911 telemedicine doctor callWhen the Los Angeles City Fire Department launched its new telemedicine program at its emergency dispatch center, the staff used physicians, nurse practitioners and physician assistants to screen potential COVID-19 patients and others calling 911 with non-life-threatening illnesses.

After six months, it’s paying off.

“We’re very excited about it,” says Dr. Marc Eckstein, the medical director for the Los Angeles Fire Department and commander, Emergency Medical Services Bureau.

“We rolled out phase one six months ago. It is dispatch initiated. The impetus was COVID-19, to keep resources available and minimize exposure.”

Los Angeles Tiered Dispatch System

911 telemedicine phoneTo activate the LAFD Telemedicine Program, an LAFD dispatcher screens all 911 medical callers using the Los Angeles Tiered Dispatch System protocols. If, during the initial interview of the 911 caller, the patient falls into a nonurgent category, is between the ages of 2 and 65, and has access to a smartphone, the dispatcher may refer them to a telemedicine provider.

Once the telemedicine provider has the call, a more in-depth screening is conducted, and a video connection is established via smartphone. As the face-to-face screening proceeds, the telemedicine provider at the dispatch center can take a number of actions to resolve the call.

These include everything from providing stay-at-home monitoring and treatment advice to sending a pre-paid taxi or dispatching an LAFD ambulance to transport the patient to a local ER, depending on the level of need.

911 telemedicine from your homeAfter two years in development, the first phase was initiated in Battalion 17—which includes Woodland Hills, Winnetka, Tarzana, West Hills and Canoga Park districts. After 90 days, staff looked at the metrics and escalated it from there. Recently, it launched field-initiated phase two, for low-acuity patients like those with COVID, the flu, nosebleeds and back pain.

“It’s a better use of resources,” he says. “The ROI is very compelling. We’re working on the reimbursement strategies right now. I think, ultimately, it will prove to be cost effective. It’s better for the patient, too, because it decreases response time.”

Eckstein says very few cities are treating patients like this, but many are “thinking about it.”

“As you might imagine, there are a lot of complexities,” he says. “But we’re very pleased. It’s better for patients. It is good for morale and it saves money. We’re looking into rapidly scaling to cover the whole city.”

Learn more about the LAFD EMS at https://www.lafd.org/about/emergency-medical-services-bureau

By Christina Fuoco-Karasinski