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Houston FD's Emergency TeleHealth and Navigation Solution Modernizes EMS with Mobile Video Teleconferencing

Author: Dr. Michael G. Gonzalez, Associate Medical Director, HFD

Copyright: Copyright 9-1-1 Magazine, Feature Content

Date: 2017-06-19
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Different means of communication have become an integral part of our everyday lives. From the way we catch up with family, broadcast our thoughts to the world, or how we order a taxi, we have adapted the way we live through modern and instant communication. Nowadays, it’s commonplace. In the healthcare and emergency response industry, we shouldn’t settle for less.

At the Houston Fire Department (HFD), we have nearly 4,000 firefighters working to protect over 2.2 million people across the city. We receive upwards of 600,000 emergency calls each year, which can translate to over 400 EMS transports a day. Like most fire departments and emergency responders, we are constantly searching to maximize the efficiency of operational resources and personnel as much as possible.

One of the major problems emergency response organizations face is screening which 9-1-1 calls actually require an emergency response. Many times, responders receive calls from patients that don’t have a relationship with a primary care provider, but have a medical issue that needs to be addressed – like refilling a prescription or diagnosing the common cold. While these needs are important to keeping our citizens healthy and safe, they do not always require an ambulance ride or a trip to the hospital. For patients, it is also unnecessary to sit in a hospital for hours when he or she could have just scheduled an appointment with a nearby clinic or physician.

We needed something that could help HFD responders provide the best advice and care to patients, but avoid the time and costs associated with unnecessary ambulance transports. Our goal was to keep the foundation of traditional response services in place, but introduce a modern approach to the care we deliver. Understanding that technology would be an important piece this, we partnered with Cisco to develop an Emergency TeleHealth and Navigation solution, or ETHAN.


HFD knew it had to solve this complex problem and provide more coordinated out-of-hospital care, which is why they created ETHAN, or Emergency TeleHealth and Navigation. ETHAN uses video conferencing technology to allow patients and on-site EMTs to instantaneously communicate face-to-face with qualified physicians to determine the most appropriate medical care solution, based on his or her individual condition.

Our HFD Solution

ETHAN is a tablet-based mobile solution that empowers both emergency services and patients to coordinate out-of-hospital care to eliminate unnecessary and costly ambulance rides – and, when appropriate, redirect patients to partner clinic appointments in lieu of a visit to a busy emergency department.

After arriving on-site to a call, HFD first responders ask patients introductory questions, such as if there are signs of physical abuse or if a gun present. If the answer is no to all, the responders will proceed with checking patient vitals and perform a routine care exam. If the emergency responders agree a patient doesn’t need emergency care, the tablet is pulled out and ETHAN is activated.

In the past, if there was any question about a patient’s condition they would be transported as a precaution. Now, ETHAN allows us to connect back to the Emergency Operations Center (EOC), allowing medical doctors across the city to work with the on-site EMS crew to interview the patient in real-time through video conferencing to determine the proper medical response.

Real-time data sharing and video conferencing allow the physician to better understand the patient’s situation and offer the appropriate option. This may include a transport to a hospital, city-paid taxi service to a medical facility or simply a reference to an appropriate provider. ETHAN physicians can even connect patients with a partner clinic and schedule an appointment on the spot.

Since we first deployed ETHAN, the city has avoided more than 6,000 unnecessary ambulance transports rides and we have steadily improved our use of the technology. Today, only about 15 percent of patients that engage with ETHAN still end up needing transportation to the hospital via ambulance. 

Last month, HFD surpassed the 10,000 mark for how many patients we attended to using ETHAN. In addition to avoiding ambulance transports, ETHAN helps minimize crewmember response time on site, reduce wear and tear on the emergency vehicles and save both the city and patients money. In certain cases, our HFD responders have cut their time away from the station from an hour and a half to as low as 20 minutes. On top of that, our community, healthcare organizations and ETHAN patients are saving money as ambulance trips typically range between $600 and $1,200, and ER visits themselves can cost even more.

The best part of all – we have just scratched the service of what is possible in this emergency healthcare space.


Creating your mobile EMS program

Emergency response organizations across the U.S. are seeking ways to improve the management of low-priority calls. With tools like video conferencing and other new technologies, we can collectively bridge the gap between patients and physicians almost instantaneously, allowing them to receive the highest level of remote medical attention.

