Emergency Triage Gets a New High Tech Identity: Meet ETHAN

Emergency room personnel may be getting a new tool for triage with ETHAN, which stands for Emergency Tele-Health and Navigation, and blends EMT traditions of emergency-room triage with modern technology. The project is funded by a provision of the Affordable Care Act supporting programs using technology to find more efficient and less costly health care.

"We're at an interesting crossroad in the U.S.," Dr. Michael Gonzalez, ETHAN's program director told the Houston Chronicle. "We are at the intersection of 'Can we safely triage that need?' and the emerging technologies of 'Right now, from anywhere?’"

"An evolution has occurred in the last 20 years or so," says professor of management, policy and community health for the University of Texas' School of Public Health Charles Begley. Predominant trauma care in the ER has become treatment of chronic conditions and basic health care for the poor and nearly poor, says Begley.

Fire officials told the Chronicle that their best guess is that 911 calls are not urgent in more than half the calls. In an interview with the newspaper, Dr. David Persse, who helped launch ETHAN and is physician director of Emergency Medical Services for the Houston Fire Department and head of Houston's Public Health Authority, said the current system is "unsustainable".

In Houston, an ambulance trip costs a minimum of $1,000 and going through the ER doors adds $1,500, according to the Chronicle. An ETHAN doctor can arrange city-paid transportation by cab at a fraction of the cost of an ambulance, thus freeing the vehicle for life-threatening emergencies.

Modern technology is combined with human know-how to take a common-sense concept approach to triage. A doctor, trained in emergency medicine, is called by the fire truck or ambulance emergency medical technicians if the situation does not appear to be an emergency. Through video chat on a specialized tablet, the doctor assesses the need for a trip to the ER or to a primary care physician or clinic. Once in the ETHAN system, follow-ups are maintained to ensure that the necessary precautions are in place for the stability of the patient.

Dr. Kenneth Margolis, an emergency medicine physician at CHI St. Luke's Health, handles 10-hour shifts of ETHAN video calls from the field. "I really think this program is going to work," he told the Chronicle.