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Prehospital Thrombolysis: A Manual from Berlin

Prehospital Thrombolysis: A Manual from Berlin

Published on: November 26, 2013

ET3 Treat in Place Program Implementation in a Large Urban EMS System.

Luis Castillo¹, Elise M Solazzo², Erik Blutinger^3,4

¹Mount Sinai Emergency Medical Service, New York, New York.

Prehospital Emergency Care

|October 17, 2025

Summary

This summary is machine-generated.

The Emergency Triage, Treat, and Transport (ET3) model in NYC saw low patient participation despite its potential to reduce emergency department visits. Implementation challenges included training, outreach, and technology barriers, suggesting a need for workflow improvements and public education.

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Area of Science:

Emergency Medical Services
Health Services Research
Public Health

Background:

The Centers for Medicare and Medicaid Services (CMS) introduced the Emergency Triage, Treat, and Transport (ET3) Model in 2019.
ET3 aims to improve emergency care quality and reduce costs via telehealth and alternative destinations for low-acuity cases.
New York City (NYC) implemented ET3 protocols within its 9-1-1 system to encourage widespread adoption.

Purpose of the Study:

To evaluate the characteristics and patient disposition within NYC's 9-1-1 emergency medical service (EMS) system under the ET3 program.
To identify challenges encountered during the implementation and operation of the ET3 model in a large urban EMS setting.

Main Methods:

A retrospective chart review was conducted on program data from a single urban EMS service in NYC.
Data analysis focused on patient eligibility for ET3 encounters, acceptance rates for telehealth treat-in-place options, patient disposition, and 72-hour return visit rates.

Main Results:

Out of 133,646 9-1-1 calls, 78,911 (59%) were triaged for ET3, with only 2,130 (3%) meeting inclusion criteria.
Telehealth ET3 encounters were offered to only 524 patients (25% of eligible), with 50 (9%) accepting and 31 (62%) treated in place.
Of those treated in place, only 4 (13%) required subsequent emergency department visits within 72 hours.

Conclusions:

The ET3 pilot in NYC experienced very low acceptance rates among eligible participants.
Key implementation challenges identified include personnel training, public awareness, and technological barriers.
While ET3 shows promise in reducing ED transports for willing participants, further improvements in workflow and public education are needed to enhance participation.