Houston Firefighters Bring Digital Doctors On Calls

It seems like every firefighter you ask in Houston can rattle off examples of 911 calls that didn’t even come close to being life-threatening. Houston ambulance driver Tyler Hooper sums it up: “Anything from simple colds to toothaches, stubbed toes to paper cuts.” The Houston Fire Department logged more than 318,000 incidents in 2014, but only 13 percent of them were actual fires. The rest were medical calls, making a career in firefighting seem more like a career in health care. On certain calls, Hooper might have taken callers to the ER, just to be safe. But now he has an alternative – a computer tablet loaded with a video chat application. He launches the app and Dr. Kenneth Margolis appears on the screen. He is seated in the city’s emergency management and 911 dispatch center, almost 20 miles away. Hooper swivels the laptop screen toward the couch, bringing doctor and patient face-to-face.

The intervention is known as Project Ethan, an acronym for Emergency TeleHealth and Navigation. It rolled out across all city firehouses in mid-December. “I think a lot of people are very surprised that they can talk to a doctor directly and have been very happy with that,” says Dr. Michael Gonzalez, the program’s director and an emergency medicine professor at Baylor College of Medicine. Gonzalez says the idea is to direct patients such as Carrington to primary care clinics, instead of automatically bringing them to the emergency room, where ambulances can be tied up for precious minutes -- even an hour -- as EMTs do paperwork or wait for a nurse to admit the patient. By diverting some patients to clinics, ambulances can stay in the neighborhoods and overloaded emergency rooms can focus on urgent cases.

Other cities have experimented with programs to relieve the burden on emergency responders. Some programs analyze 911 data to identify “super-utilizers,” and send teams into their homes to arrange needed services such as transportation and follow-up care after hospitalization. Those home-visit programs are often called “community paramedicine,” especially if they use paramedics to problem-solve the medical issues. Other cities have tried to divert 911 callers by using nurse hotlines. Houston has also tried that approach, but firefighters complained it took too long, and patients never spoke directly with the nurse. Gonzalez says a key component of the telemedicine program is that it doesn’t just turn patients away from the emergency room. It offers an alternative -- a doctor’s appointment that day or the next, and transportation there and back. City health workers also follow up with Ethan patients to identify other issues that may be leading them to use 911 inappropriately.