Give residents a licensed physician they can text before they dial 911 and low-acuity demand has somewhere else to go. Your medical director keeps protocol authority. Your crews keep every transport decision. Ferris, Texas reported 20 percent fewer non-emergent EMS runs after adopting TAP, an uncontrolled city-reported result.
Where do the avoidable transports come from?
The national picture is not subtle. NEMSIS logged 60,298,684 EMS activations in 2024, of which 46,733,668, or 77.5 percent, were emergency responses in a primary response area. The report’s transport mode from scene table covers 28,363,789 records, and 65.7 percent of them are non-emergent. Its patient and crew disposition table covers 57,610,610 records, of which 11.0 percent closed as back in service with no care or support services required and another 6.3 percent closed with care refused. Those last two are non-transport dispositions, which is exactly why they belong in this conversation. Figures are from the 2024 National EMS Data Report, published September 2025.
Most chiefs can name the calls behind those numbers without looking anything up. The resident with a fever and no primary care doctor. The refusal who has nowhere to go and calls again on Thursday, and the transport that happens only because the crew has no other disposition to offer and will not leave someone with nothing.
None of that is a training problem or a protocol problem. It is an access problem that lands on your apparatus.
How does a department keep clinical control?
TAP operates in front of the 911 call and after a refusal. It is not part of your response, and it does not touch field medical control. The boundaries matter more than the marketing, so here they are.
- Your medical director keeps protocol authority over the 911 response. Nothing in a TAP agreement changes your protocols, your standing orders, or your online medical control.
- Your crews keep every transport decision. TAP physicians do not advise crews on scene and take no part in field disposition.
- TAP escalates toward 911, not away from it. Chest pain, stroke symptoms, difficulty breathing, anaphylaxis, severe bleeding, altered mental status, and active seizure all get a direct instruction to call 911. The escalation protocol is written to push emergencies into your system fast, not to hold them in a text thread.
- Every encounter gets a follow-up within 48 hours. That is the mechanism that keeps a complaint you never heard about from turning into a repeat call later in the week.
- The text thread is the medical record. Every message is timestamped and preserved, which gives a medical director something auditable that a bedside conversation almost never produces.
- TAP physicians and advanced practice providers are licensed in your state and work under a state-specific medical director who conducts routine chart review and reviews every flagged encounter.
- Referrals run through a directory built for your city. A resident who needs in-person care gets a named local provider, not a generic instruction to go see somebody.
- TAP prescribes no controlled substances. Not in any state, for any complaint.
Residents who want no part of it can decline participation.
What does the peer-reviewed evidence show?
The anchor study is still Houston’s ETHAN program. Langabeer and colleagues ran a case-control analysis of 5,570 patients routed through physician telehealth consultation, matched against an equal-sized control group across calendar year 2015, and published in the Western Journal of Emergency Medicine. Ambulance transport to an emergency department ran 18 percent in the telehealth group against 74 percent in the control group. Back in service times were shorter. Prehospital mortality was zero in both arms.
Read the full paper before you quote that spread, because the abstract does not carry the part that matters most to a chief. Most ETHAN non-transports were offered a prepaid taxi to an emergency department, and most of those patients took it. Ambulance use fell hard. Emergency department use did not fall nearly as much. If your problem is unit availability, that study is directly on point. If your problem is downstream cost to the community, it is only half an answer, and the missing half is why the intervention has to reach people before the call is placed rather than after a crew is already standing in the living room.
The StatPearls chapter on prehospital EMS telemedicine, updated September 2025, collects the rest of the literature. It cites the ETHAN result, a separate program reporting a 67 percent reduction in transports, and a German randomized trial finding tele-EMS clinicians noninferior to on-scene clinicians on adverse events. It is also candid about where the evidence remains thin, including prehospital teleneurology.
For program design rather than outcomes, NAEMSP published its position statement and resource document on mobile integrated health care and community paramedicine in Prehospital Emergency Care in 2025. If your department is standing up anything in this space, that is the document your medical director will want in hand before the first meeting.
What should the ET3 results tell you?
CMS ran the Emergency Triage, Treat, and Transport model from January 2021 through 2023 and shut it down two years early. Read the final evaluation before anyone sells you on treat in place.
Only 38 percent of the 185 participating ambulance organizations delivered any ET3 intervention at all. Among active participants, those interventions came to less than 1 percent of annual Medicare fee-for-service ambulance transports. More than 90 percent of what did happen was treatment in place, and eight high-volume participants accounted for over three quarters of it. Patients treated in place showed higher follow-up emergency department visit rates than matched low-acuity emergency department episodes, along with a higher risk of hospitalization within five days. Higher-volume participants had a lower follow-up ED visit rate, though CMS reports that difference as non-significant. On cost, and assuming a low-acuity emergency department visit would have happened without the intervention, Medicare spending came in moderately lower for treatment in place than for the matched episodes.
