Experience of The National Emergency Tele-Critical Care Network.

The COVID-19 pandemic exposed significant frailties of the U.S. healthcare system, especially inequities facing rural areas during surges when critical access and small community hospitals could not transfer patients to referral centers that were already overcapacity. Many clinicians suffered moral injury from managing these patients beyond their scope of practice or from the need to triage care. The National Emergency Tele-Critical Care Network (NETCCN) sought to provide a lifeline of free, ad hoc consultation to clinicians who needed help - a critical care "911" system - by using mobile devices and easy-to-use applications designed to help clinicians rapidly communicate with experts. NETCCN provided 1,863 days of coverage to 60 hospitals in 17 states and U.S. territories at a fraction of the cost of boots-on-the ground emergency support. We review our experience delivering this support and provide recommendations to guide future development and integration of telemedicine programs into the National Disaster Medical System.