For years, EMS and Fire crews have responded to 911 calls only to find an increasing percentage of calls are for non-emergent health concerns. In the traditional “you call, we haul” EMS delivery model we had no other choice than to offer transport via emergency ambulance to local emergency rooms. This approach creates significant frustration when you know the patient needs can be better met in a primary healthcare setting. EMS and acute care resources are not meant to address chronic coughs, itchy eyeballs, back pain that has been present for the last year. These types of system misuse/abuse calls create compassion fatigue and added stress in a job that’s already inherently stressful.
In December of 2014, the Houston Fire Department launched a program to address non-emergent medical calls in our community. It is a pathway to link patients to more appropriate care and healthcare homes. By redirecting some of these calls to appropriate medical resources, we can more efficiently use emergency resources for actual emergencies. This transformative project is called ETHAN (Emergency Tele-Health And Navigation). It was established with the support and assistance of the Clinton Health Matters Initiative and through a collaborative effort between the Houston Fire Department and Houston Health Department, along with corporate and community partners, including local federally-qualified healthcare clinics such as Legacy, Greater Houston Health Connect, Harris County Health Alliance, and Verizon Wireless.
When a patient calls 911 a crew arrives on scene to assess the patient and general situation. Once the patient’s issue is determined to be non-emergent, they are offered an opportunity to participate in the ETHAN program. Instead of transporting the patient to an emergency room, we can now offer assessment and referral to local clinics. Participating patients may be counseled to go by private transportation to local clinics, their primary care doctor, or local emergency rooms for their complaint. The ETHAN program uses wireless technology to video link on-scene crews, the patient, and an HFD physician together to discuss the patient’s medical complaint. The physician schedules the participating patient a clinic appointment at a clinic closest to their home. For patients who insist on receiving care at an emergency room the doctor may encourage them to go by private auto or schedule the patient for non-emergent transportation. There is a pervasive misconception that if one goes by ambulance to the hospital they will be seen faster prompting some to call 911 to avoid long ER waiting room times. For patient’s lacking transportation, the ETHAN program will pay for transport by cab to the scheduled clinic appointment or local ER. This is accomplished through partnership with the Harris County Rides Program. In an effort to get patients into appropriate care settings, the ETHAN program will also pay for the initial clinic visit.
Our partner, the Houston Health Department attempts follow up on all ETHAN participants to assess for additional unmet social needs. HHD counselors contact most participants by phone and complete a satisfaction survey, inquire about immunization status, gather data about household income, and offer to connect the patient to additional social services upon request. ETHAN is a revolutionary program that gives first responders the first viable alternative to meet the non-emergent patient’s needs. In just a year and a half, ETHAN has already helped 7,380 people.
This model is an example of how cross-sector partnerships and innovative use of emerging technology can transform health services, and I hope it is replicated across the country. If there’s one thing first responders everywhere have in common, it’s our commitment to getting people the help they need, when they need it. ETHAN helps us do just that.