Getting telehealth where it’s needed when all hell breaks loose

Telehealth was a surprise technology at the start of the pandemic. In its simplest form, telehealth is easy to understand: turn on a computer, start a Zoom session and talk to a doctor without risking being trapped in a sprouted office with a group of sick people.

But more than video consultations with medical professionals, telehealth uses Internet and intranet technologies to facilitate many medical activities associated with health care and the well-being of body and mind. It is either real-time, or a variation of store-and-forward data exchange, or digitized medical knowledge.

What if communities used telehealth apps and services to help local authorities, medical professionals, neighborhood leaders and neighbors respond to natural disasters and facilitate medical and health care? It takes a full understanding of telehealth and creativity, and high-speed internet, of course.


On December 10, when major tornadoes swept through the South and lower Midwest, Kentucky seemed to suffer the brunt of the chaos. A tornado touched down and barely got away, tearing about 165 miles, leaving a trail of destruction. In Bowling Green, Kentucky, thousands of homes were without power and countless structures were destroyed. In Arkansas, dozens of buildings were razed, including a retirement home.

The United States faces increasingly destructive natural disasters – catastrophic wildfires and earthquakes on the West Coast, tornadoes in the Midwest, hurricanes and flooding on the Gulf and East Coasts. But telehealth can help.

“We have seen the immediate impact of some form of telehealth following natural disasters such as Hurricane Maria in Puerto Rico, the earthquake in Haiti and the tsunami in Japan,” said Dr Milton Chen. , CEO of telehealth provider VSee.

EXPAND THE REACH OF FIRST RESPONDERS

Telehealth is now integrated into the protocol for first responders.

“In some places, regulations have been put in place over the past two years that allow first responders to ‘treat on the spot,'” said Colin Banas, chief medical officer at telehealth and health informatics provider DrFirst. . “These rules allow them to do on-site assessments and initiate a telehealth visit with a doctor to make treatment and transport decisions. When it is more appropriate to treat at home or in an urgent care center, you save the person from going to a crowded emergency room.

In many parts of the country, cities are customizing motorhomes, vans, buses and ambulances with telemedicine tools, expanded medical capabilities and wireless connectivity to bring health care directly to communities, especially to underserved populations. During disasters, these mobile medical units can allow people to receive a wider range of care and consultations, possibly in residences or protected places.

CREATE EMERGENCY TELEHEALTH CENTERS

Low-income urban residents seem to be easily overlooked in times of disaster. When Hurricane Katrina slammed into New Orleans in 2005, killing more than 1,800 people, it was also one of the most epic public health failures in US history. It took months for poor neighborhoods to regain internet connectivity, if they ever did. Learning from this lesson, cities should use federal money for broadband and health care, build emergency health care capacity in social housing in the event of a disaster, and also leverage technology. normally.

A major disaster can knock out power for a week or two while rendering highways and streets unusable for a month, leaving communities isolated. Before a disaster strikes, communities can designate various buildings throughout the city (such as libraries, auditoriums, and gymnasiums) as “telehealth generators and centers.” Move appropriate equipment, including fixed wireless service and telehealth kiosks, depending on where the disaster occurs.

Rural jurisdictions should build stand-alone, high-powered Internet stations along rural roads to hospitals that emergency vehicles can connect to in case patient conditions deteriorate or travel delays increase. Designate schools, libraries, water towers, sports arenas and other buildings as “telehealth stations” for first responder vehicles and mobile medical units, and increase internet capacity. Open these stations in the event of a natural disaster to ordinary people in need of telehealth who might be cut off from medical help for days or weeks.

Get ready to see drones take off as an option for distributing medicine and medical supplies. It might not be pretty or cheap, but drones could potentially be used to get some blood work and basic lab tests delivered to medical facilities.

And drones aren’t the only emerging technology that will help expand health care in emergencies.

“As the technology improves and is more widely adopted, telehealth will have a greater impact on communities recovering from natural disasters,” Chen said. disaster and by rebuilding infrastructure.

THE TELESTROKE PROJECT COULD BE A MODEL FOR DISASTER RESPONSE

Arkansas once led the United States in stroke deaths because less than 1% of stroke patients there received the decoagulation drug alteplase (tPA) on time. A statewide public broadband network turned the tide in 2008, and Arkansas reduced stroke-related deaths and fell six spots nationwide in 2016.

As part of the effort to reduce stroke deaths, the Arkansas Department of Human Services has partnered with the Remote Health Center at Arkansas University of Medical Sciences (UAMS) to form Arkansas Stroke Assistance through Virtual Emergency Support (AR SAVES) which operates over a super-fast public broadband network. UAMS has connected 54 of Arkansas’ 80 hospitals to a telestroke “subnet” that is now connected to several other health and telehealth programs throughout Arkansas’ hospital systems, including including a huge trauma care program. These links provide redundancy and failover capabilities in the event of floods, tornadoes or other disasters that make it difficult to access emergency resources for large hospitals.

Tornadoes, hurricanes and earthquakes can cause broken bones and internal injuries.

Beyond stroke care, UAMS has partnered with the Arkansas Trauma Communication Center (ATCC) to create an orthopedic program for hand injuries. Similar types of telehealth for orthopedic trauma can support small hospitals and urgent care clinics.

“If there was a big explosion near one of the hospitals, that’s where patients could be triaged and treated in consultation with specialists from other hospitals via telehealth,” said Tina Benton, director of the UAMS.

Other states can borrow Arkansas’ idea to create another element of a telehealth-focused disaster response system. Some states may have networks similar to the one driving UAMS telehealth, such as the Corporation for Educational Network Initiatives in California (CENIC). CENIC has partnered with the California Telehealth Network (CTN) which provides connectivity and telehealth services to hundreds of healthcare facilities statewide.

EVERYTHING REVEALS AT BROADBAND

Ultimately, the success of these solutions hinges on the quality, capacity, reliability and affordability of the broadband infrastructure. With all the federal and state subsidies available or in the works for broadband and healthcare, it’s time for communities to step up and get going. Successful implementation of these funds requires significant planning and coordination by many community actors. Networks need to go well beyond health facilities.

“Community broadband built by power co-ops or electric utilities…is designed so that data and power are immediately rerouted around floods or other damage anywhere on the network. These networks rarely experience downtime, despite disasters,” said David Little, vice president of network operations for North Georgia Network.

About Laurence Johnson

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