Applying Telehealth to Emergency Services with Fire Chief Darrel Donatto
This is part of our weekly executive insights series where Elion CEO Bobby Guelich speaks with healthcare leaders about their tech priorities and learnings. For more, become a member and sign up for our email here.
Role: Fire Chief
Organization: Town of Jupiter Fire Rescue
Can you provide a quick overview of your background and how you engage with technology in your role?
I’ve been in the fire service for 44 years, and recently I took on the challenge of building a new fire department in Jupiter from the ground up—a three-station, 100-plus member department. Alongside this, I remain deeply involved in state-level EMS legislation and strategic planning, so I am always exploring ways that we can deliver better value in our prehospital care.
Technology has advanced exponentially, yet prehospital care hasn’t kept pace. The basic processes in fire and EMS operations have remained largely unchanged over the last 40 years, despite advances in medical technology.
We’re working to change that. For example, in Palm Beach, we introduced telehealth for low-acuity 911 calls to help divert patients—who don’t want to be in the hospital anyway—from the ER. Patients connected with board-certified physicians via iPads, received guided assessments, and, if appropriate, prescriptions delivered to their homes. Looking ahead to this new department we’re building, we want to integrate even more technology, like video and health information exchange systems into dispatch and pre-arrival workflows, allowing first responders to access patient records and communicate with callers before arriving on the scene.
That telehealth model sounds fascinating. How does the payment process work for those services?
Within the model I described, the physicians collect insurance information and bill the service as telehealth. Reimbursement rates are modest, but the startups offering these services aim to negotiate agreements with insurers by demonstrating cost savings. In our case, the telehealth provider charged nothing to the fire department or taxpayers, covering uninsured patients for free while billing insured ones directly.
Beyond telehealth, what are some other technologies you’re excited about in emergency services?
A few areas we’re currently using or considering include:
AI-enhanced ultrasound: Portable ultrasound devices with built-in AI that guide paramedics through capturing high-quality images. The AI identifies what’s visible and assists in diagnoses, with imaging shared instantly with ER or telehealth physicians.
Point-of-care diagnostics: Mobile lab equipment provides quick results for markers that indicate conditions like heart attacks or sepsis, enabling more definitive and timely care decisions.
Mobile stroke units: Equipped with MRIs, these units diagnose stroke types in the field and administer thrombolytic care if appropriate.
You also touched on the role of dispatchers earlier. Is there progress being made in empowering dispatchers as the “first responders?”
Yes, though approaches vary. Some cities, like Houston, use nurse triage systems to reduce 911 call burdens by directing non-emergent cases elsewhere. However, the focus in my community is different. Instead of reducing system impact, I want to enhance the service we provide. For example, we’re exploring live video triage with dispatchers who can assess patients’ needs before sending responders.
Are there areas where you feel more technology development or resources are needed?
One key area is improving data integration. I want to walk into a call, greet a patient by name, and say, “I see you were at your doctor’s office yesterday and received this prescription.” While HIE systems like Kno2 help, they’re not yet fast or seamless enough.
Looking ahead, AI has the potential to process massive amounts of medical history, lab results, and field observations to give paramedics actionable recommendations. For instance, AI could flag likely conditions or suggest steps to reduce diagnostic errors.
It sounds like we’re on the cusp of major transformations in emergency care. Do you have any final thoughts?
A VC told me something that’s shaped my thinking: “The hospitals of the future will be ICUs. Everything else will happen elsewhere.” I see that shift coming—care will move to homes, urgent care centers, and other alternative settings.
Hospitals might run low-cost urgent care centers to handle low-acuity cases, keeping patients within their system while reserving ERs for the sickest. As this change unfolds, our challenge in EMS will be adapting to deliver the best public value at the lowest cost. It’s an exciting time to be in this field.