Check out the EMS1 special coverage series, “Care delivery in real-time: Implementing telehealth in EMS,” to learn how you can implement and sustain a telehealth program at your agency.
Sean McDonnell
Akron Beacon Journal
AKRON, Ohio — A new program from the Akron Fire Department is bringing new meaning to the phrase “the doctor will see you now.”
By using telehealth and collaborating with the Cleveland Clinic, Akron’s EMTs and paramedics can now let patients talk to a physician before they make the trip to the emergency room, getting them care faster.
“That’s kind of the beauty of it,” Fire District Chief Joseph Natko said. “They get to talk to a doctor but not leave their home.”
Akron started the pilot with a few ambulances in January. Now, all 14 ambulances in the department are equipped to use telehealth, and it has been used about 1,100 times.
Natko, who manages Akron’s EMS bureau, said the program is only being used in non-emergency situations, where they treat a patient but don’t feel they need to be rushed to the hospital.
The department is one of only a few that won a spot in the five-year trial, which is using the Center for Medicare & Medicaid Services (CMS) ET3 model.
The end goal is to shorten the amount of time it takes for a patient to speak to a physician and to hopefully avoid taking people to the emergency room who don’t need to be there.
If it works out, it could be in ambulances everywhere one day.
“We think this is going to be the wave of EMS in the future,” Natko said. “Like anything new, you have to work out all the kinks along the way.”
How does the ET3 program work?
Natko said med units will respond to 911 calls as they normally do. In any situation where they feel patients need immediate care or to be taken to the emergency room, they’ll do so.
Telehealth will be for an option for a subset of patients who might be better off staying at home or going to an urgent care or their own doctor.
Natko said there’s a few medical situations where it can helpful. Say a patient calls for chest pains, but it turns out to be anxiety instead of a heart attack. It could be a diabetic who had blood sugar issues that paramedics or someone with a cut that doesn’t actually need stitches. It could even be someone with just shortness of breath.
In some of these situations, people may be overly cautious, or they may want to go to an emergency room just to get a physician’s opinion.
Dr. Amy Raubenolt, EMS Director at Cleveland Clinic Akron General, said the telehealth program can give patients a shorter “time-to-care” window, and possibly give them an alternative to going to the emergency room.
“Hopefully this expands their access to care and gets them the most appropriate care,” she said. “Hopefully a patient doesn’t sit for hours (in the ER) just to be told they don’t need stiches.”
The paramedics do their normal exams, checking for blood pressure, pulse and other vitals. If the person agrees, then they can phone in a physician on a video call using a tablet.
Raubenolt said there’s a group of physicians, physician assistants and nurse practitioners at Cleveland Clinic Akron General who currently take the telehealth calls. Eventually, she said they may have people dedicated for that purpose.
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The physician can ask questions, see the patient’s injuries and maybe even talk to a care giver on scene. Then they can make the decision and advise the person to stay home if it’s in the patient’s best interest.
At least once a day, Natko said all 14 of the department’s med units will be out on calls at the same time, leaving no ambulances at the ready. The hope is ET3 can help cut down on ambulances making trips back to the hospital where they’ll have to wait for beds to open up, Raubenolt said.
It can also work in reverse, Natko and Raubenolt said. Sometimes people should go to the emergency room but refuse. Telehealth can help patients discuss with it with a physician and convince them to go to the hospital if they need to.
Still, right now hospitals are pretty crowded, Natko said. And reducing trips could be good for the entire healthcare system.
He said the healthcare system is a “cycle” which goes from patient to EMS to hospital to insurance companies.
“That whole cycle generates costs and movement and a lot of working pieces,” Natko said. “If we can reduce some of that, it’s better for the whole system.”
‘Sky is the limit': Telehealth in ambulances could change healthcare
Raubenolt has been in emergency medicine since the ‘90s working as an EMT before going to medical school.
She said the level of care that paramedics and EMTs are providing has quickly grown over that time.
“To me, it’s really amazing how the field of EMS continues to change and progress,” she said.
Right now ET3 is a pretty simple program, she said. As time goes on, it can develop and help provide greater care for the communities that need it.
Today it’s helping to keep people out the ER, but it’s also directing them towards other options like urgent care. In the future, the system could be used to get people to mental health services or detox centers. It could also lead to patients scheduling next day appointments, Raubenolt said.
It could be a huge help in rural areas, where emergency rooms, hospitals and doctor’s offices are further drives than in Akron.
“The sky is really the limit on where this goes,” Raubenolt said. “I think it will greatly improve access, particular in rural areas with less resources.”
Akron fire applied to be in the program years before the pandemic started. However, the large switch to telehealth has changed a lot of conversations around medical care and virtual visits, she said. People realized it could work in a lot of situations.
“COVID has taught us one thing, if nothing else, that telehealth does work,” Natko said.
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