Telemedicine During Disaster Relief

In our journey with telehealth technology, we’ve seen digital communications tools leveraged positively in a variety of clinical settings, including:

• Cutting unnecessary hospital visits and improve the speed and accuracy of diagnosis for on-the-job worker’s compensation claims;
• Treating elderly patients with chronic diseases in the comfort and safety of their homes;
• Reducing hospital readmission penalties;
• Connecting networks of multi-specialty providers with caseworkers, other clinicians, patients and their families for better care continuity;
• Managing patient cohorts in population health management.

Today, we’re using telehealth in hospitals, in the small practice, in schools, in prisons, and just about anywhere else and for almost every medical specialty. But there is a subset of healthcare delivery that uses telehealth that may surprise you.

Telehealth is now used as a tool to advance care and facilitate recovery in disaster zones.

“Telehealth is now a critical part of the first responder toolkit, giving providers the help they need to create connected care platforms that improve care coordination and management.”
mHealth Intelligence

We seem to be living in an era of extreme weather events. Last year, the cost of recovering from the series of floods, fires, snowstorms, cold or hot weather, and more, topped $155 billion, according to The Washington Post. As we go to print, we’re just entering storm season 2019 but estimates suggest that the cost of responding to these “natural” disasters will likely increase.

Popular Science suggests that these extreme events compound public health risks by creating not only physical suffering but also emotional stress. But how can clinicians respond when acute weather patterns have wreaked havoc, including displacement from home, impassable roads, business closures, and more.

Assuming the cellular infrastructure and Wi-Fi for telemedicine is still standing, we’ve witnessed telehealth technology aiding disaster victims in these ways:

• Set up and launch of remote “pop-up” healthcare clinics, which allow for basic care and access to specialty consults.
• First responders can coordinate ambulatory treatment and evacuation with telehealth access to remote specialists.
• Telemental health visits to help survivors cope with trauma after-the-fact.

One of the biggest problems during a natural disaster is the collapse of the healthcare infrastructure. We know from hurricane relief that hospitals simply can’t handle the increased demand in the face of employees not being able to show up for work and with dwindling supplies. Telemedicine gives us a way to support these critical infrastructures at a time when they need it the most. Out-of-state physicians and mid levels can lend a hand to help reduce the pressure on local healthcare providers.

Recovery from natural or human-made disasters with the use of telehealth tools was mentioned in an interesting article from the Journal of Medical Systems in 1995. Researchers sought to collate data on how telehealth communications technology could be used for “predisaster, acute, and postdisaster rehabilitation activities.” The article suggested the growing role that telemedicine could likely play in the growing field of disaster medicine.

Their prediction has come true, and telehealth has an increasing role in improving the response to disastrous situations. Fire and rescue, EMTs, Red Cross, and the military are now using telemedicine via smartphones and new “rugged tablets” designed for first responders. These tools are improving on-the-ground immediate response to any unexpected crisis. mHealth Intelligence reports:

Hospitals and health systems are now developing telemedicine networks to stay operational during disasters or to facilitate care coordination and management when they’re forced to evacuate patients and suspend operations. These same networks enable health systems to triage care at the scene of a large accident or mass-casualty event, or coordinate care and treatment during a pandemic.

Some examples of how virtual care can be used during these situations include:

• Critical Care published a case study of a nightclub fire in Brazil describing how first responders established a telemedicine hub more than 700 miles away to coordinate triage and treatment with the responding community hospital near the disaster. Ultimately, the fire killed 242 people, with 620 people needing immediate care. Another 80 were admitted for ongoing treatment. The study stated, “Telemedicine allowed emergency staff to discuss these challenging cases with specialists from around the world.” All of the 80 critically injured people survived with the support of a telehealth network.
• Military Medicine published a surprising article on one of the most common methodologies for employing telehealth applications in the military –teledermatology. While telehealth is commonly used by the military in the field within deployed units and also during disaster response, teledermatology is used most frequently to diagnosis dermatitis in war zones. NATO and the U.S. military are using digital technology to improve the coordinated care efforts to disasters around the world.
• Becker’s Hospital Review reported that four Florida hospitals provided free telehealth services to residents during Hurricane Irma. The services connected residents to doctors via cell phone apps or remote crisis units connected to the hospitals.

Popular Science quoted data that showed an increase in the use of telehealth tools after Hurricanes Harvey and Irma. Most were first-time users and out-of-state doctors handled most of these encounters. Medical triage and consultation can help patients determine if their problem is urgent enough to go to the ER or if they’re safe to shelter in place. Patients with chronic conditions can use telemedicine to reorder prescriptions or receive health maintenance and support of their illness. The article concluded, “Relying on direct-to-consumer telehealth services may help relieve the immediate burden on local health care system so that limited in-person care resources can be reserved for those patients with the greatest need.”

“The hurricanes of 2017 produced a watershed moment for telehealth.”
mHealth Intelligence

In a wide-spread disaster, healthcare providers must not only be prepared to handle triage and care delivery, they must also harden their physical infrastructures in order to keep needed technology tools available. This includes the basics, such as electricity, as well as a broadband network able to communicate and share data. For example, Modern Healthcare reported that Texas hospitals used submarine flood doors to protect critical architectures from flooding during hurricane Harvey.

It’s clear that telehealth offers real benefits both in clinical and crisis clinical settings. It’s just another example of how useful these tools are for providing healthcare in even the most challenging environments.