providing physicians throughout Maryland and in neighboring states the ability to consult with its physicians and transfer patients from outlying facilities to the hospital in downtown Baltimore for specialized services. Celebrating its 30^th anniversary this year, Maryland ExpressCare (MEC), part of the University of Maryland Medical System (UMMS), has evolved into the state's premier access and transportation model for tertiary care institutions, providing care for more than 350 patients every month. MEC clinicians regularly provide life-saving care to acutely ill and injured patients of all ages across the state.

During the height of the COVID-19 pandemic, MEC transported dozens of critically-ill patients, many of whom were brought to the System's flagship academic medical center, UMMC, for lifesaving treatment such as ECMO (Extracorporeal membrane oxygenation) therapy. MEC also transported one of the first COVID-positive patients in Maryland, from the University of Maryland Baltimore Washington Medical Center in Glen Burnie (Anne Arundel County) to UMMC, where the patient received intensive care.

"I am deeply proud of the lifesaving work performed by the highly skilled and dedicated critical care nurses, critical care paramedics, physicians, EMTs and other staff who make up the Maryland ExpressCare team," said Mohan Suntha, MD, MBA, President and CEO of UMMS. "This team continues to be innovators in medicine; many medical experts and representatives from hospitals across the country and around the world have come to visit Maryland ExpressCare to develop a similar operation."

Maryland ExpressCare played an integral role in saving the life in April 2011 of teenager Breanna Sudano. A freshman on the Perry Hall High School JV field hockey team, Breanna collapsed during a game just after scoring the winning goal. Her heart stopped beating, she stopped breathing and was in cardiac arrest. After bystander CPR was initiated, Breanna was transported to a local hospital and subsequently transferred via Maryland ExpressCare ambulance to the R Adams Cowley Shock Trauma Center at UMMC. Breanna recovered from her injuries and now works in college athletics in Wilmington, N.C. She has advocated with the American Heart Association to for CPR and AED awareness, and "Breanna's Law" requires Maryland students to learn CPR as a high school graduation requirement.

Other memorable calls for Maryland ExpressCare staff include:

• A soldier transferred from Walter Reed Army Medical Center to UMMC; the solider had sustained multiple gunshot wounds and was critically ill, but following expert care ultimately made a full recovery and returned to duty.
• Teams who deployed to a UMMS member organization's Emergency Department to care for a pediatric patient in respiratory distress, including transporting a pediatric critical care respiratory therapist to the location. MEC crews provided critical care for the patient on-site and while transporting them to the UMMC Pediatric Critical Care Unit.
• A crew dispatched via helicopter to retrieve a patient with multilobar pneumonia at a non-UMMS hospital. The team recognized the patient's acute decompensation, resuscitated them at the bedside, successfully intubated a difficult airway and communicated the need for an upgrade in care to the receiving hospital.
• Providing lifesaving care to a patient with acute severe asthma who was unresponsive to treatment therapy. Hospital teams were encountering significant difficulty in attempting to oxygenate, ventilate, and stabilize the patient for transport. MEC teams responded to the bedside, provided expert assistance with ventilatory management, and stabilized the patient sufficiently for transport to UMMC's Critical Care Resuscitation Unit, where they received ECMO therapy and were discharged following a complicated hospital stay.
• Providing an essential link in the chain of survival from traumatic injury; when aviation transport was not possible because of inclement weather conditions on the Eastern Shore, MEC teams responded to a non-UMMS trauma center. The team assisted in the resuscitation of a patient, applied a pelvic binder, administered a transfusion and stabilized the patient for the two-hour return trip to the Trauma Resuscitation Unit at Shock Trauma.

Maryland ExpressCare Timeline:

• 1993: ONE CALL established by the University of Maryland Medical Center, improving accessibility to tertiary care services for outside hospital physicians and surrounding communities. The service was expanded that summer to include physician to physician consultation and transport services for critically ill patients from outlying facilities to UMMC. One ambulance and one transfer coordinator were available 24/7.
• 1994: A second ambulance and crew was added in Baltimore due to increasing critical care transport volumes
• 1995: Maryland ExpressCare began providing pediatric critical care transport services 24/7, and the Transfer Center continued to expand to accommodate increasing call volume.
• 1996: A third ambulance and staff was added and MEC provided medical services to the Baltimore Ravens with an ambulance and critical care team on the sideline for all home games.
• 1998: MEC ambulance and staff were added at Memorial Hospital in Easton (now the University of Maryland Shore Medical Center at Easton) in recognition of the need to provide faster transport of critically ill patients from the Eastern Shore.
• 2006: MEC contracted with PHI Air Medical for the transfer of critically ill between hospitals via helicopters staffed with critical care nurses.
• 2019-2021: Collaborated with UMMS and Shore Regional Health to increase critical care transport coverage to 24/7 on the Easton Shore.
• 2020: Incorporated regularly recurring cadaver lab and high-fidelity simulation sessions into the education curriculum. Cadaver labs conducted in partnership with expert clinicians from PHI Air Medical.
• 2021: Fully integrated pediatric critical care transport capabilities into MEC. Published evidence-based, peer reviewed critical care transport guidelines.
• Present: The University of Maryland Access Center encompasses transfer coordination, dispatch and interfacility transport, with a technologically-advanced communication and dispatch center available around the clock for local, state, interstate and international physician consultation and transport needs for the 11 hospitals within the UMMS network. Maryland ExpressCare operates four ambulances from UMMC in downtown Baltimore and one on the Eastern Shore, each equipped with state-of-the-art equipment and staffed with highly qualified, skilled and continually trained critical care nurses, paramedics and EMTs.

