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Call9 (YC S15) Delivers On-Demand Doctors in Emergency Situations
- xiaosongmu 11y agoHey HN! XiaoSong here (cofounder/CTO at Call9). Would love to answer any questions people might have about the product.
- scott_karana 11y agoAre there any liability aspects if a nurse or other practitioner doesn't call 911, in favour of calling you? Or does your product also alert ambulance services, while simultaneously providing advice?
- xiaosongmu 11y agoIf the patient needs an ambulance, the Call9 doctor can easily order one. One advantage of this system is that the doctor can prep the EMTs on what they need to know as they're en route to the emergency. The TC article elaborates on this a bit.
- scott_karana 11y agoCool. That sounds sensible. Good luck! :-)
- avelis 11y agoXiaoSong, Interesting service. My first question is what differs Call9 from any medical first responder? My second question: Thinking long term. Where do you forsee the barriers of our reactive emergency services in the U.s. from making traits of Call9 more standard.
- xiaosongmu 11y agoGreat question - Call9 is different because we immediately put you in touch with an emergency doc, even as the first responders are trying to get to you. By the time EMTs get to the site, we have already begun triaging. And, when first responders do arrive, our physicians help make decisions based on their extensive medical expertise. Right now, when EMTs get to the site, they don't know anything about the patient. With Call9, EMTs can begin work right away upon arrival. As for long-term, we want this kind of service to reach everyone - that's certainly our end goal. But traditional emergency services have to completely alter their business and operational models to offer what Call9 offers.
- civil2 11y ago> Right now, when EMTs get to the site, they don't know anything about the patient. This is completely not true. You really need to stop lying when advertising an emergency medical service that affects lives. Nothing personal.
- FireBeyond 11y agoMost EMTs and paramedics are trained to 'disregard' physicians on scene (notwithstanding common sense - am I going to listen to a trauma doc? Am I going to listen to a podiatrist?) - this is somewhat different. When Call9 has a private transport arranged by the ambulance service, whose medical license do the EMTs and paramedics operate under? The county/hospital associated therewith? The ambulance service? Your physicians? And depending on the answer to that, what does the County MD have to say about that? Or the DOH EMS section for that matter? If your ambulance service's EMS personnel are operating under county auspices, and that county has a medical protocol, how does that mesh in with instructions from your physician? What happens if your physician's instructions differ from the county protocol? Because that could and will be an issue. An instruction from your physician could lead to a paramedic losing their job (and has happened, when physicians have instructed the on-scene medic to do procedure X when the paramedic is not authorized to do so). Do you have a clear policy for this? "Right now, when EMTs get to the site, they don't know anything about the patient. With Call9, EMTs can begin work right away upon arrival." This is, as someone else noted, a very hand wavy, dismissive and inaccurate description. You have access to patient history from facilities, and that is a fantastic resource. But to say that when I roll up on scene that all I know is "Go to address X for sick person" is not remotely true. "You'll be seeing a 65 year old male with sudden onset left arm numbness, shortness of breath, shoulder pain with no known cause, and no relief. Pt has a previous cardiac history and has taken prescribed nitro with no relief. Pt caregiver states that they have been in good health with no recent illness." is a sample 'short report' I might get en route. There's a good amount of detail there. What's happening on the back end? Two 911 operators listen to the call, the Call Receiver works through a flowchart to determine base complaint and appropriate response. In tandem, the Dispatcher begins assigning unit(s) and dispatching them over the air. After the initial tones to get the units rolling, whilst the call receiver continues to gather more information, the dispatcher is preparing a short report to give more detailed information to the responding units.
- brandonb 11y agoVery cool! I think this could help with sudden cardiac arrest, where the heart stops pumping blood effectively and death happens within minutes--faster than an ambulance can arrive. http://my.clevelandclinic.org/services/heart/disorders/arrhythmia/sudden-cardiac-death http://my.clevelandclinic.org/services/heart/disorders/arrhy... The survival rate of sudden cardiac arrest is 8%, and it kills about 350,000-400,000 people in just the US. It's our #1 killer. The difference between a life saved and a life lost is whether non-medical bystanders can intervene and perform CPR or use an AED within the first couple of minutes.
- tpeck 11y agoSCD (sudden cardiac arrest) is a great example of when having a highly trained healthcare professional at the scene early can save lives. It's been well shown that there's a 'bystander effect' when it comes to CPR, which can keep the brain oxygenated in SCD and keep people alive before the ambulance arrives. The bystander effect, is that CPR is often not done when it needs to be (even by those who have been trained in CPR) because they are fearful of doing something wrong. With a doc there immediately, we can encourage bystanders to do CPR immediately and again save lives not otherwise being saved.
