Telemedicine in EMS: How Can It Help?

OPS

Telemedicine in EMS: How Can It Help?

This is the first in a six-part series examining the potential role of telemedicine in the emergency medical services.

Though not quite the “final frontier,” telemedicine is a technology category that is rapidly expanding across EMS and healthcare. Telemedical applications (when wellness-oriented applications are included it is sometimes called telehealth) range from surgery and field consultations to home health and hospice, and operate at distances from across town to across the planet. My own team at Beyond Lucid Technologies was even invited by a NASA affiliate to submit a proposal for a telemedical solution that would to allow medical directors in Houston to monitor astronaut-patients on a manned voyage to Mars!

So many of us carry cameras in our pockets these days, but to date we’ve talked little about questions that include the value of telemedicine, its legality, and decisions about protocols, training and hardware.

Some states and counties are blazing future-focused trails. This past August New York Governor Andrew Cuomo signed a law that “streamlines the credentialing process for healthcare practitioners who provide telemedicine services to patients in New York state,” according to Crain’s Health Pulse. Conversely, a paramedic in Rowan County, NC, said cameras are a strict and vehement no-no in light of concerns about HIPAA-sensitive photos or videos inadvertently ending up online.

At the Hawaii EMS Information System users conference last April, I asked prominent EMS attorney Stephen R. Wirth—a lecturer at the event and partner at Page, Wolfberg & Wirth—whether there were best practices for the use of telemedical technology by EMS providers. He said there weren’t—telemedicine in EMS and fire remains a legal gray area. How, then, can an innovative agency leverage telemedicine to maximize quality and safety for both patients and providers, while simultaneously avoiding the risk of potentially opening a Pandora’s box of quality and legal problems?

Kevin Chason, DO, director of emergency management at Mount Sinai Hospital in New York City, described the use of cameras by EMS providers as “way ahead of the curve.” But he acknowledged significant cases that could justify cautious reliance on telemedicine, especially when coupled with an electronic patient care report (ePCR). These include:

• Documentation of injuries and quality assurance of patient care;

• Documentation of scenes and other factors that contribute to medical decision-making; and

• When allegations of EMS misconduct—for example, inappropriate treatment or excessive force—pose the risk of devolving into the word of the provider vs. the word of the patient.

EMS providers in Pittsburgh echoed the suggestion that multimedia might serve as a tool to defend against false accusations of negligence or misconduct and a means to roadblock frivolous lawsuits. Sadly, there are attorneys out there who seek to capitalize on the inadequacies of paper run records by dragging medics into court and then nitpicking on miniscule details they couldn’t possibly remember years later.

Continue Reading

In future columns we’ll delve further into the technical and financial benefits of next-generation technologies for EMS, many of which have been vetted by and incorporated into adjacent industries like police and both hospital- and in-home care, but haven’t yet jumped into mission-critical EMS.

Any discussion of telemedicine’s value for emergency services is inadequate if it fails to mention the potentially transformative effect of care-at-a-distance applied to rural healthcare in the U.S. and abroad. Considering the ubiquitous tension between first responder resource availability and budget constraints, it is striking that a recent article entitled “5 Ways Telemedicine Can Boost Care in Rural Communities” failed to mentioned EMS once. This seems a major oversight. A senior official in the El Paso Fire Department explained to me last year that his agency had to take decisive legal action to reduce “frequent fliers” because “[they] are three hours from the nearest town,” and can’t afford to let abusers gum up the ambulance system. Many systems face similar challenges.

Last winter, a former Indian pharmaceutical executive who is now a senior official at a major American university asked me what it would take to deploy 50,000 electronic patient care records to rural India. I later learned that the typical “rescue” vehicle in many rural Indian villages is not an ambulance, but rather a trailer that visits periodically to perform the direst interventions. There is a current business trend to deploy souped-up shipping containers outfitted with telemedical gear to disaster-ravaged regions around the world; these pods transport with them critical clinical insights. Medical flights routinely transport patients from the Tanzanian bush to South Africa’s metro hospitals—a distance of 2,500 miles, equivalent to the distance from Pittsburgh to San Francisco. Perhaps even more effectively than these capital-intensive overtures, field-deployable telemedical innovations for EMS providers around the world have the capacity to connect even rudimentary EMS teams with highly trained counterparts and physicians around the world in seconds…changing everything.

Jonathon S. Feit, MBA, MA, is cofounder and chief executive officer of Beyond Lucid Technologies, Inc., an IT firm committed to connecting first responders with the care facilities they serve using cutting-edge technology. In 2011, he partnered on the first white paper on telemedicine applied to EMS. For more see www.BeyondLucid.com.

Inc. magazine ranked GD 2503 on its 36th annual Inc. 5000, the most prestigious ranking of the nation's fastest-growing private companies.
Developed with the help of paramedics, bystanders who witness a heart attack or cardiac arrest can use the app to send an SOS to nearby CPR-trained people, check if someone has called the emergency number 119, and alerts them of nearby AEDs.
Verizon brought responders together to see the benefit of new technologies.
Previously used between first responders to share urgent information during disasters, BerksAlert can now alert residents of local emergencies.
Vitals is an app that provides first responders with an individual's diagnosis, medications and caregiver contact info so they know how to respond appropriately to people with mental or physical disabilities.
Healthcare leaders select Redivus Health clinical decision support platform as Best in Show and winner of Clinical Information Management category.
The Pulsepoint app sends alerts from dispatch calls to citizens who know CPR if a nearby person needs aid before EMS can arrive.
Emergency Reporting’s integration with StreetWise links the data used or produced in the apparatus during a response with data stored in a department’s records, significantly improving accuracy, situational awareness, safety and efficiency during emergency response.
Pulsara knows that time is brain and radios can be unreliable, which is why their communications app for EMS to relay clear, accurate patient information to the ED has been improving patient care.

More than 300 state and local agencies have added drones to their arsenals, including a Texas police department that used a drone to spot an escaped convict. The drones can be used to locate active shooters inside buildings, people trapped in burning buildings, and lost hikers.

Redivus Health was selected as a finalist for its innovative, industry leading product, which improves patient care by providing physicians, nurses and paramedics with actionable, clinical guidance during a critical care event.
Frank Gresh, MS, discussed the risks that agencies face in cybersecurity breaches and how they can protect themselves from these threats.
Canada’s premier event for paramedic personnel draws attendees from coast to coast.
Thousands of public safety communications officials will attend this international event next week in Denver, Colorado.
AngelTrax, a leading provider of mobile video surveillance solutions, recently relocated all operations into a fully renovated 40,000 square foot facility which serves as the new headquarters for the company's expanded corporate offices and manufacturing, inventory and distribution centers.