In 2017, less than two months, two Category 4 and two Category 5 hurricanes ripped through the nether parts of the United States and beyond, laying waste to communities and costing hundreds of billions of dollars and countless lives.
Local providers who are able to treat patients cannot possibly accommodate the groundswell of people who need care during a natural disaster. Without medical attention, hurricane survivors face the additional peril of untreated injuries and exacerbated illnesses.
Telemedicine has proven to be a lifeline for disaster relief. Physicians from any pocket of the country can provide services to people affected by natural catastrophic events, assisting with emergency and ongoing care. When patients have been separated from their families, isolated from their communities and the providers they trust, and when facilities are overflowing with people traumatized by disaster, telemedicine offers relief and fills in the gaps of care.
Utilization during hurricane season
2017’s spate of severe hurricanes did not prompt the first uses of telemedicine for disaster relief, but did see it more widely embraced and utilized. In Texas, ER physicians at Children’s Health in Dallas remotely cared for patients displaced by Hurricane Harvey. Teladoc– a telehealth company which connects patients to doctors over phone and video chat– received calls from more than 1,000 people to their emergency line.
Teledoc, Doctors on Demand, MDLive and others offered free services to people impacted by Hurricane Irma. According to MobiHealthNews, in just 5 days there was a 554 percent increase in downloads of Nemours Children’s Health System’s telemedicine app CareConnect as Irma tore through Florida. Florida Hospital also revealed that their eCare service had 2,700 new users between September 8th and 10th.
The need for increased medical assistance stems from more than hurricane-related trauma injuries. Physician’s diagnose rashes and discern the severity of cuts and injuries, but they also identify infections from exposed sewage, and determine animal and insect bites. Severe storms may beget flooding, causing mold to proliferate and intensify medical conditions like asthma. Floodwaters can spread viruses, and carry bacteria from chemicals or deceased animals to people in contact with the water. Telehealth cannot treat life-threatening conditions, but can help triage ER admissions by advising patients who aren’t in need of critical care. This ensures the people in dire need of quick medical attention receive it.
In times of crisis, access to behavioral and mental health support is critical. Post-disaster trauma may heighten anxiety and depression, as can chaotic conditions and loss. People may need mental health providers as they endure the emergent stress of a natural disaster and its aftermath, while others need continued support for previously diagnosed conditions.
The comfort of a provider tending to the physical or psychological concerns of people amidst the upheaval caused by a devastating force majeure is invaluable. Even remotely, they assuage patients’ fears and calm anxious families. It can take weeks or longer to re-establish the infrastructure decimated by natural events, but telemedicine allows doctors to continuously support and monitor their patients as their communities rebuild.
Preparing for the worst
The allowance of out-of-state practitioners caring for patients via telemedicine is determined at the state level. Both Florida and Texas allowed physicians unlicensed by their state to care for those affected by Harvey and Irma because they declared states of emergency, but Texas only signed into law the use of telemedicine without an initial in-person appointment in May 2017. Teleheath organizations who aided Harvey’s victims only established a presence in Texas weeks before the storm touched down. Other states have entered into the Interstate Medical Licensure Compact to provide patients quality care which they can’t receive locally- no state of emergency required.
Though the medical community has been an early adopter of telemedicine, it hasn’t yet permeated the public for widespread utilization. To optimize its potential, people must adopt telemedicine into their emergency preparedness planning. When we discuss natural disasters, telehealth needs to be a part of the conversation. Raising awareness for telemedicine options preceding disastrous events for sweeping public adoption must be a priority. For telemedicine organizations, the engagement engine should always be running.
Telemedicine providers must also have their own emergent disaster plan to be prepared with the appropriate response for high volume, distressed patients. They should establish relationships with relief and government organizations on the ground who can direct the swell of patients to them when disaster strikes. They’ll also need to guarantee they have enough on-call providers to contend with patient volume.
Organizations, care facilities, and shelters must be readied with the requisite equipment or technology to sustain telemedicine, such as videoconferencing, assuming there is power as well as phone and internet connectivity. Another limitation facing telemedicine is an assumption that pharmacies are open and able to provide the medicine prescribed by these providers. Patients who suffer chronic disease and require their medication to stay alive are especially vulnerable if they cannot access care.
Infrastructure, telehealth companies, and the public must all have a plan and the technology in place to best manage the worst case scenarios nature throws at us. Dr. Maeve Sheehan, a pediatrician at Children’s Health, told STAT “We didn’t have telemedicine for Katrina…I was on [call] all night. This time, I don’t have to be. Telemedicine makes a big difference.”