- FireBeyond 11y ago"With a doc there immediately, we can encourage bystanders to do CPR immediately and again save lives not otherwise being saved." That definitely helps. But is not unique to Call9. Call 911 and you'll get dispatcher-assisted CPR. Counting compressions with you, talking you through the process.
- tpeck 11y agoThat is true. But there's a difference in being able to see the patient vs. having a bystander explain the situation verbally. There's no question that a dispatcher brings value to the CPR process - I think that we can bring more.
- FireBeyond 11y ago
- trisomy21 11y agoThis is really interesting. I know it's not a replacement for it, but 911 seems so inefficient and outdated to me today. I'm excited to see how this company progresses. Small improvements here can really save lives.
- uber_for_cats 11y agoIt's not going to seem so outdated when you or one of your loved ones has a heart attack, and the ambulance is rushing him to the hospital where an interventional cardiologist is going to unblock his/her heart arteries in an operating room.
- tpeck 11y agoI think the EMS system does what it can for our patients, and paramedics save lives. As an ED doc and resident, I served as med control for EMS and saw first hand all of the difficulties they have with an outdated system created in the late '60s. Like most industries, there is lots of room for improvement, and being scared of change should not hold us back from exploring how we can save even more lives and help more people.
- trisomy21 11y agoWell, one of the reasons why the medical response aspects of 911 feel so outdated and inefficient to me is because the system has to treat all calls as if they are life threatening heart attacks, when most often they are not.
- uber_for_cats 11y agoRight, so this startup introduces an additional delay / filter before 911 is called. I would not want that for my loved ones in an emergency.
- tpeck 11y agoSurely your right to not use our product. But, we've already saved lives, decreased transport times, identified conditions in patients that otherwise would have been ignored (because we have doctors doing the assessment, not bystanders/nurses/EMS). The way the system works is that there are many triage steps before a patient ever sees a doctor - we've flipped that model and put the physician (who is ultimately the one making the medical decision) as the first step rather than the last. To us (and our patients), it just makes sense.
- tcook 11y agoWhy not just call an ambulance?
- trisomy21 11y agoSo you can get an ER doctor as the first point of contact instead of the last.
- xiaosongmu 11y agoMost people don't realize this but there are a lot of inefficiencies with the current 911 system that jeopardize the safety of patients. It takes on average over an hour to see an MD from the time you call 911. In that time, a lot of triage and diagnostics, and even treatment can happen. We cut down that time drastically. Additionally, a very large portion of 911 calls come from patients who should not be going to the emergency room. Going to the emergency room is always exposing yourself to risk (such as hospital infections), not to mention unnecessary stress and pain. For the elderly, or very young patients, or very ill patients, this undue (and often unnecessary) stress can have very detrimental effects on the patient. Call9 can prevent that portion of calls from going to the hospital. So with call9, we either A: provide safer, better service on top of traditional 911, or B: we skip the emergency room altogether.
- FireBeyond 11y agoThis confuses me. These aren't necessarily benefits to your service. If the patient needs an ER visit, you are getting one, however it is initiated. Community-outreach / in-call? Absolutely. I love that aspect of your service. Your "A" and "B" benefits seem to be the same, not an either-or. The safer route in A comes from skipping the emergency room in B where applicable and appropriate. I do like that you cut the waiting time to see an MD, regardless of the situation. Diagnosis is an important first step. But I'm curious about the 'medical kit' provided. Because diagnosis is limited to cases that don't require (for example) lab services, and for non-emergent cases, great. Prescribe the appropriate medication or treatment regime. For anything else, the outcome is likely to be the same - not much is changing in that "golden hour" (with all caveats thereto) in terms of definitive care. I realize I may be coming across as cynical or skeptical in many of my comments, but I really do wish you success and would be very happy to talk with you further. I'm just raising some of the thoughts and questions that come to my mind as a first responder and, as I'm sure anyone will agree, anything that alleviates pressure on the 911 system is "A Good Thing(TM)".
- uber_for_cats 11y agoIt looks like this product introduces an extra delay before an ambulance is called - terrible idea. When you have a heart attack, you want an ambulance, not an Uber driver (UberFIRST-AID) or a Skype call with a doctor (this startup).
- trisomy21 11y agoActually, from my understanding, this is more like an ER doctor acting as the ambulance dispatcher. Instead of waiting on a minimally trained phone operator to get you an ambulance, you can have an actual doctor figure out what's going on while you wait. Seems like a big improvement to me, you get to a doctor first rather than last.
- tpeck 11y agoGood point trisomy21. Amazingly, it take 64 minutes on average to see an MD after calling 911! With Call9, you see one immediately.