"Maryland ExpressCare will continue evolving in the relentless pursuit of our primary mission," said Ben Lawner, DO, EMT-P, Medical Director for Maryland ExpressCare. "In addition to rigorous clinical education, training, and protocols, we are grateful to be able to leverage the system's medical expertise to provide the latest in resuscitation and stabilization interventions to patients in need."

"After 30 years of continual evolution, the University of Maryland Access Center and Maryland ExpressCare continues to be the premier access and transportation model for tertiary care institutions," added Megan Lynn, PhD, MBA, RN, CPHQ, Director of Nursing for the University of Maryland Access Center. "It will always remain our mission to provide timely physician access and patient transportation to all of the comprehensive health care services that UMMS offers."

Dozens of care providers today, including physicians, nurses, techs and paramedics, started their medical career working for Maryland ExpressCare.

Michael Rolnick, MD was one of the first medical directors of the program. "It strikes me that ExpressCare is probably one of the most important programs in the last 50 years for the citizens of Maryland," Dr. Rolnick said. "The program undoubtedly has saved thousands of lives. The time sensitivity for evaluation and treatment for many medical and surgical problems was just becoming recognized in the early 1990s and this referral service certainly helped get patients to definitive care. I was really proud and humbled to work with such extraordinary people to accomplish this important service."

Cathy (Loessi) Rhoades was one of the original five nurses to start with the program at its inception in 1993.  She eventually earned a master's degree in Nursing Informatics at the University of Maryland School of Nursing and today works at a hospital in Florida. "I loved being one of the first nurses to help start Maryland ExpressCare," she said. "This was the most exciting jobs I ever had! I still talk about that experience, even recently with old friends who came to visit. I enjoyed the rigorous training, the program development and the autonomy of the job. I have so many patient memories, especially going to small emergency departments to assist doctors who were so relieved when we showed up. They knew our competence and many times, we not only stabilized these patients before leaving their ER but many times, we improved their condition."

Lynn Thomas first worked as a paramedic for Maryland ExpressCare on the Eastern Shore and finished as a nurse several years ago. During her time with MEC, she earned her Registered Nurse and Master of Science in Nursing degrees and now works in nursing leadership at a Maryland hospital. "I have had the privilege to work with some of the finest providers and people in the world," Thomas said. "So many memories in my 22 years with the program. Thanks for making me the provider I am today. Without the encouragement and mentorship of the MEC nurses, I never would have become a nurse." Thomas also highlighted the technological advancements that she experienced working with MEC. "The two biggest changes I lived through during my years were the multiple advances in the ventilators and intra-aortic balloon pumps allowing us to bring the technology from the hospital Intensive Care Unit into the back of our ambulances."

Another of the original paramedics working for MEC on the Eastern Shore, James Jenkins earned his nursing degree and currently serves as Chief Deputy Director of the Virginia Department of Health Professions and as a Special Advisor to the Governor of Virginia responsible for 13 licensing boards across the state. "I didn't realize it at the time, but we were trained on the latest monitoring and invasive therapy equipment. Ten years later as a new RN, I became a resource for ER staff on understanding the Intra-Aortic Balloon Pump. Five years after that, our ER was introduced to 'ground-breaking' technology, the i-STAT, which, of course, we were using on the scene at MEC on the late 1990s." Jenkins, who has authored chapters for nursing textbooks, added, "I enjoyed being able to practice at the top of our license and being challenged with the next higher level of care. There was true collaboration among EMTs, paramedics, nurses and the on-site medical teams."

Currently serving as the Regional Resource Manager for the University of Maryland Shore Regional Health, Ryan Killough was also a member of MEC's inaugural paramedic team on the Eastern Shore. "I was truly amazed by the level of critical care you could deliver in the back of an ambulance, the care I only knew to be available in a tertiary care center ICU. This is where my love and life journey for critical care began. I was so intrigued with the drugs and equipment such as a portable ventilator and balloon pump that I wanted to learn all I could and because of this decided to go to nursing school. The Maryland ExpressCare team exemplifies our UMMS values of Compassion, Discovery, Excellence, Diversity and Integrity."

Editor's Note: On September 21^st at 11am, the University of Maryland Medical System is holding a 30^th Birthday Party for Maryland ExpressCare, at the System's office at 920 Elkridge Landing Rd in Linthicum. Visuals will include one of the brand-new MEC ambulances with Maryland flag design, a PHI helicopter, and historical artifacts from the past three decades including MEC uniforms and photos. Interviews will also be available with current and former MEC team members.

About the University of Maryland Medical System

The University of Maryland Medical System (UMMS) is an academic private health system, focused on delivering compassionate, high quality care and putting discovery and innovation into practice at the bedside. Partnering with the University of Maryland School of Medicine, University of Maryland School of Nursing and University of Maryland, Baltimore who educate the state's future health care professionals, UMMS is an integrated network of care, delivering 25 percent of all hospital care in urban, suburban and rural communities across the state of Maryland. UMMS puts academic medicine within reach through primary and specialty care delivered at 11 hospitals, including the flagship University of Maryland Medical Center, the System's anchor institution in downtown Baltimore, as well as through a network of University of Maryland Urgent Care centers and more than 150 other locations in 13 counties. For more information, visit www.umms.org.