tpeck

You seem to know your stuff and work in a great system. . There's a lot here in these comments, and I'll do my best to sum up my thoughts succinctly:

We've done A LOT of user research including days of time on the back of ambulances, days of sitting in nursing homes and watching how a typical 911 call (not a Call9 call) works, countless conversations and late nights with world-leading experts in EMS care, and years of being an EM doc on the receiving end. . Paramedics are NOT just ambulance drivers. They are some of the most valuable members of our society (and surely undervalued/underpaid). But THE reason I left my job to pursue Call9 with my team, is because I have felt if only a trained EM doc could have been in the field, than many of my patients with unfortunate outcomes could have decreased morbidity/mortality. With Call9, we can do that, and save patients who are not otherwise being saved.

I still don't know who this is writing this, but I thank you for the sentiments!

We've done our best to research the stats and present a thoughtful representation of the current state of EMS. We have many official and unofficial EMS advisors who have spent tireless hours to make sure this is true. I assure you, nothing on our site or in our advertising is meant to be misleading - the 911 system is antiquated and could benefit from an overhaul. Like many large systems, there are a lot of good, smart people involved, but change is difficult. We hope to work from the outside in, and save lives/improve outcomes in the process.

Research and academic integrity is important to me and my Call9 colleagues.

We insure ourselves and our physicians.

Thanks! (although I'm not sure who this is - text me outside of HN if you want to stay anonymous). . Those Sn/Sp numbers are in collection - I don't have hard data for you yet. But you'll be sure to know when I do.

i) A group from University of Arizona is actually doing a prospective study on our patients. The have IRB (Institutional Review Board) approval to collect data and will see our impact on the patients as we move forward. After we proved concept, we were confident enough in our product to let them in and see what we're doing. I stay out of their way, so I don't have details on how the study is structured, what data they're collecting.

How so? Would love to address this question and your concerns. What is your perception of how our business model works?

Hahaha. I like this comment. We have 130 physicians who will do part time calls - we also have full time docs. But the benefit of the part time model is that Emergency Medicine docs have never had a model to make extra income for clinical work in which they can only work a couple hours at a time. As an EM doc, when I go to work now, I have to stay there until I'm done usually 10-12 hours later.

Yes

thanks for this. we'll work on it right away.

That is true. But there's a difference in being able to see the patient vs. having a bystander explain the situation verbally. There's no question that a dispatcher brings value to the CPR process - I think that we can bring more.

Sorry - let me explain myself. The term SCD is often used as analogous to SCA (sudden cardiac arrest). In this context, SCA is a more proper term - good catch. The only difference between the two is that the SCA didn't get treated in time and so the patient expired.

If I may clarify some of the misunderstandings of what happens in a typical emergency. If a patient is clutching their chest, we're calling our ambulance service, not doing an EKG. However, the great majority of heart attacks don't present with crushing chest pain. If they did, Emergency Care would be easy, and EM docs wouldn't have had to do 11 years of schooling to recognize and treat these subtleties. The patient that the TechCrunch article is referring too had a subtle tachypnea (slightly elevated respiratory rate because the dying heart muscle causes the blood to become acidic and so the body compensates by blowing off Co2) and a vague abdominal discomfort with a lot of confounding factors like constipation. This patient would not get an EKG in the overwhelming majority of nursing homes in the country, and it's not their fault! It's just because the system doesn't allow for the evaluation the patient may need. Also - an EKG is quite easy to do - this is a non-issue.

So many good questions/points. Responding to each: 1. This would be an ideal world, but it just isn't the case. Nor do I think its a feasible solution to train nursing home nurses to be as knowledgeable about pathophysiology as physicians. Subtleties of acute cardiac syndrome (heart attacks, etc) are difficult to recognize, and it takes a few years of residency after medical school to be able to quickly recognize and act on them. There are many great nurses that can too, but that usually comes with lots of experience in critical situations (especially in the ICU, ER, and PACU). Nursing home nurses just don't have the same exposure to critically ill patients. 2. Which county? Those are great times. A word of caution when interpreting response times - they often start the clock at the time of dispatch, not the time of the patient calling 911. A lot of Call9's value is cutting out the inefficiencies between the 911 call and the dispatch. 3. Administering aspirin (ASA) is very significant. Anti-platelet therapy (e.g. aspirin) has been shown to decrease the mortality of heart attack patients significantly, and the earlier you give the aspirin, the sooner it works. As for nitroglycerin ('nitro'), the medication that dilates the blood vessels on the hearts surface and allows for better oxygen delivery to heart muscle as its dying in a heart attack, it is extremely dangerous to self administer nitro in certain situations that can only be interpreted if you have an EKG - in one of our patients, we in fact identified this issue and purposefully held the nurses giving off this medication which could have killed the patient. As for the nursing home, this situation happened in, the nurses are well trained and I've been happy with their level of care and concern for their patients. 4. I too think a proactive response makes sense. Good point about the utility of these diagnostics - we surely have cases where they are useful in facilitating the care of patient in an emergency. But they are extremely useful in preventing unnecessary hospitalizations - another key value of Call9. In this way, we do practice urgent care too. . Thanks for your comments - seems like you've been in the field and know your stuff.

Surely your right to not use our product. But, we've already saved lives, decreased transport times, identified conditions in patients that otherwise would have been ignored (because we have doctors doing the assessment, not bystanders/nurses/EMS). The way the system works is that there are many triage steps before a patient ever sees a doctor - we've flipped that model and put the physician (who is ultimately the one making the medical decision) as the first step rather than the last. To us (and our patients), it just makes sense.

We don't claim to - we do. Here's a great graphic on what happens when you Call 911: http://www.nyc.gov/html/911reporting/html/anatomy/call.shtml Our first step enters into this process later on in the schema, saving time.

SCD (sudden cardiac arrest) is a great example of when having a highly trained healthcare professional at the scene early can save lives. It's been well shown that there's a 'bystander effect' when it comes to CPR, which can keep the brain oxygenated in SCD and keep people alive before the ambulance arrives. The bystander effect, is that CPR is often not done when it needs to be (even by those who have been trained in CPR) because they are fearful of doing something wrong. With a doc there immediately, we can encourage bystanders to do CPR immediately and again save lives not otherwise being saved.

use callnine.com !!! we're surely working on this

I think the EMS system does what it can for our patients, and paramedics save lives. As an ED doc and resident, I served as med control for EMS and saw first hand all of the difficulties they have with an outdated system created in the late '60s. Like most industries, there is lots of room for improvement, and being scared of change should not hold us back from exploring how we can save even more lives and help more people.

Good point trisomy21. Amazingly, it take 64 minutes on average to see an MD after calling 911! With Call9, you see one immediately.

We get an ambulance to the scene faster than 911, which is a great benefit of using Call9 - I completely agree that it would be a terrible disservice to cause a delay in emergency response. Because we have a direct line to an ambulance service dispatcher, we don't first need to go through a central call-center like other 911 emergencies. Therefore, we save time by a) not having to explain if its a medical vs. police/fire emergency, b) not explaining our location - they know it already, c) having the doctor tell them if advanced life support is needed vs basic life support.