Telemedicine for disaster relief: MDLive's Dr. Deborah Mulligan on responding to Hurricane Harvey

As Texas addresses the aftermath of Hurricane Harvey, which struck the state's coast Aug. 25, Florida is working to prepare for the nation's next natural disaster: Hurricane Irma, a Category 5 storm expected to make landfall as early as Friday.

In the wake of Harvey — the Category 4 storm HHS Secretary Tom Price, MD, declared a public health emergency in Texas and Louisiana last month — a range of telemedicine vendors provided free services to victims in evacuation areas. MDLive, a Sunrise, Fla.-based provider of remote nonemergency general and behavioral care, offered individuals in cities along the Gulf Coast in Texas and Louisiana access to one telephone or video visit at no cost between Aug. 25 and Sept. 8. In advance of Irma, MDLive is planning a similar intervention, waiving visit fees for impacted individuals in Florida.

"It's just the right thing to do. There's nothing more complicated about it," explains Deborah Mulligan, MD, chief medical affairs officer at MDLive. "Did we have past experience? Not at this level. We did offer the opportunity during Hurricane Matthew [in 2016], but that wasn't near the magnitude of Harvey in this country."

Dr. Mulligan, who joined MDLive in January 2011, is a practicing physician, board-certified in pediatrics and emergency medicine. In one emergency medicine project, she led a national initiative to develop the Family Readiness Kit, an American Academy of Pediatrics-endorsed resource framework that helps parents prepare for natural and manmade disasters, from winter storms to terrorist attacks. She has also worked in emergency rooms during a slew of natural disasters, including Hurricane Wilma in 2005.

Dr. Mulligan spoke with Becker's Hospital Review about how telemedicine can help physicians prepare for and respond to incidents like Harvey.

Editor's note: Responses have been lightly edited for length and clarity.

Question: What challenges do patients face when attempting to reach medical care during a natural disaster, such as a hurricane?

Dr. Deborah Mulligan: One of the biggest problems that occurs with any natural disaster is the collapse of the healthcare infrastructure, particularly in those areas where there's an influx of demand. With Harvey, you're already seeing multiple hospitals cannot keep up with the surge. Why? There are all sorts of reasons. For example, do they have the resources? Or, many employees don't come into work because they're so fearful for their own families, homes or pets. Now you don't have enough people, you're running out of resources, and in other scenarios, you could triage patients out or you could send them to other hospitals to decompress, but there's nowhere to send anyone right now. That means we're a great partner in the community.

Q: What role can telemedicine play during a natural disaster?

DM: MDLive is bolstering the brick-and-mortar medical triage capabilities of our colleagues in emergency departments. We at MDLive provide nonemergency care; we should not be managing acute emergency care, which requires in-person management for critical injuries or illnesses. However, we were very well-positioned and well-prepared to help victims avoid the time it takes to be transported to any disadvantaged area. We're a high-level triage, because we're not nurses, we're physicians who are board-certified with five to 10 years of experience. We're able to answer concerns and questions for the public and to steer them where they need to go. Can you stay where you're sheltered, and can we help you get your medications? Do you need to see a physician? Does that have to be in an emergency department? Can you go to an urgent care center or a clinic set up in a local shelter?

Q: What nonemergency medical needs do you expect to increase after a natural disaster like Harvey?

DM: We're getting patients who are unable to get medications for underlying health conditions like diabetes, asthma and cardiovascular disease. For these patients, their physician's office may be closed or they may be displaced; they may not even be in Houston; they may be in another location in Texas, Oklahoma or wherever they were able to be transported. Their medications may have been lost or they may need refills. Another health complaint we're seeing is for emotional disturbances. Twenty percent of the population is on some form of medication for an ongoing mental health condition, but there are also people who are not on medications for those purposes who are now under such stress that they can't sleep; they have headaches; or they're feeling nervous, worried or anxious.

Then, what's going to happen the week after the hurricane? We've got an awful lot of water. That water's standing water, and although they're trying to clean it up, there's sewage spillover. I have a feeling we're going to run into problems with insect bites — mosquitoes, fire ants and bees. With mosquitoes, there's also the worry of Zika, dengue and West Nile, all of which have a presence, to some degree, in Texas.

Q: Are there any barriers to working with patients who have not used MDLive before, such as not having medical histories on file?

DM: I'll answer that question in two ways. One, we sometimes still get information about patients who have not already been part of our system, because they might not realize they have this as a benefit. For example, if they're a member of Blue Cross and Blue Shield of Texas, we might get a lot of medical information right when they register, as part of their benefit package with their employer or insurance company.

Two, for someone with no known benefit, it's the same as if you walked into the ER as one of the walking wounded. We ER docs know nothing about you beyond what you share with us. When they register we'll go through the entire medical history — including medications, allergies, past surgeries, anything that's going to be relevant to that consultation — just as we would if you walked into an urgent care or ER and were new to that facility. From my point of view, I don't consider that a problem, because that's what we do every day in the ER.

Q: How did MDLive prepare to offer free services in the wake of Hurricane Harvey?

DM: We knew, prior to landfall, Harvey was starting to look like it would require one of the largest disaster responses the community has ever faced. Because of my background, I contacted our founder, Randy Parker, on August 23 to ask if we could start preparing. He listened and agreed, and we contacted all our doctors who are licensed in Texas, Oklahoma and Louisiana, because those are the places people will move if they're evacuated. We asked the physicians to stand ready 24/7 to manage patients that might come, so we had those physician soldiers teed up. We also contacted our partners and agencies, and I am so grateful to tell you Blue Cross and Blue Shield of Texas stepped up immediately. We were able to work with them in advance to start the ball rolling and to prevent critical problems, for example, by putting out that Family Readiness Kit and letting individuals know MDLive would be there to provide care.

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