ETHAN Successfully Helps EMS

Primary care related 911 calls which are roughly 30 to 40 percent of the 700 to 800 calls made to 911 in Houston each day, do not involve true emergencies and could be treated effectively and efficiently in the primary care setting.

Treating primary care-related problems in the emergency department costs $600 to $1,200 per visit, roughly four times what it costs to treat the same problem in an outpatient clinic. In addition, using EMS and emergency department providers to treat patients who could be treated more effectively and efficiently elsewhere takes up scarce resources.

A program known as “Emergency Telehealth and Navigation” (ETHAN) is now being used by Houston’s Fire Department Emergency Medical Services. The use of video and other technology enables emergency physicians to conduct real-time assessments of patients in the field to determine if they require transport to the emergency department or could be better served elsewhere.

In the first nine months of operation, the use of ETHAN has steadily been rising, which has reduced unnecessary ambulance transports and ED visits, and connected a meaningful number of non-emergency patients to primary care medical homes.

ETHAN has received approximately $12 million in funding over a five year period. The program received additional grant funding from Houston’s Pay-or-Play Fund, a pool of money paid to the city of Houston.

This funding resulted from a legal provision requiring companies doing business with the city to either provide health insurance to employees or pay a penalty. Since many companies have chosen to pay the penalty, this fund has become a significant source of grant funding for local healthcare programs including ETHAN.

Also, the Houston Fire Department Emergency Medical Services works with a partner known as “Care Houston Links”, to provide follow-up monitoring and if necessary connects patients to community-based resources to address social services and other health related needs.

Due to limited resources, “Care Houston Links” prioritizes ETHAN patients referred to partner clinics over those who refuse such referrals or have their own primary care physician since these patients are most likely to accept and benefit from care management services.

This case study is described on the AHRQ site Use the word ETHAN in the search box or go to the box on top “Browse by Subject” then go to the right side where the states are listed and select Texas.

For more information, email the Innovator Diaa Alqusairi at

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