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Angel “Al” Brotons of the University of Miami: “Everyone in the same space needs to know how the system is applied”

For us, the perfect telehealth system would give us each patient’s medical history. What conditions or diseases they have, what medications they are on, etc. If we had this information available each time we take care of a patient in the field, that would be incredibly valuable. It would help us make quick decisions on […]

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For us, the perfect telehealth system would give us each patient’s medical history. What conditions or diseases they have, what medications they are on, etc. If we had this information available each time we take care of a patient in the field, that would be incredibly valuable. It would help us make quick decisions on what to do on the spot and what to leave to the doctors at the hospital. In my career I’ve learned that you cannot simply rely on the information the patients provide — if they are able to speak with you at all — they often don’t know their own medical history or the details of their medications.


One of the consequences of the pandemic is the dramatic growth of Telehealth and Telemedicine. But how can doctors and providers best care for their patients when they are not physically in front of them? What do doctors wish patients knew in order to make sure they are getting the best results even though they are not actually in the office? How can Telehealth approximate and even improve upon the healthcare that traditional doctors’ visits can provide?

In this interview series, called “Telehealth Best Practices; How To Best Care For Your Patients When They Are Not Physically In Front Of You” we are talking to successful Doctors, Dentists, Psychotherapists, Counselors, and other medical and wellness professionals who share lessons and stories from their experience about the best practices in Telehealth. As a part of this series, I had the pleasure of interviewing Angel “Al” Brotons.

As Director of Training Operations at the Gordon Center for Simulation and Innovation in Medical Education at the University of Miami, Al focuses on the integration of telemedicine into the prehospital environment for trauma, STEMI, and stroke. He also leads trainings in community paramedicine and response strategies for EMS in active shooter environments.

Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?

Until my recent retirement, I worked as battalion chief for fire rescue in addition to my role at the Gordon Center, and I have been involved in prehospital and emergency healthcare for decades. The idea to incorporate some form of telemedicine in emergency care came to me about 7 or 8 years ago. At the Gordon Center, we were working with the U.S. Department of State to ensure that EMTs, paramedics, physicians, etc. who were serving abroad stayed up to date on their trainings to ensure that their certifications wouldn’t lapse. To do this, they participated in monthly teletrainings with us from wherever they were stationed in the world. At the time, I worked as a firefighter/paramedic in Monroe County, which includes the Florida Keys, and I thought to myself: Why can’t we do telemedicine inside ambulances, in the field, using similar technology? That is when it got all started. I realized that including telemedicine in emergency care would benefit the residents and tourists who visited the Florida Keys. And it definitely would help us, the ones working in emergency services. Nobody in the U.S. was doing it at the time. We embarked on a journey to make this work in the field and started with a fairly normal mobile device that connected via WiFi. The quality of the WiFi connection was an issue in the beginning, but we worked it out over time. Suddenly, we were able to be in touch with a stroke fellow in Miami, 220 miles from where we were in the Keys, to discuss a stroke patient we took care of. It was truly revolutionary. Soon after, we went from cell phone to a hard-mount system inside the ambulance that is supported 24 hours a day. Now this type of telemedicine system is used by several other fire departments in South Florida.

Can you share the most interesting story that happened to you since you began your career?

The system we introduced was not only used for stroke patients, it also came in handy for trauma patients. For example, one time we were connected to a trauma expert at Ryder Trauma Center in Miami. He showed us, while we were taking care of a patient in the Florida Keys, how to do a needle thoracostomy mid-axillary line instead of the standard anterior chest, where it is usually performed. This was only possible because of the telemedicine capability. And that is why telemedicine is so important in emergency care — experts with high levels of specialty knowledge and expertise can assist paramedics live with procedures they may not be fully comfortable with. This can be life-saving and it made me really proud. I couldn’t believe what we were accomplishing.

On the flip side, can you articulate for our readers a few of the main challenges that arise when a patient is not in the same space as the doctor?

This is a debate that is going on right now when it comes to telemedicine in emergency care. We often use the technology for consultation if a patient actually needs to go to an ER. We can use it as a triage tool to see if transport to an ER is necessary. Not all of the patients need ER care. On the flipside, telemedicine can in rare cases delay transport to the ER. Doctors are used to asking a lot of questions to gauge the patient’s medical history and current condition. If that happens through telemedicine, it can push back departure for the ER. A good example for this is stroke care. Doctors and fellows routinely conduct the NIH Stroke Scale Exam, which can take several minutes. However, as more and more healthcare professionals get used to this kind of technology, we will see this time go down and it will become less and less of an issue.

Let’s zoom in a bit. Many tools have been developed to help facilitate Telehealth. In your personal experiences which tools have been most effective in helping to replicate the benefits of being together in the same space?

The most important tool for us here is that everyone is applying the same set of protocols for telemedicine in emergency care. Everyone in the same space needs to know how the system is applied. For example, whenever new stroke fellows join the team of a hospital we work with, we meet with them and discuss the protocols for consultations, transportation, etc. that we have in place.

If you could design the perfect Telehealth feature or system to help your patients, what would it be?

For us, the perfect telehealth system would give us each patient’s medical history. What conditions or diseases they have, what medications they are on, etc. If we had this information available each time we take care of a patient in the field, that would be incredibly valuable. It would help us make quick decisions on what to do on the spot and what to leave to the doctors at the hospital. In my career I’ve learned that you cannot simply rely on the information the patients provide — if they are able to speak with you at all — they often don’t know their own medical history or the details of their medications.

The technology is rapidly evolving and new tools like VR, AR, and Mixed Reality are being developed to help bring people together in a shared virtual space. Is there any technology coming down the pipeline that excites you?

In addition to tools that would give us immediate access to a patient’s medical records, it would be great to have technology that recognizes someone’s face and, without even needing a name or ID, grant us access to the person’s medical information. In fact, we are working on a facial recognition tool — completely voluntary for participants — that does exactly that. Now, if a patient is unconscious and doesn’t have an ID, we would know right away who she or he is and provide us with medical data. That will be a game changer.

Also, I am excited about novel technologies that will enhance training and education opportunities so we are not stuck with a static manikin. Technologies such as AR and VR allow us to use different types of simulations, environments, and patient profiles. How this technology will eventually be fully integrated into trainings and simulations, I am not yet sure. But the potential is huge.

If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be?

It would absolutely be the community paramedicine concept. To me, and many of my colleagues, it is the future of healthcare in this country. The idea is that we visit people in their homes regularly to assess what their needs are right there, so they don’t have to be brought to the ER in the first place. We make sure all of their medical and social needs are met in the home. A key element of the concept is also to move some calls that are not emergencies away from 911 and into social services. All of this is organized in collaboration with primary care physicians.

To me, the future will not just be telemedicine; it will be a combination of telemedicine and community paramedicine. Ultimately, we want patients to be comfortable with telemedicine right at their bedside. It is our job to educate the public and learn the best ways to make people feel comfortable with the concept. Just keep shuttling patients to the ER cannot possibly be the solution. This will not only help patients long term, it will also be good for our healthcare system.

How can our readers further follow your work online?

They can go to https://gordoncenter.miami.edu and follow me on Twitter @Al_Brotons.

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