Telehealth in the field puts doctors (virtually) inside ambulances

by Kathleen Steele Gaivin

The Brecksville Fire Department has partnered with the MetroHealth System, through the Center for Medicare and Medicaid Innovation, to receive real-time advanced life-saving physician care right from a patient’s home or from the back of an ambulance.

The Emergency Triage, Treat and Transport (ET3) program could result in fewer trips to the emergency room for seniors who call 9-1-1, or at least provide them with an assessment by an emergency room doctor ahead of the ride.

“It’s a pilot project,” Brecksville Mayor Jerry Hruby said at the March 2 city council meeting. “It looks like it’s going to have tremendous success. We’ve heard nothing but good things about it thus far.”

Though the program was launched in Northeast Ohio in 2020, Brecksville’s participation in the ET3 program didn’t begin until January as the department first had to apply to be considered for the program.

Hruby said the administration was pleasantly surprised Brecksville was selected.

“We’re one of four agencies [three fire departments and a private ambulance company] in this region to be selected,” he said. “It gives immediate contact though the internet for a physician to speak to the paramedics and also to observe, and for the patient to observe the doctor if they are able to.”

Brecksville Fire Chief Nick Zamiska said ET3 is an outgrowth of virtual care that has evolved since the onset of the COVID-19 pandemic. The idea is to provide quality on-the-spot care and, at the same time, lower costs by reducing avoidable transports to the emergency department and unnecessary hospitalizations.

Sometimes as a result of a virtual visit, Zamiska said, paramedics will be instructed to take the patient to urgent care or arrange for the patient to follow up with their primary care physician for the problem. Of course, when medically necessary, a patient will always be taken to the emergency room.

“The goal of the program is to help people have a higher level of care right from home or the back of the ambulance with a doctor on call,” he added.

Often times, the doctor can provide reassurance the patient is looking for, Zamiska said. For example, if paramedics recommend the patient go to the hospital and the patient doesn’t want to go, sometimes the doctor might be able to convince the patient why it’s the better option.

Other times, Zamiska said, the physician may direct paramedics to simply treat the ailment at the scene after speaking with and observing the patient. When it comes to treating diabetics in crisis, for example, this could mean that with the click of a tablet, paramedics can have the doctor assess the situation, treat the patient on the scene and counsel the patient on at-home follow up care instead of taking them to the emergency room.

Although the ET3 program comes from Medicare and Medicaid, Zamiska said the city utilizes it to treat everyone who can benefit, regardless of insurance carrier or whether the patient has insurance at all.∞