“Rural emergency medical services (EMS) provide essential care to remote and isolated communities, however, they are often overstretched, understaffed, and underfunded.” [1] – National Advisory Committee on Rural Health and Human Services
The gap between EMS need and EMS capacity for America’s 60 million rural residents is large. While the solutions required to close the gap are multi-faceted, one is available now and has been proven to deliver almost immediate relief.
Hospital-based specialty telemedicine.
Typically thought of primarily as a means of ameliorating the physician shortage in rural areas, specialty telemedicine has another powerful advantage: getting patients the care they need at their local hospital and avoiding a lengthy transfer to another hospital that can be detrimental to their health outcome.
Avoiding transfer preserves emergency response capacity.
In a rural community that may have just one or two staffed ambulances, having one of those ambulances unavailable, even for a short time because it is needed for a hospital-to-hospital patient transfer, compromises local emergency response. That means longer wait times for on-scene emergency assistance for a car crash, fall at home, industrial or hunting accident, rattlesnake bite, or high school sports injury. Those longer wait times easily translate to poorer outcomes.
While many interhospital transfers occur for a good reason like providing access to a life-saving procedure unavailable at the rural facility, a large number are clinically unnecessary and avoidable by making specialty care available at the originating hospital.
Every year, there are an estimated more than 5.1 million interhospital patient transfers. One study of 193 million emergency department encounters by Medicare beneficiaries found the median transfer distance to be 33.7 miles, but the distance can often be 40 to 60 miles or even further. That can be two or more hours of paramedics’ time.
These transfers happen when there is no local specialist to provide the care the patient’s condition requires.
When a stroke patient presents at his local hospital emergency department but cannot be treated because there is no neurologist, he has to be transferred to another hospital. When a patient needs surgery but there is no consistent critical care coverage to manage conditions post-surgery, she has to be transferred to a facility that can both perform the surgery and monitor the patient after surgery. When a patient needs to be admitted for a heart condition, but the hospital has no cardiologist, he has to be transferred.
“The advantages of hospital-based specialty telemedicine for rural hospitals and patients are many, but preserving rural EMS response benefits entire rural communities,” said Joshua DeTillio, CEO, Access TeleCare. “Delays in emergency response can have a material impact on outcomes and quality of life for someone in a car accident, a high school athlete injured on the field, or a ranch hand trapped under a piece of farm equipment – all scenarios that regularly play out in rural communities. Avoiding using EMS for hospital-to-hospital patient transfers means EMS is available when emergencies like these happen.”
NEMSIS data show the 5.1 million interhospital transfers involving EMS represent the second largest EMS service category, behind only emergency response, comprising 9.1% percent of all EMS service requests. Reducing these interhospital transfers would mean adding valuable capacity to their primary emergency response responsibility, reducing wait times for response, and improving outcomes.
A significant portion of interhospital transfers can be avoided with specialty telemedicine. They can be avoided by having the specialist the patient needs at the original hospital. Virtually.
With our teleNeurology programs in place, for example, our hospital partners do not have to engage local EMS to transfer a stroke patient to a more distant hospital. One regional health system of six hospitals saw a 60% reduction in transfers of neurology patients after implementing teleNeurology.
With telePulmonology and critical care, another rural hospital west of Dallas, Texas saw a 36 percent decrease in ED patient transfers Still another hospital, a North Carolina medical center, reduced transfers by 15 percent when it created a Virtual ICU with our telePulmonology and Critical Care program.
With telemedicine, hospitals can diagnose, stabilize, and treat the patient at the presenting hospital. We do that by equipping them with virtual access to a pod of dedicated neurologists obligated to clinically urgent response times for strokes, epilepsy, severe migraines, and many other neurological conditions. Patients are diagnosed, treated, and discharged all in their local hospital. Without transfer.
Scaled across other specialties – cardiology, infectious disease, pulmonology and critical care, nephrology – the transfer reduction impact is exponential, as is the expansion of EMS capacity.
Bottom Line:
Rural communities need EMS for emergency response. Deploying telemedicine programs for specialty care in hospitals reduces the need to transfer patients to another, more distant hospital and frees up rural EMS teams to more quickly respond to emergencies, saving lives.
[1] https://www.hrsa.gov/sites/default/files/hrsa/advisory-committees/rural/access-to-ems-rural-communities.pdf
