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Operations

Telemedicine in a Hurricane

Emergency operations in the wake of a catastrophic storm rely on an intricate and seamless interplay between multiple agencies from the local level to state and federal agencies. While no two incidents are the same, and no response effort goes perfectly, lessons learned by one event can lead to process improvements before, during and after subsequent disasters.

On October 10, 2018, Mexico Beach, Florida—about halfway between Pensacola and Tallahassee on the coast of the Florida panhandle—bore the major brunt of the impact of Hurricane Michael, a Category 4 superstorm with maximum sustained winds of over 150 mph and a 14-foot surf surge.

Lifeguard Ambulance Service, an Alabama-based agency that operates in seven southeastern states, including Florida, deployed support units from surrounding areas to support local crews in the heavily impacted areas in the landfall zone.

Kim Landry, MD, chief medical officer for Lifeguard Ambulance Service in Pensacola, and medical director of several local EMS systems, said his service acted as a multitiered “quasi-backup” to county operations and worked closely with local hospitals, acute care facilities, strike teams and the state emergency operations center to address the immediate needs of the asset-depleted community. While not directly responsible for 9-1-1 response, Lifeguard assisted offices along the coast, many of whom were holding 9-1-1 calls as a result of the overwhelming volume of communications coming in.

Pre- and post-storm evacuations, building rescues, setting up street shelters and staging areas, assigning priorities, and handling equipment and infrastructure problems were foremost in the response effort.

“Communications was definitely the weak spot,” said Robert Sims, corporate compliance manager of Lifeguard Ambulance. “County-wide, internet and cell service was sporadic. By far, that’s one of the most crucial things to restore in a situation like this.”

Time for Telemedicine

One major advantage to the Lifeguard crews on scene were real-time hookups between the ambulance and Landry. Thanks to specially outfitted ambulances, Landry was able to conduct base-to-base encounters with medics in patient's homes and medical facilities from his remote office in Pensacola. Stethoscopes, otoscopes, high-definition cameras and other diagnostic devices in the hands of the field providers served as Landry's eyes, ears and hands.

“I can do almost a better exam virtually,” says Landry of the system, which he developed himself. The technology can either be custom-fit into an ambulance or be fitted into a suitcase-sized rollable kit to take into homes or difficult call scenes. The system relies on cellular service that searches across frequencies and locks on to the strongest signal, regardless of the cell provider.

Lifeguard deployed several ambulances outfitted with the telemedicine system to hurricane-damaged areas, says Sims.

The main advantage of telemedicine consultations, according to Landry, is being able to complete assessments and treatments in a patient’s residence that would otherwise require transport to the hospital, thus keeping ambulance crews on the street and able to help more people. “A lot of these people didn’t need to be transported,” says Sims. “But they were in a state of panic. Some lost everything. They reached out for emergency help, many times just to have someone there with them and reassure them that they’re OK.”

Relief for the Responders

One complication rarely discussed during and in the immediate aftermath of a catastrophic storm is the toll it takes on the responders themselves. While Landry and Sims are in the business of rescuing people in distress, they’re also business managers responsible for the health and well-being of their workforce.

Lifeguard deployed RVs to the area for responders to use as a base of operations and for much-needed down time.

“I’ve lived here my entire life and never saw anything like this,” Sims says of Michael’s devastation. “It’s difficult to witness. But it also encouraging to meet so many strangers saying, ‘What can we do to help?’”

Jonathan Bassett is editorial director at EMS World. Contact: jon@emsworld.com

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