New initiative may improve patient outcomes by expanding EMS access to lifesaving care

Advanced telehealth technology is being used to improve patient care in the field by connecting rural emergency medical services (EMS) responders to Tucson emergency medicine physicians in a joint project involving the University of Arizona Health Sciences and Banner - University Medical Center Tucson.

Rural EMS and ambulance agencies face several challenges in providing sustainable prehospital care to remote communities, including low call volumes, long transport distances, reliance on volunteers, an aging workforce and difficulty meeting increased educational standards. The Arizona Rural EMS Advanced Telemedicine Demonstration Initiative (AzREADI) addresses these challenges by giving rural EMS responders 24/7 access to real-time consultations with board-certified EMS physicians.

Connecting to a remote specialist prior to hospital arrival can decrease the time from symptom onset to treatment, which is especially important for stroke or traumatic brain injury, for instance, when 'time is brain.'"

Joshua Gaither, MD, Associate Professor and EMS Fellowship Director, UArizona College of Medicine - Tucson's Department of Emergency Medicine

The use of telemedicine services is vital in rural areas, where the COVID-19 pandemic has stressed already limited resources. AzREADI capitalizes on improvements in wireless broadband capabilities to extend communications and improve real-time patient care while optimizing resources and decreasing costs.

"EMS vehicles are being equipped with broadband cellular connection and high-speed internet access to the Banner - University Medical Center Tucson Emergency Department, making it much easier for an emergency department physician to immediately access the information, make a diagnosis, recommend a transfer or prepare the medical equipment necessary to treat the patient upon arrival," Dr. Gaither said.

Two partner EMS agencies are participating in the pilot program: the Rio Rico Fire and Medical District, serving the rural area just north of the Arizona-Mexico border; and the Sonoita-Elgin Fire District, serving rural communities between Tucson and Sierra Vista. Cobmined, their EMS service areas include 19,941 Arizona citizens and span 792 square miles in southern Arizona.

"Having the AzREADI resource available to the crews gives them a very near 'in-person' medical support experience," said Richard Johnson, deputy chief of the Rio Rico Medical and Fire District. "The ability for them to contact a physician and, via the technology, hear the medical recommendation is a great comfort to me as a supervisor, knowing that my personnel are supported to that extent regardless of their location."

"With the technology resources provided by AzREADI, we now have the ability to share vital clinical information with doctors in real time, which makes for more effective decision making and ensures that patients get the best care while allowing us to maximize our resources," added Marc Meredith, acting operations chief of the Sonoita-Elgin Fire District. "We are grateful to be part of this important program to enhance medical care in rural settings."

AzREADI is funded by a Health Resources and Services Administration (HRSA) grant with the UArizona Center for Rural Health at the Mel and Enid Zuckerman College of Public Health. The Center for Rural Health was one of only eight recipients in the nation to receive a three-year, $750,000 supplement to its HRSA Rural Hospital Flexibility Program award for the AzREADI project.

"EMS providers can use the AzREADI telehealth platform at the scene of the accident or illness or en route to a medical facility to virtually receive additional input on the best treatment option for the patient," said co-investigator Amber Rice, MD, an assistant professor in the Department of Emergency Medicine who also serves as medical director for two Tucson fire departments. "The anticipated effects are better triaging, advanced onsite care, and referrals to facilities that could best meet the patient's needs."

Other co-investigators are: Melody Glenn, MD, assistant professor and base hospital medical director for Banner - UMC Tucson, and Daniel Spaite, MD, professor and Virginia Piper Distinguished Chair of Emergency Medicine, from the Department of Emergency Medicine; and Arizona Telemedicine Program Founding Director Ronald Weinstein, MD.

"We are thrilled to partner with these outstanding agencies, using technology to help connect patients and providers to more resources," Dr. Glenn said. "This innovative project allows us to achieve one of the main goals of high-quality prehospital care: get the right care to the right patient at the right time."

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