Emergency Triage, Treat, and Transport (ET3) Modle


Currently, Medicare regulations only allow payment for emergency ground ambulance services when individuals are transported to hospitals, critical access hospitals, skilled nursing facilities, and dialysis centers. Most beneficiaries who call 911 with a medical emergency are therefore transported to one of these facilities, and most often to a hospital ED, even when a lower-acuity destination may more appropriately meet an individual’s needs.

Model Details

With the support of local governments, their designees, or other entities that operate or have authority over one or more 911 dispatches, ambulance suppliers and providers will triage people seeking emergency care based on their presenting needs. The model aims to ensure Medicare Fee-For-Service beneficiaries receive the most appropriate care, at the right time, and in the right place. The model may help make EMS systems more efficient and will provide beneficiaries broader access to the care they need. Beneficiaries who receive treatment from alternative destinations may also save on out-of-pocket costs. An individual can always choose to be brought to an ED if he/she prefers.

The ET3 Model aims to reduce expenditures and preserve or enhance the quality of care by:

  • Providing person-centered care, such that beneficiaries receive the appropriate level of care delivered safely at the right time and place while having greater control of their healthcare through the availability of more options

  • Encouraging appropriate utilization of services to meet health care needs effectively.

  • Increasing efficiency in the EMS system to more readily respond to and focus on high-acuity cases, such as heart attacks and strokes.


The key participants of the ET3 model will be Medicare-enrolled ambulance service suppliers and hospital-owned ambulance providers. In addition, to advance regional alignment, local governments, their designees, or other entities that operate or have authority over one or more 911 dispatches in geographic areas where ambulance suppliers and providers have been selected to participate in the model will have an opportunity to access cooperative agreement funding.

Any individual who calls 911 and is connected to a dispatch system that has incorporated a medical triage line under the model would be screened for eligibility for medical triage services prior to ambulance initiation. Upon arriving on the scene, participating ambulance suppliers and providers may triage Medicare FFS beneficiaries to one of the model’s interventions upon ambulance dispatch following a 911 call. As part of a multi-payer alignment strategy, the Innovation Center will encourage ET3 model participants to partner with additional payers, including state Medicaid agencies, to provide similar interventions to all people in their geographic areas.

Military Medics transition to civilian EMS.. 

Standardize Prehospital Trauma Care Training Across the US military


On March 16, 2018, the Under Secretary of Defense for Personnel and Readiness issued DoD Instruction (DoDI) 1322.24 on Medical Readiness Training (MRT), requiring that all service members receive role-based Tactical Combat Casualty Care training and certification to meet the MRT requirement. Tactical Combat Casualty Care (TCCC), created by the U.S. Department of Defense Committee on TCCC (Co-TCCC), teaches evidence-based, life-saving techniques and strategies for providing the best trauma care on the battlefield.


The U.S. Armed Services have required MRT for many years, but there has been wide variation in how this requirement is met. Even units that use the TCCC curriculum have no standardized system in place to ensure consistent and appropriate training. There is currently no standardization of TCCC instructor training or no training offered at all. The DoD needs to use a recognized, reliable system to ensure successful implementation of DoDI 1322.24.