As part of the Maryland EMS system, Maryland’s GO-TEAM, based at the R Adams Cowley Shock Trauma Center, has seen an increasing request for services. The team was requested on 13 incidents in 2024, nearly triple the incidents since 2020.
“I think there has been an increase in requests because we have – over the last 2 years – made a concerted effort at outreach and collaborative training with EMS, fire and rescue crews across the state,” GO-TEAM Medical Director, Dr. Rishi Kundi, said. “We meet and talk to these squads; they can see more of what we do and what our guiding philosophy is.”
“We work with the goal of erasing the clear bright line between prehospital and hospital care. We are able to do, on scene and enroute, everything that we would do in the first 15-30 minutes upon arrival at the Shock Trauma Center,” Kundi added.
The team, consisting of an attending physician (anesthesiologist, surgeon or critical care medicine specialist) and a certified registered nurse anesthetist is stationed at Maryland’s only primary adult resource center in Baltimore.
“I think the biggest challenge that our team faces is the idea that we are the amputation team – which was true 20 years ago, perhaps, but is very much not the case at present,” Dr. Kundi said.
“I think there’s also – and this is undoubtedly related to the former idea – the sentiment that calling for the GO-TEAM is a declaration of failure on the part of the special operations teams or the paramedics on scene,” Dr. Kundi noted. “Every prolonged extrication scene that has involved the GO-TEAM has meant only that when the squad completes their extrication, we work with the medics on scene to start the stabilization and resuscitation of the patient there.”
Trooper 2 responded directly to the scene and Trooper 1 transported the Shock Trauma Center GO-TEAM.
(Photo/courtesy Anne Arundel County Fire Department)
(Photo/courtesy Anne Arundel County Fire Department)
The Shock Trauma Team members are pictured with Trooper 4 in October 2024, near Ocean City, Maryland, after a joint training exercise with the U.S. Coast Guard and the Ocean City Fire Department.
(Photo/courtesy Anne Arundel County Fire Department)
When the prehospital clinician consults with a trauma attending and extrication of the critically ill and injured victim is expected to exceed 1 hour, or some other type of advanced specialty care is needed, the GO-TEAM will be put on alert or dispatched.
Depending on the location in the state, the team responds with the assistance of Maryland ExpressCare, University of Maryland’s critical care ground transport service or Maryland State Police Aviation Command. In most cases, MSP Aviation has already dispatched one helicopter to the scene and the second closest aircraft will pick the team and their gear up at the Shock Trauma Center, according to Kundi.
The GO-TEAM’s capabilities
Once the team arrives on the scene and performs an assessment, the team is able to see the extent of injury and determine potential consequences that delays in time to definitive care might have on patient outcome. They use this assessment and information to communicate with rescue personnel so, as a team, they may better plan the pace and type of rescue. The GO-TEAM is equipped to perform:
- Advanced airway maneuvers, including surgical cricothyrotomy and mechanical ventilations
- Chest tube decompression of hemopneumothorax
- Surgical procedures to achieve hemostasis
- Administer advanced fluid resuscitation, including blood transfusion
- Administer sedative, analgesic and paralytic medications
- Initiate invasive and non-invasive vital sign monitoring including: arterial oxygen saturation, quantitative measurement of expired ETCO2, measurement of core body temperature, arterial pressure and central venous pressure
- Insert gastric and urinary bladder drainage catheters
- Administered vasoactive medications to support blood pressure and maintain organ blood flow
- Administer medications and institute measures to reduce brain swelling and lower intracranial pressure
- Administer treatments and medications to patients with crush injury in order to reduce the risk of myoglobin-induced acute renal failure
- Perform life-saving extremity amputation
- Provide advanced medical and triage expertise for mass-causality incidents, including incidents potentially involving weapons of mass destruction.
GO-TEAM requests have included:
- 2020: 5 requests
- 2021: 9 requests
- 2022: 11 requests
- 2023: 10 requests
- 2024: 13 requests
The most common indications for deployment were motor vehicle entrapment, followed by trench collapse and lasty building collapse.
GO-TEAM training
The GO-TEAM performs regular training in-house and in the field across the state of Maryland, from the beaches of Ocean City to the mountains of Western Maryland.
GO-TEAM members’ training includes:
- Field surgical care
- Maryland EMS protocols
- Scene safety
- Helicopter safety
- Hazardous materials awareness
- Radio communications
- Incident command
- Vehicle rescue
- Emergency vehicle operations
- Field operations
- Use of SCBA
- Supporting closed space, trench and high elevation rescue operations
- Techniques for farm equipment rescue, water rescue
- Assisting with law enforcement tactical operations
The GO-TEAM ‘exemplifies a few things that I love about my job,” Dr. Kundi said. “It is the manifestation of the idea that the Shock Trauma Center serves the people of the state of Maryland ... not Baltimore and not even Baltimore County – but the entire state. If you are hurt and you’re in Maryland, the Shock Trauma Center can come to you.”