- tpeck 11y agoWe get an ambulance to the scene faster than 911, which is a great benefit of using Call9 - I completely agree that it would be a terrible disservice to cause a delay in emergency response. Because we have a direct line to an ambulance service dispatcher, we don't first need to go through a central call-center like other 911 emergencies. Therefore, we save time by a) not having to explain if its a medical vs. police/fire emergency, b) not explaining our location - they know it already, c) having the doctor tell them if advanced life support is needed vs basic life support.
- uber_for_cats 11y agoHow can you claim to get an ambulance to the scene faster than 911 (on a practical scale)? 911 / the ambulance are first responders.
- tpeck 11y ago
- FireBeyond 11y agoA few comments (which aren't necessarily a complaint about your product) from a firefighter/paramedic: 1. Nursing home staff should be able to recognize typical and atypical signs of cardiac arrest ('should' being a key part of this). 2. My county's 911 service (serving 300,000 people) has the following response times: 6.0min for BLS (Basic Life Support) services, 6.1min for ALS (Advanced Life Support). 15 minute response times would be... a whole new world. 3. Impending cardiac arrest, I'd be curious as to what the 'difference made' would be. Administering ASA (aspirin)? Not emergently significant. Nitro? Typically self-administered, and again, I'd question the quality of a nursing facility that didn't feel comfortable administering such drugs based on vitals and symptoms alone, without needing the assistance of an ED physician (granted, several in our area as a policy/liability concern will immediately phone 911 as their 'treatment plan' for these situations - but similarly, these same facilities would be on the low end of the bell curve for utilizing a service like Call9). 4. Similarly, a nursing facility that wasn't vigorous in training and utilization of CPR/AED (because that's the number one hope for an arrest patient, high quality chest compressions - in the absence of tele-EKG for administering cardiac drugs for certain arrhythmias and dysrhythmia - again, if your 911 arrival time is 15+ minutes, perhaps...) I can definitely see a use case for anything that moves from "proactive" (nor necessarily in a positive, often actually a negative sense) ED / 911 visit called by a skilled nursing facility. Indeed any increase in the use of a community outreach / service for high risk patients is a good thing. I did read that you are indeed going to supply EKG and US to clients, and this helps - but I'd be curious about the value of some interventions. A presentation of impending cardiac arrest should be a first call to 911 (I realize your example presented with constipation and stomach pain). And in the context of having to talk a nurse through an EKG, what interventions do you really expect them to be able to reliably perform (start an IO/IV)? I am intrigued though, to see how this could grow, but it seems to me that your target might want to be 'urgent care' as much as emergency medicine. Of course, where 911 response truly is that slow (and I know that it can be in several parts of the country), then anything that helps the patient's prognosis cannot be a bad thing.
- uber_for_cats 11y agoLook their own sales pitch in the article is the death knell for this startup. Protocol with 911: * Person has suspected heart attack symptoms. * 911 is called, short triage on the phone. * Ambulance is dispatched. Protocol with this new startup: * Person has suspected heart attack symptoms. * Skype with doctor, short triage on Skype. * Doctor quickly trains nurse (conveniently available on site) to take EKG (presumably while patient is grasping his chest). * Nurse takes first EKG in her life. * Doctor reads EKG, and calls 911. Who in their right mind would call a gatekeeper instead of 911 in an emergency?
- mangeletti 11y agoDO NOT visit call9.com If you were curious, like me, why Call9 didn't use call9.com, don't visit that domain to find out. It will redirect you to a malware website. IMHO, Call9 should attempt to acquire the call9.com domain (or sue for it), since it clearly serves no decent purpose.
- tpeck 11y agouse callnine.com !!! we're surely working on this
- mangeletti 11y agoAh, good deal. One more thing: The "Request Access" button doesn't function properly on Firefox, due to the use of... an <input type="text" ...> there (not sure what the purpose of this is, but surely you could get by with just a <strong> or something.
- tpeck 11y agothanks for this. we'll work on it right away.
- yuvadam 11y ago> "In a few years, people are going to be using Call9 instead of calling 911" 'Murica, your shit is beyond repair.
- deleted 11y ago[deleted]
- jbob2000 11y agoThis is dangerous for one reason and one reason alone: It conflates the message of "Medical emegency, call 911". We've had that drilled into our heads and drill it into our children's heads. Now, you want people to question that in a time of emergency? "Crap! Mom is having a heart attack! Should I call 911 or use Call9? It's supposed to be better! Shit, where is my smartphone, all I have is this landline. Crap, my smartphone is upstairs, I'll just use my tablet. Wait, I don't have Skype installed on my tablet. Dammit, I'll just call 911".
