City Council unanimously approved a $149,000 contract Thursday for the San Antonio Fire Department to begin using a videoconferencing app to respond to 911 calls.
“This application will allow our residents to get assistance for medical professional staff from the comfort of their home,” Deputy City Manager María Villagómez told City Council members. “This idea started early in the summer when the fire department was looking for innovative ideas to provide medical assistance to our residents.”
The app, called GoodSAM, was created by a company in the United Kingdom and will serve as part of the San Antonio Fire Department’s participation in the Medicare Emergency Triage, Treatment, and Transport model (ET3), which City Council also unanimously approved Thursday. SAFD joins 12 other agencies participating in the new federal program in Texas, which aims to address the health care needs of Medicare Fee-for-Service beneficiaries, Assistant Fire Chief Bryan Norris said.
Currently, emergency dispatchers answer 911 calls by sending ambulances to the scene, Norris said. There are only two choices that people who call for assistance can take: be transferred to a hospital’s emergency department or not.
The fire department only gets reimbursed for taking people to the hospital emergency department, but there’s “no consideration for the medical needs of the patients” who might not require emergency care, he said.
“Every problem looks like a nail, and so the only option that we have is to bring the hammer,” Norris said. “Sometimes a screwdriver or a pair of pliers are more appropriate depending on the patient’s needs.”
The ET3 model is designed to allow 911 responders the option to consult with the caller before sending out an emergency team. If the responder decides to send an ambulance, that ambulance does not necessarily need to take the caller to a hospital, Norris said. Instead, emergency services can take people to clinics or urgent care centers.
“This allows EMS units to be compensated for transporting to the most appropriate facility for the patient,” Norris said. “So now we don’t have to look at every problem as a nail … We can start to see these different options and we can add options for both handling services and the beneficiaries of the services.”
Though the program is limited to people covered by Medicare Fee-for-Service, Norris said the fire department is looking to help expand its scope.
“We’re working with the Texas Association of Health Plans, Health and Human Services, all of those different organizations to try to get this expanded and the response has been very popular,” he said. “However, one thing … we do not do as the fire department is what we call ‘insurance triage.’ And so we’re not going to walk into somebody’s house and say, ‘OK, what kind of insurance do you have?’ and that’s going to depend on the care that you get. We’re going to supply this program for everybody and we’ll take care of the reimbursement on the back end.”
The ET3 model also calls for the use of telehealth when applicable to answer questions before dispatching an ambulance. That’s where the GoodSAM app comes in, Fire Chief Charles Hood said. The app not only allows 911 responders to see the caller but also can report the caller’s pulse.
The GoodSAM app does not need to be downloaded but it does rely on cellphones, something that council members expressed concern about – especially with senior citizens who may not be tech-savvy or parts of San Antonio without steady internet access.
“I’m still concerned that in my area the digital divide is alive and well; a lot of people don’t know how to use [smartphone apps],” Councilwoman Adriana Rocha Garcia (D4) said.
Hood assured council members that 911 responders would take callers step-by-step on using the app.
“A lot of seniors have smartphones but they don’t text, and this message is going to come in your text file,” Hood said. “But we’re easily able to walk them through [it].
Dispatchers can text a link to 911 callers that pulls up the GoodSAM app. That app then connects two parties via videoconference. By seeing the caller, 911 responders can assess how urgent the situation is and decide how to respond.
The San Antonio Fire Department began using the GoodSAM app in a pilot program in October for a total of 704 calls so far, and Hood said he has been impressed with the results. Hood recounted a call that he observed where a man called 911 for his father, reporting that his father’s hand was shaking. Instead of sending out an ambulance, the dispatcher asked the caller’s father questions about his symptoms through the GoodSAM app’s video call and was able to see his pulse rate through the app as well.
“We were able to consult him and not send any resources whatsoever,” Hood said. “Basically, it’s allowing us to put a face [to a name] and put a paramedic in your living room.”