BALTIMORE -- A panel of national experts reviewing Maryland's renowned medevac program will issue recommendations Tuesday morning.

On Monday, the panel heard how Maryland's EMS system works. They learned how the network was initiated and how it has developed into a model program.

The panel was assembled at the request of Dr. Robert Bass, executive director of Maryland Institute for Emergency Medical Services Systems, following the September crash of a state police helicopter.

The crash claimed the lives of four people – the pilot, the flight paramedic, an EMT and a patient. The lone survivor was released from R Adams Shock Trauma Center on Monday afternoon while the panel was deliberating.

Since the Sept. 28 crash, the number of medevacs has dropped. Dr. Douglas Flocare, state aeromedical director, said some ambulance crews are skittish now about calling for a helicopter.

That hesitation concerns trauma physicians. Bass said he's worried that some patients who should be flown to trauma centers are instead being transported by ambulance.

He made it clear that providers shouldn't hesitate to call.

Bass added that it's often very difficult for providers to perform adequate triage at the scene of a crash due to noise and other factors. They also don't have the diagnostics to rule out internal injuries.

The Maryland triage protocol for helicopter vs. ambulance transports were changed in July. Since the crash, providers are required to consult with a physician for patients who do not fall into priority categories.

Panel Chairman Dr. Robert MacKersie said the panel has its work cut out for them. He said reviewing the state's triage policy is the first step.

After hearing several hours of testimony, the group went into closed session to discuss and develop its recommendations which will be presented Tuesday morning.

Bass said he was pleased with the panel's choice to deliver their work before heading back to various areas of the country.

The state's 29-member EMS advisory council will consider the proposal next. After that, the state EMS board will review the document to determine if the suggestions should be adopted.

"I believe the panel is balanced. They were chosen for their expertise," Bass said. "These are tough issues, and there are no clear answers."

In the past 11 months, the NTSB has investigated nine fatal medevac crashes that have claimed 29 lives. For years, there's been discussion on the benefits vs. risks of transporting patients by air.

The panel will be reviewing trends in helicopter utilization as part of its work. Bass said he was well aware of the criticism that too many patients are being transported by air rather than by ambulance.

Other members of the panel include Dr. John Morris, director of trauma, burn and LifeFlight Patient Care Center, Vanderbilt University; Dr. Ellen MacKenzie, chair department of health policy and management, Johns Hopkins Bloomberg School of Public Health; Tom Judge, executive director of LifeFlight of Maine; Dr. Stephen H. Thomas, associate medical director, Boston MedFlight; Bryan Bledsoe, clinical professor of emergency medicine, University of Nevada School of Medicine; and William Metcalf, Chief, North County Fire Protection District, Fallbrook, Ca.