Every year, the Houston Fire Department (HFD) responds to about 300,000 Emergency Medical Services (EMS) calls. While half of those calls results in patient transport by ambulance to an emergency room, the majority of those transports are primary care-related and do not require emergency transportation or a hospital visit. The traditional response of transporting EMS patients to hospital emergency rooms creates great inefficiencies by unnecessarily tying up highly specialized medical resources with non-emergent patients and receiving primary health care through the emergency medical services does not deliver quality patient outcomes and compromises continuity of care. To alleviate this problem, HFD experimented over the last eight years with different models of what is currently called the Emergency TeleHealth and Navigation (ETHAN) program. Those early models included multiple variations of a nurse phone line and an online triage algorithm used by centralized paramedic units and connected with the field. Those programs produced mixed results and had very limited impact on reducing the number of unnecessary ambulance transports and emergency room visits. Using lessons learned and newly available technology, starting in 2013, HFD brought together over 25 local and national organizations to design and collaborate on implementing a new project, called ETHAN. This includes the major local hospitals, community clinics, Houston Health Department, Clinton Foundation, Harris County Rides program, University of Texas Health Science Center-Houston, the local health information exchange, and multiple software and hardware providers. HFD obtained a grant from a state-federal government partnership to start the program. ETHAN allows patients who are determined to be non-emergent by the responding units to speak directly with an emergency physician via video conferencing software available on the tablet with each of HFD’s 225 fire and EMS units. Patients are triaged by the physician and navigated to the appropriate care setting and are also provided with cab transportation when needed instead of an ambulance transport. This allows the responding unit to go back in service much faster compared to a traditional non-ETHAN response, saving an average of 44 minutes per response. Health-care navigators from Houston Health Department later engage the patient to address any additional social and human services needs to reduce the patient’s dependence on 911 for the future. ETHAN’s technology infrastructure is integrated in a way that minimizes the effort needed from involved providers and securely shares patient information with all partners (primary care clinics, taxi provider, field responders, ETHAN physician, and health-care navigators).