5 ms·

Look 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 call

• tpeck 11y ago
  If I may clarify some of the misunderstandings of what happens in a typical emergency. If a patient is clutching their chest, we're calling our ambulance service, not doing an EKG. However, the great majority of heart attacks don't present with crushing chest pain. If they did, Emergency Care would be easy, and EM docs wouldn't have had to do 11 years of schooling to recognize and treat these subtleties. The patient that the TechCrunch article is referring too had a subtle tachypnea (slightly elevated respiratory rate because the dying heart muscle causes the blood to become acidic and so the body compensates by blowing off Co2) and a vague abdominal discomfort with a lot of confounding factors like constipation. This patient would not get an EKG in the overwhelming majority of nursing homes in the country, and it's not their fault! It's just because the system doesn't allow for the evaluation the patient may need. Also - an EKG is quite easy to do - this is a non-issue.
• Jessdonig 11y ago
  Hi, this is Jessica from Call9. Just wanted to address a few points here: 1) When you call 911, you talk to a gatekeeper. That gatekeeper is a phone dispatcher, not a doctor. Talking to a doctor is not a delay in care--it's the reason people call 911 in the first place. 2) Since Call9 works with facilities such as nursing homes and has access to patient information, using Call9 actually saves time in the dispatch process. 3) As described in the article, it's not always that clear to the person calling 911 has "suspected heart attack symptoms". In the given example, he presented with abdominal pain. That is why having the doctor be the first point of contact is so important.
  • FireBeyond 11y ago
    "Since Call9 works with facilities such as nursing homes and has access to patient information, using Call9 actually saves time in the dispatch process." Wait. The facility shares PHI (protected health information) with Call9? Have the facility residents consented to this?
    • tpeck 11y ago
      Yes
      • FireBeyond 11y ago
        If this information is provided and accurate, this is awesome. I love it. :) Too much time is taken while care providers ask each other vague questions about "do you know what he/she has?" when in my head I'm thinking "You should KNOW this. Or have it readily available!"
  • civil2 11y ago
    Your doctor is a gatekeeper to 911, so you have an additional gatekeeper. I think you will find that anyone in the general public experiencing an emergency is going to call 911, not your service. Your service might be useful in non-emergencies. It's basically like a family doctor visit on Skype. There are a number of companies offering this, but it's not clear how this helps with outcomes. (For example, http://nyti.ms/1fyWXeK http://nyti.ms/1fyWXeK) For healthcare facilities, like nursing homes, you are basically providing a doctor on call via telemedicine. That is already heavily used. Many hospitals employ radiologists, neurologists, etc who can view diagnostic images and data remotely and provide consultation to the medical staff on site. What I think is dishonest (and could cost lives) is advertising your service to the general public as an alternative to 911, and especially claiming that it is faster than 911.
    • ctenev 11y ago
      These are interesting points. I think that it’s important to clarify a major differentiating factor between Call9 and other telemedicine providers: not only do we have an ER doctor directly interfacing with the patient immediately, but we also have on-site healthcare staff who are prepared to perform diagnostic tests and immediate medical interventions under a doctor’s direction. This is different than a consult where a doctor can only virtually advise, but cannot intervene; it is also different that calling a doctor for a specialty consult or a second opinion. It is true that putting a doctor first in the process adds another step before calling 911. But it is a meaningful interaction that improves the quality and efficiency of the medical care (both by having an ER doctor assess the patient, and by having information ready so that the 911 call can go faster). It’s not about cutting out steps, but reorganizing the system to optimize care and save lives.
