But more than video consults with health-care professionals, telehealth is using Internet and intranet technologies to facilitate many medical activities associated with health care and wellness of the body and mind. It's either real time, some variation of store-and-forward data exchange, or digitized medical knowledge.
So what if communities used telehealth applications and services to help local officials, health-care professionals, neighborhood leaders and neighbors respond to natural disasters and facilitate medical care and health care? It takes full understanding of telehealth and creativity, plus high-speed Internet, of course.
On Dec. 10, when major tornadoes swept the South and the lower Midwest, Kentucky seemed to take the brunt of the mayhem. One twister touched down and almost didn’t leave, tearing through approximately 165 miles, leaving a wake of destruction. In Bowling Green, Ky., thousands of homes were without power and countless structures were destroyed. In Arkansas, dozens of buildings were flattened, including a nursing home.
The U.S. faces increasingly destructive natural disasters — catastrophic forest fires and earthquakes on the West Coast, tornadoes in the Midwest, hurricanes and floods on the Gulf and East coasts. But telehealth can help.
“We've seen the immediate impact of some form of telehealth in the aftermath of natural disasters such as Hurricane Maria in Puerto Rico, the Haiti earthquake and the Japan tsunami” said Dr. Milton Chen, CEO of telehealth vendor VSee.
EXPANDING FIRST RESPONDERS' REACH
Telehealth is now being incorporated into first responder protocol.
“In some places there are regulations that have been in place within the last two years that allow first responders to ‘treat in place,’” said Dr. Colin Banas, chief medical officer of telehealth and health IT vendor DrFirst. “These rules allow them to make on-site assessments and initiate a telehealth visit with a physician to make treatment and transport decisions. When it’s more appropriate to treat at home or at an urgent care center, you are saving the person from traveling to a crowded ER.”
In many parts of the country, cities are customizing RVs, vans, buses and ambulances with telemedicine tools, expanded medical capabilities and wireless connectivity to bring health care directly to communities, underserved populations in particular. During disasters, these mobile medical units can enable people to receive a broader range of treatments and consultation, possibly in residences or sheltered places.
CREATE EMERGENCY TELEHEALTH CENTERS
Low-income urban residents especially seem to be easily forgotten when disaster strikes. When Hurricane Katrina smashed into New Orleans in 2005 causing over 1,800 fatalities, it was also one of the most epic public health fails in U.S. history. It was months before poor neighborhoods got Internet connectivity back, if they ever did. Learning from that lesson, cities should take federal broadband and health-care money, create emergency health-care capabilities within public housing facilities for times of disaster and also leverage the technology during normal times.
A major disaster can take out the power for a week or two while making freeways and streets unusable for a month, leaving communities isolated. Before disaster strikes, communities can designate various buildings citywide (like libraries, auditoriums and gyms) as “generator and telehealth centers.” Move in appropriate equipment including fixed wireless service and telehealth kiosks, depending where disaster strikes.
Rural jurisdictions should build out standalone high-powered Internet stations along rural routes to hospitals that emergency vehicles can connect to in case patients’ conditions deteriorate or there are increased travel delays. Designate schools, libraries, water towers, sport arenas, and other buildings as “telehealth way stations” for first responder vehicles and mobile medical units, and increase Internet capacity. Open these stations in natural disasters to regular people needing telehealth who could be isolated from any medical help for days or weeks.
Get ready to see drones take off as a distribution option for medications and medical supplies. It may not be pretty or cheap, but drones could potentially be used to get certain bloodwork and basic lab tests delivered to medical facilities.
And drones aren’t the only emerging tech that will help expand health care during emergencies.
"As technology improves and gains adoption, telehealth will make a greater impact on communities recovering from natural disasters,” Chen said. “Innovations such as continuously monitoring medical devices and AI health coaches will keep more health-care services easily accessible in the aftermath of a disaster and through infrastructure rebuilding."
TELESTROKE PROJECT COULD BE MODEL FOR DISASTER RESPONSE
Arkansas used to lead the United States in stroke deaths because less than 1 percent of stroke patients there received the declotting drug alteplase (tPA) in time. A statewide public broadband network turned that situation around in 2008, and Arkansas reduced stroke-related deaths and dropped six places nationwide by 2016.
As part of the stroke death reduction effort, the Arkansas Department of Human Services partnered with the Center for Distance Health at University of Arkansas Medical Science (UAMS) to form Arkansas Stroke Assistance through Virtual Emergency Support (AR SAVES) that runs on a super-fast public broadband network. UAMS connected 54 of the 80 Arkansas hospitals to a telestroke “subnetwork,” which now links with several other health and telehealth programs throughout the Arkansas hospital systems, including a huge trauma care program. These links provide redundancy and failover capabilities in case of floods, tornadoes or other disasters that make it difficult to reach large hospitals’ emergency resources.
Tornadoes, hurricanes and earthquakes can produce broken bones and internal injuries.
Beyond stroke care, UAMS partnered with the Arkansas Trauma Communications Center (ATCC) to create an orthopedics hand injury program. Similar types of telehealth for orthopedic trauma can support smaller hospitals and urgent care clinics.
“If there was a big explosion near one of the hospitals, that’s where patients could be triaged and treated in consultation with specialists at other hospitals via telehealth,” said Tina Benton, a director at UAMS.
Other states can borrow Arkansas’ idea to create another element of a telehealth-driven disaster response system. Some states may have networks similar to the one that drives UAMS’ telehealth, such as the Corporation for Educational Network Initiatives in California (CENIC). CENIC has partnered with the California Telehealth Network (CTN) that provides connectivity and telehealth services to hundreds of health-care facilities throughout the state.
IT ALL COMES DOWN TO BROADBAND
Ultimately the success of these solutions rest on the quality, capacity, reliability and affordability of broadband infrastructure. With all the federal and state grants available or in the pipeline for broadband and health care, it is time for communities to step up and go for it. Properly implementing these funds requires significant planning and coordination from a lot of community stakeholders. Networks have to go far beyond health-care facilities.
“Community broadband built by electric co-ops or public electric utilities … are designed so both data and electricity immediately reroute around flooding or other damage to any location throughout the network. These networks rarely have downtime, despite disasters,” said David Little, vice president of network operations for North Georgia Network.
