Boston, Worcester EMS agencies use telehealth to preserve ED capacity

In Boston, 911 callers can elect to speak with a physician rather than send an ambulance; in Worcester, EMS providers are equipped with a telehealth mobile app


Melissa Hanson
MassLive.com, Springfield, Mass.

BOSTON — Boston EMS was already working on trying to make the use of telehealth part of its routine when the COVID-19 pandemic emerged.

As the respiratory illness started to fan across Massachusetts, EMS companies started to change the way they operate, donning protective gear and working with caution, never knowing which patients could be positive for the highly contagious COVID-19, caused by the new coronavirus.

An ambulance on a call drives on Commonwealth, Ave., Friday, April 24, 2020, in Boston. Boston 911 callers now have the option to speak with a physician rather than send an ambulance, a measure implemented to prevent emergency rooms from overflowing during the COVID-19 pandemic.
An ambulance on a call drives on Commonwealth, Ave., Friday, April 24, 2020, in Boston. Boston 911 callers now have the option to speak with a physician rather than send an ambulance, a measure implemented to prevent emergency rooms from overflowing during the COVID-19 pandemic. (AP Photo/Michael Dwyer)

Technology has proved to be a valuable tool amid the pandemic. Telehealth techniques are now being utilized by dispatchers, paramedics and EMTs, helping to connect patients with the best resources for their condition and helping to keep emergency rooms from being overwhelmed.

For Boston EMS, telehealth services just started rolling out in response to the pandemic and are being used at dispatch and on the ground by EMTs and paramedics.

If someone calls 911 and describes symptoms, they can be connected through the push of a button with physicians based at Boston Medical Center, explained James Hooley, the chief of Boston EMS. From there, physicians can consult with the patient and suggest care options, like going to a local clinic, or advise to send an ambulance.

“It could be for other more minor complaints like a dental emergency or maybe some anxiety or in some cases, somebody with some very minor respiratory or other problems or aches, who are looking for a place to get tested and again, an emergency room is not the best place for that," Hooley said.

Up to 45 times last week, a caller opted in for the telehealth physician consultation, according to Hooley.

“If you had not been exposed [to coronavirus] maybe even just bringing someone to the emergency room has the potential of doing that," Hooley said, “so you want to weigh that.”

In the field, paramedics and EMTs are donning protective gear, communicating with the patient and determining if they’re a good fit for telehealth consultation. In those cases, they’re using phone calls and some video conferencing to connect patients with doctors.

Hooley stressed that telehealth is not a substitute for someone who is really sick and needs immediate medical attention. And, patients can always say they’re not interested in the telehealth option.

In Worcester, paramedics using telehealth earlier this month found it especially helpful in keeping hospital beds clear as the predicted mid-April surge period approached, said Mike Hunter, the Deputy Chief of Worcester EMS.

Worcester EMS worked with medical directors and IT services from UMass Memorial Medical Center, which owns and operates the EMS service, to organize paramedics using iPhone apps to connect with physicians. The method is being used from patients’ homes, as well as with a van Worcester EMS has been using to assist members of the city’s homeless population.

“If we do have patients that have flu-like symptoms but maybe don’t necessarily need to go to the emergency room … we can talk to them about maybe you want to just stay at home. Maybe you don’t want to go to the emergency room, you can always call us back," Hunter explained.

After video-chatting with a physician, paramedics can give a patient a swab test for coronavirus if that’s the best option.

Helping to limit potential exposure to the virus, telehealth has worked to everyone’s benefit, Hunter said.

“It’s a sad time but everyone’s stretching their legs a little bit and they’re getting to try some new stuff, to try to do better for the population,” Hunter said. “We’re really thinking a little bit outside of the box here.”

Hunter said he feels Worcester EMS will keep using telehealth methods after the pandemic.

When things eventually return to normal, Hooley hopes to pitch bringing telehealth methods into Boston EMS’ daily routine. From using telemedicine through the pandemic, Hooley said he believes Boston EMS will be able to present a well-documented demonstration of how efficiently the method works.

The measure could be a big help in the future, during snowstorms, for example, Hooley said.

Hooley wanted to remind residents that they should still call 911 if they have a life-threatening emergency. EMS companies and hospital emergency rooms have reported seeing fewer patients coming in than usual during the pandemic. It appears that some people have been staying at home trying to recover from injuries out of fear of going to the hospital. That delay has lead to amputations and patients facing permanent damage after ignoring the first signs of a stroke in some cases, health officials said last week.

Hooley said Boston EMS understands the anxiety but reiterated that the ambulances are cleaned between every patient.

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©2020 MassLive.com, Springfield, Mass.

McClatchy-Tribune News Service

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