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Houston Steers Cities Into Reducing 'Red Lights and Sirens'

Most 911 calls don't actually require a trip to the hospital. Instead, telemedicine can do the trick, and Houston's system is catching on among the country's paramedics.

A fire truck in Houston.
For people living in cities, the constant sight of red lights and sound of sirens can be taxing. Their omnipresence can be particularly frustrating given that around 80 percent of calls to 911 aren't actual emergencies.

To cut back on these expensive and often unnecessary trips to the hospital, cities are revamping their emergency services programs. Houston, a sprawling metropolis made up of more than 2 million people, is leading the charge.

In 2014, the city launched a telemedicine service that has reduced 80 percent of the number of unnecessary emergency visits. The program is called ETHAN, which stands for Emergency TeleHealth and Navigation. It works like this: When paramedics arrive at the scene of an emergency and realize a patient doesn't need to be rushed to a hospital, they use a tablet to video chat with a specialist. For instance, a patient can chat with a nurse to get a prescription refilled or get an appointment scheduled on the spot with their primary care doctor for joint pain.

Michael Gonzalez, ETHAN’s program director, says the program is approaching its 10,000th patient encounter and has prevented 6,000 unnecessary ER transports. The average teleconference visit clocks in at about seven minutes, and the cost of treating a patient virtually is around $220 -- substantially less than the $2,200 it costs to transport someone to the ER.

As a result, Houston's use of telemedicine in emergency services is catching on. Gonzalez says he's had about 300 teleconferences with health agencies from around the world since ETHAN launched. A handful of American cities are also about to launch their own EMS telemedicine programs similar to Houston's.

“It’s very clear to us that telemedicine has a place in EMS," says Vince Robbins, president of the National EMS Management Association. "It depends on the agency, and how effective it would be for them, but it’s a good technology and can have good value.”

This is Houston's third effort in a decade trying to modernize emergency services. In the first iteration in the early 2000s, the city went with a hotline, where chronic 911 users could call and chat with a nurse. The problem, however, was getting someone who normally calls 911 to dial a whole new number.

“It was like fitting a square peg in a round hole,” says Gonzalez.

Houston then created a computer-based algorithm to triage patients. Once paramedics arrived at a scene and again realized it wasn't an emergency, they would connect a patient with a paramedic at headquarters. But it turned into a headache for paramedics: It was time-consuming and often required immediate transport to a hospital anyway. 

While Houston’s latest approach to redirecting people away from the ER is novel, Robbins says there are other ways to use telemedicine that can make emergency care better for everyone.

A couple of localities -- including Minneapolis and Berks County, Pa. -- use telemedicine to treat stroke victims en route to the hospital. These programs can shave 20 minutes off of a patient’s treatment time once at a hospital, which is important because “in a stroke, time is of the essence," says Robbins. "If you can intervene early enough, you can even reverse the symptoms.”

The goal behind these efforts is not only to reduce the number of "frequent fliers" -- those who repeatedly show up at the ER -- but also to reduce the overall number of “red lights and sirens” that residents have to deal with on a daily, sometimes hourly, basis. 

“There’s a public expectation when you call 911 that you want an immediate response, so we as an industry need to re-educate the public," says Robbins. "We need to let people know that there is strong medical literature that shows there are some instances where your condition is not going to get any worse, and we have time to better help you.”

Mattie covers all things health for Governing.

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