Adventures in #telemedicine. Why it's important to have an Emergency Plan. I was seeing an elderly patient this morning with chronic medical problems for an annual visit. Pleasant visit, nothing exciting, refilled medications, ordered labs. As we are about to wrap up visit.../1
...patient says "I suddenly don't feel so well." What? "I feel like I'm going to pass out." Then BOOM. Face plant. Patient is home alone, I am the only witness. I yell out the door to my assistant to tell my next patient that I will be late. /2
Patient regains consciousness after 10 long seconds. Please call 911 now. "I don't want to call 911. I'm fine." She loses consciousness again and falls off screen. I can't see her. I call 911. /3
I'm in DC but she's in Virginia, so I tell @dcfireems to connect to Alexandria 911 (remember, Emergency Plan - I verified her address). I give the patient's address to Alexandria 911 and paramedics are dispatched. Patient regains consciousness again. /4
I tell patient to unlock door and lie down. A few minutes later, I see a @AlexandriaVAFD paramedic wearing an N95 in my Zoom screen. She pulls down her mask, I relay the history. Thank you for taking care of my patient. I get a call from the local hospital ER 90 minutes later. /5
Patient is doing well, admitted for observation. Lessons reinforced: (1) All #telemedicine visits should begin with location verification. In case of emergency, location may be unknown or incorrect. /6
(2) In case of emergency during a #telemedicine visit, patient should call 911 if possible since call routing is local. But if not possible (as in this case), 911 can connect you to the correct EMS locale. /7
(3) If the patient is alone during a #telemedicine visit and you've called 911, stay with the patient until EMS arrives. Your history is important to direct proper care. /fin
