80 Los Angeles Fire Department Telemedicine Program: An Emergency Dispatch Center Based Pilot

Abstract

The Los Angeles Fire Department (LAFD) has experienced an unprecedented growth in 911 calls for emergency medical services (EMS), including a disproportionate growth among low-acuity 911-callers. Managing these low-acuity calls is even more critical in the era of COVID-19 (CV19) where EMS over-utilization puts both EMS providers and patients at risk. The LAFD Telemedicine Program (LTP) integrates advanced providers (AP) (nurse practitioners, physician assistants, and emergency physicians) into the Los Angeles Tiered Dispatch System. 911 callers between the ages of 2 and 64 years old with low-acuity complaints and no priority symptoms are transferred from the emergency medical dispatcher to the AP. Through a telemedicine platform, the AP can perform an assessment and release the patient without dispatching field emergency resources or dispatch the appropriate EMS field resource or a taxi to transport the patient to an emergency department (ED) or alternative destination. The objective of this pilot study is to describe the initial experiences of this novel program. This is a 2-month retrospective review from April 6 to May 31, 2020 of electronic medical records for 911-calls that were referred to LTP. Additionally, all patients who received care through LTP were contacted within 24 hours via phone to evaluate the need to access further emergency care through 911 or an ED and to assess their overall satisfaction. The primary outcome is the disposition of patients who were triaged to the LTP. Secondary outcomes include the need for further emergency care, and patient satisfaction. Descriptive statistics are used. During its first 2 months of service, the LTP attended 159 patients, of whom 49 (30.8%) were treated via telemedicine alone and no resources were dispatched (“No Send”); 9 (5.6%) were sent for further care via taxi; and 101 (63.4%) were dispatched and evaluated by EMS providers on scene. Of these 159 patients, 94 (59.1%) completed a brief phone survey. No patients reported accessing further emergency care through 911 or an ED after their LTP encounter. Overall, the mean satisfaction score of care provided by the LAFD was 9.3 out of 10. As a result of LTP intervention, 58 LAFD field resources remained available for the next time-critical call, >100 sets of PPE were preserved, and countless potential CV19 exposures were avoided. Preliminary data suggests that dispatch-initiated telemedicine with a “No Send” option can be safely integrated into EMS systems to preserve emergency resources, reduce exposure of field medical providers, and provide quality care for low-acuity calls. Further, larger studies are needed to evaluate safety and efficacy.