- DanBC 11y agoThis looks fascinating. i) do you have plans to gather data? Correct research would be tricky, but have you considered collaborations with researchers / statisticians? It'd be fascinating to see some robust numbers after a year ii) in England a considerable amount of 999 calls are either alcohol or mental health related. You've limited the "custer base" to schools and care homes and etc, but how will you handle such calls? For example: you get a call for someone who has engaged in severe (requiring surgery and hospital admission) self harm but who has no suicidal intent. Do you have procedures for that kind of call? Thanks for patiently answering questions! HN is sometimes somewhat hostile. :-/
- tpeck 11y agoi) A group from University of Arizona is actually doing a prospective study on our patients. The have IRB (Institutional Review Board) approval to collect data and will see our impact on the patients as we move forward. After we proved concept, we were confident enough in our product to let them in and see what we're doing. I stay out of their way, so I don't have details on how the study is structured, what data they're collecting.
- mattmireles 11y agoGood idea for patients, terrible awful business model.
- tpeck 11y agoHow so? Would love to address this question and your concerns. What is your perception of how our business model works?
- lbhnact 11y agoHi Tim, congrats on the launch from back here in Boston! I had a couple of questions on what I'll call 'sensitivity' and 'specificity' in your early work: Sensitivity: What's the OR, relative delta, or NNT in calls for changing prehospital acuity or intervention to a higher than initially suspected level? Specificity: How often does the early contact result in a less intense, on-site, or diverted response? So many questions! Would love to hear what you're finding. (edit: copy)
- civil2 11y agoSo much misleading medical marketing in the article and this thread, by the time this thread is done, he's going to have his medical license pulled. :)
- lbhnact 11y agoWell, like usual on HN I don't read the actual linked content and probably won't here as well. For my own peace of mind, I'll recuse myself from reading the website and it's likely necessary launch rhetoric. You're right that HN suffers from less than rigorous medical analysis more often than I would usually like, but there are usually at least a few penetrating questions on the medical threads I read. However, I have met Tim before and can attest to his interpersonal candor on problems with EMS, and the reputation for rigor of his medical training. In short, I think he's a smart, hard working guy who is legitimately committed to solving a real problem. Given my own experience (as an EMT, working in the ED as an admin and medical student, and as a federal emergency response officer in a previous life), I do think solutions along the lines of higher fidelity information on scene will be useful for patients and providers. There will need to be piles and piles of evidence before we can conclude that products like this will provide the outcomes we want in our health system. In the meantime, I'll try to appreciate the obstacles I know this team has overcome to get as far as they have.
- tpeck 11y agoI still don't know who this is writing this, but I thank you for the sentiments! We've done our best to research the stats and present a thoughtful representation of the current state of EMS. We have many official and unofficial EMS advisors who have spent tireless hours to make sure this is true. I assure you, nothing on our site or in our advertising is meant to be misleading - the 911 system is antiquated and could benefit from an overhaul. Like many large systems, there are a lot of good, smart people involved, but change is difficult. We hope to work from the outside in, and save lives/improve outcomes in the process. Research and academic integrity is important to me and my Call9 colleagues.
- carterehsmith 11y ago"The team has a group of 130 doctors standing by" I think that this is not a startup, but a psychology experiment that needs to find out just how gullible we are.
- tpeck 11y agoHahaha. I like this comment. We have 130 physicians who will do part time calls - we also have full time docs. But the benefit of the part time model is that Emergency Medicine docs have never had a model to make extra income for clinical work in which they can only work a couple hours at a time. As an EM doc, when I go to work now, I have to stay there until I'm done usually 10-12 hours later.
- ngoel36 11y agoAre they insured?
- qq66 11y agoWhy not dispatch the ambulance as soon as the call is received, and call it back a few seconds later if the doctor determines it's not an emergency?
- semerda 11y ago“In a few years, people are going to be using Call9 instead of calling 911,” says Tenev. I doubt it. I would never put my life in the hands of an insurance like app which may or may not work; say where data is not available. You can call 911 over all cell network even if yours is not available/no sim/unregistered phone. I hope Call9 understands the emergency side of the business esp around PSAP? Otherwise it won't scale and will be liable should their technology fail to save a life. A problem with mobile phones is location. Unlike a home phone which is tied to your physical home address, how will the emergency personnel know where you are if you pass out before telling them the address? Cell tower location find can be up to 100m away from you. Satellite requires 3+ direct satellite triangulation. Then there is the routing issue. So the app connects to a Physician in a hospital? But hospitals don't own Ambulances. Ambulance companies are private in the USA. So a hospital will in turn contact the Ambulance company. Additional piping that can be avoided with a better model. Say; if Call9 connected directly with an Ambulance company that is running a Home Visit Program (HVP) ie. Paramedicine, then use the EMT to triage the situation using industry Protocols/ICD. Then, Call9 would be starting to solve Hospital Readmission Penalties/Rates. That's a big fish worth $$$ per patient and thus a great disruptive business model. Now of course this is all easier said than done since the red tape to get this going is the major hurdle. The technology part is easy. I've been down this rabbit hole ;-)