But Pasadena startup Tele911 Inc. seeks to expand those options with a telehealth platform that allows paramedics at the scene to consult with physicians trained in emergency response.
The physicians can then determine what additional care the patient might need besides heading to the emergency room.
Marc Eckstein, founder and chief executive of Tele911 and emergency medical services director for the City of Los Angeles, said the idea is to address a crucial and worsening problem with 911 systems.
According to Eckstein, only about 15% to 20% of 911 patients that paramedics attempt to stabilize in the field need to go to the emergency room, yet most are transported anyway.
Tele911 aims to reduce the number of patients being transported to hospitals, which not only keeps emergency room facilities available for those who truly need them but also frees up paramedics to handle more call responses.
“We try to bridge that gap between ‘We’ll haul you to the hospital’ and ‘Sorry, you’re on your own — not a serious situation,’” Eckstein said.
When 911 emergency response systems came into widespread use some 50 years ago, they were designed to get paramedics on scene quickly, so patients in acute medical distress could be transported to the nearest emergency room.
But over the years, the number of calls has skyrocketed, placing strain on the responding paramedics, local trauma centers and emergency rooms.
As call volume has increased, so has the proportion of calls for all sorts of medical problems, such as back or abdominal pain, that are not life-threatening emergencies.
“People have over the years been trained to dial 911 for all their medical concerns,” said Kenneth Scheppke, emergency medical services director for the Florida Department of Health, who is familiar with Tele911. “We don’t want to tell people not to call 911. We need another path besides the emergency room so that the patients can get the right care.”
Until recently, there’s been a major stumbling block to treating 911 patients on a nonemergency basis: Medicare and private insurer reimbursement policies.
For decades, these health payer systems have only reimbursed for emergency transport to the hospital. That created a financial incentive for paramedics to transport 911 patients — even when they don’t need emergency treatment.
When emergency medical systems have tried to branch out into nonemergency care options, they had to secure more funding to make it work.
Unnecessary transports to the emergency room — even if they are reimbursed — carry other costs. Once 911 patients are taken to the emergency room, a paramedic must stay with them until they are handed off to emergency room personnel.
Then the paramedic has to fill out a lot of paperwork. “This can take an hour, two or even more — time that the paramedic could be responding to other, truly urgent calls,” Eckstein said.
As the number of unnecessary transports has increased, emergency response services have been forced to add paramedic staff to keep response times as short as possible.
Change in law
This includes transport to the patient’s primary care physician office or designated urgent care center, or to a mental health clinic. It also includes telehealth services.
According to the CMS website, “The model will allow beneficiaries (patients) to access the most appropriate emergency services at the right time and place. (It) will also encourage local governments, their designees, or other entities that operate or have authority over one or more 911 dispatches to … establish a medical triage line for low-acuity 911 calls.”
Passage of this law in 2019 prompted Eckstein to establish Tele911.
Like many other emergency medical service chiefs across the country, Eckstein was desperately searching for ways to direct 911 patients who were not facing life-threatening emergencies to other forms of treatment.
Few alternatives were viable without a change in reimbursement policies.
Eckstein teamed up with two partners — one an expert in digital medicine and the other, Chris Maloney, a founder of a software program for 911 dispatch systems — and formed Tele911.
Maloney provided a significant amount of seed money — “in the seven figures,” according to Eckstein — to fund development of Tele911’s telehealth platform. The company formally launched last year, right at the start of the Covid-19 pandemic.
Eckstein said Tele911 is nearing the final stages of another seed funding round that is expected to provide another seven-figure boost. When that round is complete in the next few weeks, he said, Eckstein expects to announce an expansion of the company’s management team. And he will consider leaving his L.A. Fire Department post to run the company full-time.
“Everybody we’ve pitched this to has said the concept made a lot of sense, and they’ve asked why this hasn’t been done before,” Eckstein said.