LAUSR

Study Objectives: The Los Angeles Fire Department (LAFD) has experienced an unprecedented growth in 911 calls for emergency medical services (EMS), including a disproportionate growth among low-acuity 911-callers Managing these low-acuity calls is even more critical in the era of COVID-19 (CV19) where EMS over-utilization puts both EMS providers and patients at risk The LAFD Telemedicine Program (LTP) integrates advanced providers (AP) (nurse practitioners, physician assistants, and emergency physicians) into the Los Angeles Tiered Dispatch System 911 callers between the ages of 2 and 64 years old with low-acuity complaints and no priority symptoms are transferred from the emergency medical dispatcher to the AP Through a telemedicine platform, the AP can perform an assessment and release the patient without dispatching field emergency resources or dispatch the appropriate EMS field resource or a taxi to transport the patient to an emergency department (ED) or alternative destination The objective of this pilot study is to describe the initial experiences of this novel program Methods: This is a 2-month retrospective review from April 6 to May 31, 2020 of electronic medical records for 911-calls that were referred to LTP Additionally, all patients who received care through LTP were contacted within 24 hours via phone to evaluate the need to access further emergency care through 911 or an ED and to assess their overall satisfaction The primary outcome is the disposition of patients who were triaged to the LTP Secondary outcomes include the need for further emergency care, and patient satisfaction Descriptive statistics are used Results: During its first 2 months of service, the LTP attended 159 patients, of whom 49 (30 8%) were treated via telemedicine alone and no resources were dispatched (“No Send”);9 (5 6%) were sent for further care via taxi;and 101 (63 4%) were dispatched and evaluated by EMS providers on scene Of these 159 patients, 94 (59 1%) completed a brief phone survey No patients reported accessing further emergency care through 911 or an ED after their LTP encounter Overall, the mean satisfaction score of care provided by the LAFD was 9 3 out of 10 As a result of LTP intervention, 58 LAFD field resources remained available for the next time-critical call, >100 sets of PPE were preserved, and countless potential CV19 exposures were avoided Conclusion: Preliminary data suggests that dispatch-initiated telemedicine with a “No Send” option can be safely integrated into EMS systems to preserve emergency resources, reduce exposure of field medical providers, and provide quality care for low-acuity calls Further, larger studies are needed to evaluate safety and efficacy