Two lessons fall out of that, and both are unflattering to easy pitches. On-scene alternative disposition is operationally hard to run at any real volume, which is why most participants never really ran it. And what happens after the disposition is where the outcome is won or lost, which is why the follow-up ED numbers went the wrong way. A resident-facing layer that works before dispatch sidesteps the first problem. The 48-hour follow-up is the answer to the second.
What did Ferris, Texas report, and how solid is it?
Ferris is a small city south of Dallas, mostly in Ellis County, with fewer than 6,000 residents. After putting TAP in front of its residents, the city reported 20 percent fewer non-emergent EMS runs, with household adoption above 50 percent. The figure comes from Brooks Williams, who was Ferris city manager when the program was adopted and is now city manager emeritus.
Here is the method, stated plainly, because it changes how much weight the number carries. This is a city-reported comparison of the department’s own non-emergent run volume before and after the program. There is no matched control group, no randomization, and no adjustment for anything else that changed in Ferris over the same period. Ferris is also small, so the absolute run count behind that percentage is small. It is an observed operational result in one city, not a study.
What makes it worth looking at anyway is the adoption figure. A program reaching more than half of households is at least in a position to move call volume. Most municipal health programs never get close to that, which is usually why their outcome numbers are indistinguishable from noise. Algonquin, Illinois, a much larger and longer-running partner, has held 70 percent household retention. Across the partner base as a whole, residents rate the service 9.9 out of 10, and 93 percent of TAP encounters close without generating a downstream claim.
That last number deserves a caveat. It is a claims measure, not an EMS measure. It tells you the episode ended rather than migrating somewhere more expensive. It does not by itself tell you what happened to anyone’s transport volume.
What is observed and what is modeled?
Mixing the two is how vendors lose a room full of chiefs. So they are separated here.
| Figure | Type | How it was produced |
|---|---|---|
| 20 percent fewer non-emergent EMS runs, Ferris, TX | Observed | City-reported before and after comparison of the department’s own run volume. One city, no control group, small absolute numbers. |
| Household adoption above 50 percent, Ferris, TX | Observed | City-reported enrollment measured against billed households. |
| 70 percent household retention, Algonquin, IL | Observed | Village-reported household retention in an established program. |
| 93 percent of encounters resolved without another claim | Observed | TAP platform data across partners. Measures downstream claims, not EMS transports. |
| 9.9 out of 10 resident rating | Observed | Post-encounter resident survey. |
| 18 percent versus 74 percent ambulance transport rate | Published research | Langabeer et al., case-control study, 5,570 matched pairs, Houston, 2015. Measures ambulance use, not emergency department use: most non-transports were offered a prepaid taxi to an ED and took it. Not a TAP result. |
| $450 to $900 per avoided dispatch | Modeled | Planning range only. Multiply avoided non-emergent responses by your own fully loaded cost per response. Substitute your figure, not ours. |
If a number in the left column matters to your budget conversation, run it against your own dispatch data before you repeat it to a council. The modeled row is a planning input. It is not a savings claim and should not be presented as one.
What will TAP not do for your department?
TAP is not emergency care and does not present itself as emergency care. It provides no online medical control, directs no crews, and replaces no resident’s primary care doctor. Controlled substances sit outside the formulary everywhere TAP operates. And it will not reduce calls that were genuine emergencies, which is the point.
Bring TAP to your department
TAP works with more than 780 public-sector partners. If you want to see how the clinical governance holds up against your protocols, and what the model looks like against your own run data, bring your command staff and your medical director. Partner with TAP.
Sources
- Langabeer JR, Gonzalez M, Alqusairi D, et al. Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments. Western Journal of Emergency Medicine. 2016;17(6):713-720. doi:10.5811/westjem.2016.8.30660
- Su JS, Shanes A, Quinn E. EMS Telemedicine in the Prehospital Setting. StatPearls. Updated September 25, 2025.
- National Association of EMS Physicians. Mobile Integrated Health Care and Community Paramedicine: A Position Statement and Resource Document of NAEMSP. Prehospital Emergency Care. 2025. doi:10.1080/10903127.2025.2541899
- Centers for Medicare and Medicaid Services. Emergency Triage, Treat, and Transport (ET3) Model, Final Evaluation Report at a Glance. 2025.
- National EMS Information System. 2024 National EMS Data Report. Published September 2025.