There is tremendous potential for organizations to embrace a mobile healthcare and video solution, like ETHAN. As emergency care responders, we are constantly striving for ways to make sure our citizens receive the best possible care. As we adapt to different ways of communication in our everyday lives, our emergency response tactics must change too.

From our experience at HFD, there are three foundational things EMS organizations can do to embrace a mobile healthcare solution. 

First, organizations need to have an internal group of people who are motivated about the project. The inspiration to develop a solution, like ETHAN, starts from within. At HFD, we had a very successful transition because we had our people advocate for it and become familiar with the technology. Once our dispatchers and on-site crews learned what it could do, and became excited about it, we noticed a 30 to 40 percent spike in ETHAN usage. 

The second – and critical – step to implementing a mobile healthcare solution is community collaboration. For a solution like ETHAN to be possible, it takes partnerships across private, public and non-profit organizations to sit down and discuss the issues and priorities. It requires teamwork to determine what we as public service organizations can bring to the table and help tackle. Although HFD led the development of ETHAN, its success would not be possible without the hard work of all of the local partners and clinics involved.

The third, and perhaps most important piece to the puzzle, is to have an open mind. At first there were, and always will be, a lot of “no’s.” However, what matters is the key group of people who say “yes” to the idea. When we first adopted ETHAN, we told many organizations to “think about saying yes” so they could envision the possibilities. Just because an organization has never participated in a mobile healthcare solution, doesn’t mean that it isn’t a great solution to supplement or enhance what’s already being done.

One of the most important lessons we’ve learned is that technology itself is not something to fear with patient engagement. Less than one percent of HFD patients haven’t understood what ETHAN is and/or refused to use it. This is a testament to how much people have embraced technology in their own lives and proves they’re willing to use it in more situations than ever before.


Since deployment, ETHAN has been integral in the response of 7,500 patients and it has already successfully prevented 6,000 unnecessary hospital transports (80 percent). HFD’s modern healthcare approach is saving hours of hospital wait and transport time. Plus, it’s already saved taxpayers, the department and patients several thousands of dollars in medical care costs.

The Future of Healthcare

Emergency response services will always be rooted in people helping others. When we hear the word “telemedicine,” we think of modern technologies used to provide patients across the country – even the world – the highest level of remote care. While this is true, the term telemedicine today is somewhat limiting because our work involves so much more than a phone or radio system. Solutions like ETHAN bring together the latest technology – video conferencing, HIPAA-approved tablets, and advanced call manager systems – to push the envelope of how emergency response care is delivered.

When it comes to embracing technology and modern communications capabilities, it is important to find a solution that disappears in to the background. It should enable responders to do their jobs more efficiently and speed up operations – especially in time-sensitive situations.

Strong partnerships in local communities are fueling innovative healthcare programs across the country. There will always be a need for public safety and human response, and there will always be a need for the brick and mortar healthcare system. People are still going to continue to have accidents and seek medical help, but the way we manage and act as emergency responders is changing for the betterment of everyone involved – EMS teams, hospitals and patients.

Traditional healthcare services and interactions aren’t going anywhere. But through innovative technology and open-minded partners, ETHAN is helping us push the boundaries to bring a faster, more efficient system of emergency care to Houston-area residents. It will only take a few generational leaps in technology for immediate and on-site care to become the norm, and ETHAN is a small step in that direction.

Watch Houston FD’s explanatory video about the ETHAN system here

Dr. Michael G. Gonzalez, MD, FACEP serves as Associate Medical Director for the City of Houston Fire Department/EMS Division, Director of the ETHAN Project and faculty with Baylor College of Medicine, Emergency Medicine Residency Program and Director of Advanced Airway Management and Simulation Education. Dr. Gonzalez is a native Texan and graduate of Rice University and the University of Texas Medical School at Houston. A veteran of the U.S. Air Force, with tours of duty in support of Operations Enduring Freedom, Iraqi Freedom and New Dawn, Dr. Gonzalez has served as Chief of Emergency Services, Landstuhl Regional Medical Center, Germany, as well as Deputy Director & Lead Physician for Critical Care Air Transport Team (CCATT) operations, U.S. Armed Forces Europe and Bagram Air Base, Afghanistan. He lectures nationally and internationally with research interests in pre-hospital airway management, telehealth, critical care transport and trauma.

Photos via HFD.





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