• ctenev 11y ago
  I think it might be helpful as we are discussing this to be able to explain how the current 911 system works. As it exists now, calling 911 for an ambulance sets off a chain of 9 human-to-human information transfers and averages over an hour for you to get to the hospital and be treated by a doctor. Many articles and research papers are out there showing the inefficiencies of the current system. Current 911 system STEP 1: You call 911 STEP 2: Cellular service carrier connects you to an operator (4.5% busy signal rate) STEP 3: Operator with no medical background takes your basic information and location STEP 4: Operator types that info into a processing/relay system STEP 5: EMS Dispatcher reads the relayed info STEP 6: EMS Dispatcher radios paramedics to go to scene [Steps 1-6: average of 3.9 mins] STEP 7: Paramedics type address into dashboard GPS system STEP 8: Paramedics drive to scene [Step 7-8: average of 9 mins] STEP 9: Paramedics treat, stabilize, and package you STEP 10: If advanced procedure or medication is needed, paramedic must call a designated physician in a local emergency department to gain approval. STEP 11: Nurse or other employee answers phone and then finds a physician who is concurrently taking care of other patients in the ER STEP 12: ER doctor hears your case from the paramedics STEP 13: ER doctor approves advanced procedures or asks for clarifying information [Step 9-13: average of 14.9 mins] STEP 14: Paramedic transfers you to the hospital STEP 15: Paramedics drop you off at an ER (may not be the same ER who approved the advanced procedure) [Step 14-15: average 12.2 mins] STEP 16a (CRITICAL): In critical situation, paramedic with 2 years of training and no access to your medical records tells what they know about your case to an ER physician STEP 16b (URGENT/EMERGENT): In noncritical situation, paramedic tells the ER triage nurse about your case STEP 17: ER triage nurse tells the treating nurse assigned to you about your case STEP 18: Treating nurse tells an MD about your case STEP 19: You wait for an MD [Step 15-19: average 24 mins] STEP 20: An MD finally sees you As physicians who worked in the emergency departments of the world’s leading medical institutions we were able to see first hand the inefficiencies of the current emergency care system leading to poor patient outcomes and avoidable costs. TLDR - 1) 911 is an outdated system in many ways 2) there is room for improvement.
  • FireBeyond 11y ago
    This is an overly 'exaggerated' flowchart. Whilst there are many flaws with the 911 system, there are also several fallacies (though not universal): STEP 2: <1% busy signal is a goal of and attained by a large number of PSAPs. 3: Many PSAPs have their dispatchers trained to the EMT level. 4 through 6 are happening concurrently, not as a single step flow. 6: Many PSAPs have a goal that the initial unit dispatch is within 60 seconds of call reception. 7: I've not seen a system yet that relies on ALS units punching an address manually into a TomTom. AVLS (automatic vehicle location system), and mobile data terminals pull the exact information that is entered into 911 (which whilst still prone to error, is an issue with Call9, too) and use GPS which is linked into maps + county GIS overlays. 8: Highly dependent on location. My county has an average 6min response time. 10: Most advanced procedures and medications are governed by offline medical control ("here's our protocol for using this drug / treatment. Indications, contraindications, dosing regime") - the goal is that the need to contact a physician is the exception, not the rule. If the time taken for 'online medical control' is 14.9 minutes I'll be at the hospital already, because that's where definitive care happens. I, as a medic, am not going to wait on hold and have a leisurely chat with a physician for nearly quarter of an hour on scene. This is a gross distortion of reality. If I do need to call the ER doc, there will be one available, or the charge nurse will know that one needs to be found, now. 16a: at an SNF if we need access to medical records, we can get them. If a patient uses the same healthcare system, they're available at the hospital. Pretending like we're stabbing in the dark and shrugging our shoulders is devaluing the care that paramedics and EMTs do down to the 'ambulance driver' stereotype. Both are trained in patient assessment and history taking, even if not medically qualified to the same level as a physician. In 16b: In a non-critical situation AND there are insufficient resources, then triage is the most appropriate care situation. If you're non-emergent and there's capacity in the ED you're going to a bed. 17/18: As opposed to... what? Unless Call9 claims to be the sole definitive (and remote) care provided, there's going to be a transfer of knowledge. Your example has it taking a quarter of an hour to get to the patient, an undefined amount of time treating, stabilizing and packaging the patient, supposedly before requiring an online sign-off and discussion with a physician lasting another quarter of an hour before finally loading the patient for another nearly quarter hour trip to the hospital, while some paramedic with no situational awareness gives a nurse a hand off to relay to the physician. What really happens on scene in a cardiac arrest: BLS providers show up first, AED, CPR, bag patient, potentially with advanced airway, LMA, etc. ALS shows up, determines quickly whether to stabilize on scene or load-and-go, CPR still in progress. A call is made to the hospital, with no discussion with a physician, only the charge, giving pertinent information, and ETA. "Code Blue, Ambulance, Bed A3, 4 minutes out." RT, IV, pharmacy, imaging, are all ready. A team is ready to continue CPR. Physician is there. All staff with the exception of the physician move patient from gurney to bed, begin work, while physician gets information from ALS, and then begins directing the code.
• trisomy21 11y ago
  I think you're confused or just being overly cynical. The process, as described, is exactly like traditional 911, but your first point of contact is a physician who can, if needed, immediately dispatch an ambulance (just like in your first scenario). If deemed appropriate (by a emergency physician trained to deal with life threatening situations), an EKG can be requested and the nurse can be guided through the process. If I'm in an emergency medical situation, I would absolutely want to connect with an emergency physician first and I'm sure there are many other people who feel the same way.