Hurricane Florence struck North Carolina as a Category 1 storm on Sept. 14, 2018, bringing with it record rainfalls and flooding, an estimated $50 billion in damages, and a death toll of 51.1,2
Mandatory evacuations forced thousands of residents from their homes. To help those affected, Wake County created six shelters serving 1,100 people. Many of the evacuees had multiple chronic medical conditions, such as diabetes, high blood pressure, heart conditions, and kidney failure. In their flight to safety, many forgot their medications. Additionally, due to the stress of the circumstances, many of the shelter residents developed acute medical conditions, and their only access to physician care was through EMS and local emergency departments. The added call volume from the shelters strained the Wake County EMS system and taxed the already crowded emergency departments in Wake County.
Wake Emergency Physicians and RelyMD
Staffing six different shelters simultaneously with individual qualified providers was beyond the human resources capabilities of the stressed Wake County infrastructure. Wake County EMS and North Carolina Department of Health and Human Services contacted a local telemedicine company, RelyMD, and asked it to deploy its services to the shelters. RelyMD is a telemedicine service that is 100 percent owned and staffed by Wake Emergency Physicians, PA (WEPPA). With more than 160 emergency medicine and telemedicine specialists, WEPPA is a private, independent emergency medicine practice based in Raleigh, North Carolina, that staffs nine different emergency departments across three health care systems. RelyMD provides thousands of annual online medical evaluations via mobile app and internet-enabled computers. Its providers are available 24-7-365 in an on-demand model.
Just before the storm hit, the RelyMD team provided a one-hour in-service covering the basics of the platform, which operates on an iPad. During a 10-day hurricane-related period, RelyMD cared for 95 shelter patients, with 67 percent of the care delivered during the first three days of Florence making landfall. The medical issues included respiratory conditions, chest pain, wound care, minor injuries, mental health issues, dialysis coordination, and medication refills. Nurses would evaluate the patient’s needs, take vital signs, review medication lists, and transmit 12-lead ECGs, after which they contacted the RelyMD provider, who would get the “quick story” from the nurse. Then using synchronous real-time audio and video, a physical exam would be performed through the camera of the iPad, with the nurse acting as the provider’s hands. Of the 95 telemedicine consults, nine patients were evaluated and advised to go to the emergency department for further care (see Table 1). The diversion rate of patients who said they would have gone to the emergency department if the telemedicine consult hadn’t been available was 33 out of 41 cases, or 80 percent. (See “Telemedicine Response, By the Numbers” for a summary of this telemedicine initiative.)