SCHENECTADY — The Schenectady Fire Department on Monday unveiled a telemedicine pilot program it has been testing to good effect for the last month.
When they arrive on the scene of a non-critical medical call, firefighter-paramedics are now able to set up a three-way video conference with themselves, the patient and an emergency medicine physician in a matter of minutes. This can potentially avoid the need for a time-consuming and expensive trip to a hospital emergency room for patients whose injuries or illness aren’t severe enough to require treatment in an ER.
Those who have urgent or severe problems will be transported immediately, but others can be treated on-scene by the paramedic, given a prescription or referral by the doctor via the video link, or be transported to an urgent care clinic instead of an ER.
There will be extensive opportunity to use the new system: About 12,000 of the roughly 18,000 calls Schenectady firefighters are dispatched to each year are medical situations rather than fires, rescues or hazardous conditions.
In the first month of the pilot program, the Fire Department used telemedicine on 41 calls, and was able to treat two thirds of the patients without transporting them away from the scene.
Assistant Chief Dan Marino said telemedicine is “another tool in [paramedics’] toolbox to provide the right care to that patient.”
He added: “Telemedicine that you see on TV, that’s bringing the doctor into your home. Telemedicine that we’re providing, that’s bringing the ER into your home.”
At Monday’s announcement, Schenectady Mayor Gary McCarthy said the savings that will be realized through the new telemedicine program aren’t known yet and won’t be a straightforward calculation — they’ll be spread among the partners, which include Ellis Medicine, operator of the county’s only hospital emergency room.
Ellis CEO Paul Milton noted that the use of telemedicine has grown sharply through the COVID pandemic, and said it will remain part of the medical care model afterward.
“For everybody that comes into the ER, there may be much better places to take care of them in the community,” Milton said.
Fire Chief Raymond Senecal said the department was an early adopter of the firefighter-paramedic model back in 1980, using a federal grant to start training its members for certification as paramedics, which can provide more advanced treatment in the field than emergency medical technicians.
“It was cutting-edge back then,” he said.
Having a corps of paramedics has been increasingly valuable, as a growing percentage of the calls have been for medical complaints or emergencies. But the cost of training the entire force was prohibitive, so the department made paramedic certification a pre-condition for hiring. Today, 115 of the 117 men and women who roll out the firehouse doors are paramedics.
The need for social distancing and the constraints that this year’s pandemic placed on hospitals added a new impetus for the telemedicine program.
“We were looking at it a couple of years ago, but when COVID-19 came into play we said, hey, we can leave somebody in their home rather than expose them,” Senecal said.
He explained the benefits of telemedicine with the example of a home-improvement mishap that results in a large cut to the hand. A precautionary trip to the ER puts the patient and/or their insurer on the hook for a large bill, potentially parks a patient in a waiting room for hours, and further strains hospital personnel that may be stretched at that moment.
Telemedicine can offer a chance to triage in the field. Did the gash to the hand damage a joint or tendon? Will it not stop bleeding?
With the doctor looking on via video link, the paramedic can evaluate and stabilize the cut and the doctor can advise patient and paramedic alike on the best way to treat it. The paramedics would bandage a less-serious cut in this example but would not stitch up a particularly bad gash. The patient would still need to go to urgent care or an ER for stitches, or if the telemedicine doctor were concerned about the severity of the cut and potential complications.
Dr. Michael Bibighaus, co-founder and chief medical officer of UCM, recalled that there were occasions during the test period where paramedics asked the doctor on the other end of the video link to convince the patient to go to the hospital.
Stanley Wilgoki, the Fire Department’s emergency medical services captain, led the effort to set up the pilot program at the SFD.
The equipment is fairly straightforward, a tablet computer; it has been installed on one truck each in three of the department’s four stations.
The Fire Department won’t see a cash savings from the program — it’s not reimbursed for the medical services it provides, except a relatively small fee when it’s part of the care team on an advanced life support call with Mohawk Ambulance Service.