Long stretches of “wall time” have been an ongoing challenge for paramedics from Cosumnes Fire Department and other emergency medical agencies for years.
After a patient calls 911 and paramedics transport the person to an emergency room, the first responders must wait with the patient there until hospital staff admits him or her. Paramedics cannot leave the patient in order to respond to another emergency call. This situation can be difficult for first responders if the emergency room is crowded and short-staffed.
Cosumnes Assistant Fire Chief Rick Clarke said that a wall-time period can last anywhere from 74 minutes to 10-plus hours.
“Because of that, ambulances are in short supply in Sacramento County — not necessarily because the fire services don’t have the resources, but because that patient transfer from the paramedics to the hospital is just taking too long,” he told the Herald.
Last month, Cosumnes Fire became Sacramento County’s first fire agency to join the Tele911 program. It is a telemedicine service that provides online support from a Tele911 physician to patients in their homes if it’s determined they don’t need to visit the emergency room.
Tele911, a Pasadena-based service, addresses “low acuity calls” or cases that don’t require emergency medical care. Examples include a patient experiencing coldlike symptoms for a few days, and a patient needing a medication refill.
“Many calls were from patients who run out of medicine and their doctors are not getting back to them,” Clarke said about 911 calls his staff received.
Under Tele911, Cosumnes paramedics arrive at the patient’s home to see if the patient needs to be transported to a hospital based on the patient’s symptoms. If it’s considered to be a possible low acuity call, then a paramedic brings out an iPad to access the Tele911 application. The first responder connects with a Tele911 physician online and uses the iPad’s camera to help the physician interact with the patient and see his or her physical state. Afterward, the physician can recommend a medical treatment or direct the patient to medical resources.
Tele911 will also assign a caseworker to reach out to the patient to see how they are doing.
“It’s an alternative to transporting a patient to an ER just to get a diagnosis on what may or may not be an emergency,” said Brad Bihun, the head of operations for Tele911.
Clarke described telemedicine’s value for first responders.
“We can’t control hospital staffing and what they can do for us,” he said. “Telemedicine is something we can control.”
The assistant fire chief said that Tele911 is currently used by staff members at Station 45 in Galt and at Station 75 in west Elk Grove. During his interview, Clarke said that his staff had used Tele911 services about 17 times and they all had positive outcomes.
He mentioned that there are times when an emergency room visit is not the best solution for a patient.
“This is really about access to healthcare for people with the concept of the right type of access for the right patient at the right time,” Clarke said. “Not everyone needs to be rushed off in an ambulance to the emergency room.”
He noted that paramedics often visit people with dementia who live in care facilities where they slipped and fell. An emergency room could be a “hostile environment” to them.
“Unfortunately, most of these dementia folks will now spend upward of two to six hours in wall time with our paramedics in a pretty hostile environment to them. And they actually fare worse for it,” Clarke said. “(Tele911) will give them opportunities for a telemedicine visit, get evaluated by a physician and relieve some of the concerns of the facility they’re in.”
He emphasized that patients still have the right to refuse Tele911 services and instead request a visit to the emergency room.
Bihun said there are plans to launch the Tele911 program for the Sacramento City Fire Department this month. The service is also being used in Kern and Alameda counties, he added.
“We look at it as being the new way of (emergency medical service) because of all the struggles and operations of EMS with the increased call volume,” Bihun said.
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