Telemedicine911 Use Cases

The cases below are common real patient cases.  Names, images, and details have been changed for privacy purposes.

Psychiatric Crisis

“this is an emergency, hang up and call 911”

Our primary care telehealth practice has been seeing a patient for the past year.   Late January she told her psychiatrist over telehealth she was going to kill herself.  The psychiatrist said this was an emergency and told the patient to “hang up and call 911” to receive in-patient care. They hung up and the patient did not call 911.  A few days later she called her psychologist, said she was going to kill herself by taking pills, and again was told to “hang up and call 911.”   The patient hung up.  The patient didn’t call.

On Tuesday afternoon the next week, she took a whole bottle of hydroxyzine pills and OTC pills. A few minutes later she called our telehealth practice in Little Falls, NJ and told us she had “done something stupid.”  She is normally in Bergen county but this week she was in Toms River many hours south.  We have emergency telehealth protocols and were able to activate 911 in Toms River.  She became altered to the point she could not open the front door, so our providers coordinated with police and EMS to enter and identify the pills.  She made it to the emergency department and survived.

The psychologist and psychiatrist had no idea what happened until we called them a few days later.  The psychiatrist does not track how many patients she asks to go to the ER or call 911 and does not follow up to find out what happened.

March 2019:

A depressed female is on a laptop video consult with Dr. Chiu.  She says she wants to kill herself by stepping in front of a train. Despite video de-escalation measures, she says again she will kill herself and closes the laptop.  Dr. Chiu uses Telemedicine911 and coordinates both EMS and Police to the route nearest the train tracks and met her in transit.  Over 200 people died in 2018 in the New York metro area from completed suicide by train tracks alone.  Suicide is the 10th leading cause of death in the United States and a top use of the Telemedicine911 system.


After Hours Phone Call

A 74 year old male calls your office because he is having epigastric and chest pains.  The after hours answering service gets you on the phone.  The patient says he usually has pain when he eats spicy foods, but this time it has lasted longer and feels more like a squeeze.  Antacids were not helping.  He has a history of CAD.  His niece insisted he call his doctor.  You ask him to call 911, the patient agrees, and you hang up.

Thirty minutes later you called him back to see how things are going.  His niece picked up and said he did not call 911 because he was afraid of getting COVID at the hospital and did not want to go.  You talk to the patient again and activate Telemedicine 911.  He arrives in the ED and is shown to have an inferior wall MI.

When patients have chest pain, they hesitate to call 911 for an average of 3.5 hours.  Even if you tell the patient to call 911 and hang up, they still hesitate.  Telemedicine911 allows you to talk directly with 911 dispatchers and direct them to send your patients to cardiac centers with cath labs rather than the closest emergency room which may not be equipped.

Time is heart muscle.  Your Telemedicine911 response gets the patient to the right facility without hesitation.  If the patient were in your office, you would coordinate 911, not your patient.  Take control of the situation

This same doctor has had 3 patients die in 2020 due to reluctance to call 911 and go to the hospital.


Home Monitoring

A 55-year-old female was being evaluated for COVID-19 exposure and monitored on mobile cardiac telemetry (MCT).  She was being managed by Nurse Practitioner Macadams who was 130 miles away.  The patient had a history of cardiac arrhythmia and poor compliance with beta blockers.  NP Macadams noticed an alarm on the remote monitor and started a video conference with the patient.  The patient was in full supraventricular tachycardia (SVT).  She had no chest pain but felt light headed.  NP Macadams activated Telemedicine 911 with COVID-19 precautions and contacted Dr Chiu.  Paramedics arrived in minutes with PPE protection for COVID and initiated treatment on site with an IV, fluids, and first dose of beta blockers.  The patient was transported to the ED where her heart rate normalized.


Radiology Callback

Image not from actual case

A 42 year old patient was seen in the Emergency Department for a headache after a fall.  The CT Head was normal as per tele-radiology.  The patient left and went home to a different city.  The next day on follow up the patient was found to have a subdural hematoma which was missed on CT.  When the doctor called, the patient’s headache had worsened and he was somnolent.  He coordinated the emergency with Telemedicine911 to take the patient to their affiliated facility with Neurosurgical ORs.  The patient completed the procedure within the hospital system, had a short post op stay, and was discharged home to follow up.

About 30% of malpractice cases originate from a communication breakdown with nearly half in the ambulatory setting.5

Nearly 35% of EMS and 911 malpractice dollars lost are due to claims related to medical negligence and all parties may be at fault.6  In an established provider patient relationship, failure to activate 911 in a remote emergency may be considered breach of duty and negligence.

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