ctenev

These are interesting points. I think that it’s important to clarify a major differentiating factor between Call9 and other telemedicine providers: not only do we have an ER doctor directly interfacing with the patient immediately, but we also have on-site healthcare staff who are prepared to perform diagnostic tests and immediate medical interventions under a doctor’s direction. This is different than a consult where a doctor can only virtually advise, but cannot intervene; it is also different that calling a doctor for a specialty consult or a second opinion.

It is true that putting a doctor first in the process adds another step before calling 911. But it is a meaningful interaction that improves the quality and efficiency of the medical care (both by having an ER doctor assess the patient, and by having information ready so that the 911 call can go faster). It’s not about cutting out steps, but reorganizing the system to optimize care and save lives.

I think it might be helpful as we are discussing this to be able to explain how the current 911 system works.

As it exists now, calling 911 for an ambulance sets off a chain of 9 human-to-human information transfers and averages over an hour for you to get to the hospital and be treated by a doctor. Many articles and research papers are out there showing the inefficiencies of the current system.

Current 911 system STEP 1: You call 911

STEP 2: Cellular service carrier connects you to an operator (4.5% busy signal rate)

STEP 3: Operator with no medical background takes your basic information and location

STEP 4: Operator types that info into a processing/relay system

STEP 5: EMS Dispatcher reads the relayed info

STEP 6: EMS Dispatcher radios paramedics to go to scene [Steps 1-6: average of 3.9 mins]

STEP 7: Paramedics type address into dashboard GPS system

STEP 8: Paramedics drive to scene [Step 7-8: average of 9 mins]

STEP 9: Paramedics treat, stabilize, and package you

STEP 10: If advanced procedure or medication is needed, paramedic must call a designated physician in a local emergency department to gain approval.

STEP 11: Nurse or other employee answers phone and then finds a physician who is concurrently taking care of other patients in the ER

STEP 12: ER doctor hears your case from the paramedics

STEP 13: ER doctor approves advanced procedures or asks for clarifying information [Step 9-13: average of 14.9 mins]

STEP 14: Paramedic transfers you to the hospital

STEP 15: Paramedics drop you off at an ER (may not be the same ER who approved the advanced procedure) [Step 14-15: average 12.2 mins]

STEP 16a (CRITICAL): In critical situation, paramedic with 2 years of training and no access to your medical records tells what they know about your case to an ER physician STEP 16b (URGENT/EMERGENT): In noncritical situation, paramedic tells the ER triage nurse about your case

STEP 17: ER triage nurse tells the treating nurse assigned to you about your case

STEP 18: Treating nurse tells an MD about your case

STEP 19: You wait for an MD [Step 15-19: average 24 mins]

STEP 20: An MD finally sees you

As physicians who worked in the emergency departments of the world’s leading medical institutions we were able to see first hand the inefficiencies of the current emergency care system leading to poor patient outcomes and avoidable costs.

TLDR - 1) 911 is an outdated system in many ways 2) there is room for improvement.