What is telemedicine, and what might it mean to the future of EMS? This three-part series will discuss potential benefits and offer thoughts on approaching this emerging technology. Part 1 outlined its basics and history. Part 3 discusses system examples and lessons learned.
While there is not yet solid evidence supporting the efficacy, utility or cost-effectiveness of any EMS telemedicine application, there are several uses we might find appropriate and worthwhile.
Recorded refusal--Prominent emergency physician Raymond Fowler, MD, chief of EMS operations for the Dallas-area BioTel system and an advocate of EMS’ use of advanced data collection tools to support evidenced-based improvements to care, summarizes the value of recorded refusals using EMS telemedicine this way:
“Technology, hardware and data bandwidth is now available to directly connect the field encounter to a medical oversight platform with the resources necessary to assist in difficult patient situations. The case where the patient demonstrates adequate capacity for understanding the medical condition and refuses the care advised by the medic allows a telemedicine platform…to lend support to the medic by providing medical control the ability to clearly evaluate the patient from a video, audio and physiologic data perspective. The entire episode…including the patient being told that declining care would remain as a part of the permanent record of the event can then be recorded and archived, clearly documenting the evaluation of the patient, what the patient was told regarding risks and benefits and the patient’s declining of care.”
Stroke assessment--The single most important factor in determining good outcomes for patients with acute ischemic stroke is time to treatment, notes Steven Levine, MD, a stroke neurologist at the State University of New York Downstate Medical Center and expert in the assessment and treatment of stroke using telemedicine techniques.1 Linking prehospital acute stroke care to ED physicians and stroke experts, Levine says, would allow earlier recognition, support and triage of patients before hospital arrival. Current communications and imaging technologies make this possible. Using these technologies could also help speed use of tPA therapy, as well as making greater use of prehospital data. This should result in improved outcomes and reduced costs.
Treat and release--Cullen Hebert, MD, a pulmonologist at Our Lady of the Lake Regional Medical Center in Baton Rouge, LA, and one of the “fathers” of the local BR Med-Connect system, believes EMS telemedicine can help bring more advanced forms of healthcare to the poorer outlying areas of East Baton Rouge Parish. He feels medics are often trapped by the current medical/legal paradigm into transporting patients who could be cared for at home to hospitals. He describes how an EMS telemedicine system could provide a better way to treat a child with an asthma attack:
“The mom calls EMS, which arrives promptly. The patient is evaluated by the medic, who feels the need to transport is questionable. A remote ED physician is brought to the scene by telemedicine. He assesses the vital signs and observes the patient during and after appropriate therapy. The physician and mom then speak. He determines she is competent to provide the needed therapy, and they agree to follow the patient’s response by phone. The medic reviews the treatment plan with the mom, and the decision is made not to transport. Audio, video and data are captured for medical/legal purposes.”
Hebert considers such a scenario a win-win, with lower costs, less disruption to the family, reduced ED overcrowding, and a far less traumatic event for the child. “This is what I want BR Med-Connect to be able to bring to my parish,” he says.