As a paramedic in the Florida Keys, Al Brotons often was forced to send emergency patients to Miami trauma centers for complex care that wasn’t available in the region’s community hospitals.
Every second counts when treating patients suffering strokes, heart failure, and other life-threatening events, and Brotons struggled to watch the delay in critical care that came with the long flights to Miami.
“If we can use something to send a video message to the doctor that’s receiving these patients, will that improve patient outcomes?” Brotons wondered at the time.
Telehealth soon became an essential component of Brotons’ work and the region’s health care. Serving communities that often were hard to reach, essential hospitals were early adopters of telehealth services; for example, 53.6 percent of essential hospitals provided stroke care via telehealth in 2020, compared with 43.8 of hospitals nationwide.
After serving as battalion chief of fire rescue in the Keys, Brotons, whose career in fire rescue and emergency medical services (EMS) spans 32 years, joined essential hospital and association member University of Miami Health System (UHealth), in Miami. He now serves as associate director for operations and instructor development in the Division of Prehospital and Emergency Healthcare at the University of Miami Miller School of Medicine’s Gordon Center for Simulation and Innovation in Medical Education.
The center’s mission is to improve the training of health professionals and first responders to enhance patient outcomes and, most important, to save lives. Offering a variety of community paramedicine and disaster management trainings, including active shooter and hurricane responses, the center currently trains the City of Miami Fire Rescue and is in the process of training the Broward County Sheriff’s Office and Department of Fire Rescue.
Telehealth is central to that mission. UHealth’s telehealth medicine program has expanded to 50 Miami-Dade County Fire Rescue trucks with telehealth capabilities. These capabilities allow paramedics to call or send videos to physicians using a tablet computer in the EMS vehicle, so doctors can begin visually assessing a patient and prescribing time-sensitive medication before they get to the hospital.
During training, community paramedics use a tablet computer to contact physicians by video. Photo courtesy of the Gordon Center for Simulation and Innovation in Medical Education.
This, for a patient in critical condition, can mean the difference between life and death.
In two years, all Miami-Dade Fire Rescue units will have telehealth capabilities, Brotons says.
Telehealth capabilities also allowed Floridians in more rural areas, often where hurricanes hit the hardest, to speak with health care professionals and receive medical attention they otherwise wouldn’t receive.
This integrated community element of paramedicine is another focus of the center, particularly to alleviate the overwhelming stress put on health systems and emergency departments (EDs) nationwide during a health care workforce shortage.
“A lot of people can’t afford insurance, but that doesn’t mean that they should go to the [ED] for all their health care needs. That’s why this is so important, this type of community approach,” he explains.
Brotons notes that a high number of patients discharged from the ED are readmitted within 30 days, often due to complications related to a failure to fill their prescriptions.
“If those patients get readmitted to the hospitals, guess what? The hospitals cannot bill for them. That’s huge,” explains Brotons. “Think about the impact on the hospital. Now, think about the impact it has on 911 when we’re going back to pick up a patient and bring them to the ED when they really don’t need to go.”
Thus, the center trains community paramedics and emergency medical technicians to pay home visits to patients within 24 hours of discharge to ensure patients have access to their prescriptions and are in a safe environment where they’ll be able to recover.
“That community paramedic’s role is really social services. Their job is to make sure that that patient has everything they need to hopefully be okay,” Brotons says.
As a result of these programs, readmission rates have dropped dramatically.
“Hospitals can save thousands of dollars, 911 is not burdened with transporting patients that don’t need to go, and you’re getting to learn [about] your citizens in your own community, and they appreciate it more,” he says.
However, the retired battalion chief stresses the importance of centering community paramedicine protocol on each community’s particular needs.
“What worked for us in the Keys doesn’t work here in Dade County, or it may not work in Brevard County or Broward County,” he explains. “It’s [about] what the community needs are and the demographics and the patients that need this help.”
The Gordon Center also works beyond its Miami community, including by collaborating with the U.S. Army for more than 20 years to develop and implement training to save lives on the battlefield. Most notably, however, the center provides training to the White House Medical Unit, which Brotons describes as an honor.
Instructors and students at the Gordon Center take part in an emergency simulation. Photo courtesy of the Gordon Center for Simulation and Innovation in Medical Education.
“They can go and train anywhere if you think about it. And they come here, to the Gordon Center, for their training,” he says.
As for the future of the center’s trainings, Brotons says the goal is to launch the first community paramedicine curriculum in Florida.
“Community paramedicine is the future. Everyone’s testing this out and going through the ‘How do we do this in our backyard?’ type of thing,” he says.
That’s why Brotons aims to create a curriculum for all Florida fire rescue and EMS units to adopt and use as a pathway for improved patient care.
“You know the most famous saying, ‘It takes a village?’ Well, in a sense, it takes a community,” Brotons says.
