This video system installed in an ambulance, allows paramedics in rural areas of South Dakota to get help from more experienced healthcare personnel. — Photos: TNS
Rural paramedics who rescued rancher Jim Lutter in South Dakota, United States, after he was gored by a bison didn’t have much experience handling such severe wounds.
But the paramedics did have a doctor looking over their shoulders inside the ambulance as they rushed Jim to a hospital.
The emergency medicine physician sat 140 miles (225 kilometres) away in a Sioux Falls, South Dakota, office building.
She participated in the treatment via a video system recently installed in the ambulance.
“I firmly believe that Jim had the best care anyone has ever received in the back of a basic life support ambulance,” said Ed Konechne, one of the volunteer emergency medical technicians (aka paramedics) with the Kimball Ambulance District who treated him.
The ambulance service received its video system through an initiative by the South Dakota Department of Health.
The project, Telemedicine in Motion, helps paramedics across the US state, especially in rural areas.
Telehealth became commonplace in clinics and patients’ homes during the Covid-19 pandemic, and the technology is starting to spread to ambulances.
Similar programmes recently launched in regions of Texas and Minnesota, but South Dakota officials say their partnership with Avel eCare – a Sioux Falls-based telehealth company – appears to be the US’ only statewide effort.
An unexpected attack
Jim, 67, and his wife, Cindy Lutter, are among the 12 residents of Gann Valley – a town just east of the Missouri River in central South Dakota.
They operate a hunting lodge and ranch, where they raise more than 1,000 bison.
Last December (2022), Jim went to check on a sick bison calf.
The animal was in the same pen as Bill, a three-year-old bull that was like a family pet.
“We raised him from a tiny little calf, and I always told everybody he thinks I’m his mother.
“He just followed me everywhere,” Jim recalled.
He climbed into the pen and saw Bill calmly walk toward him.
“What does Chuck Norris say? ‘Always expect the unexpected.’
“Well, I didn’t do that. I didn’t expect the unexpected,” he said.
The bison suddenly hooked Jim with his horns, repeatedly tossed him in the air, and then gored him in the groin.
Jim thought he was going to die, but somehow escaped the pen and found himself on the ground, bleeding heavily.
“The red snow was just growing,” he said.
He couldn’t reach his cellphone to call 911.
But he managed to climb into a front-end loader – similar to a tractor – and drove a few miles to the house of his brother Lloyd Lutter.
Jim’s pain didn’t kick in until his brother pulled him out of the loader and into a minivan.
Lloyd called 911 and began driving toward the ambulance base, about 18 miles (29km) away.
The Lutters rear over 1,000 bison on their ranch in central South Dakota.
A rare case
Rural ambulance services like the one in Kimball are difficult to sustain because insurance reimbursements from small patient volumes often aren’t enough to cover operating costs.
And they’re largely staffed by dwindling ranks of ageing volunteers.
That’s left 84% of rural counties in the US with at least one “ambulance desert”, where people live more than 25 minutes from an ambulance station, according to a study by the Maine Rural Health Research Center.
Konechne was working his regular job as a hardware store manager when a dispatcher came onto his portable radio with a call for help.
He hustled two blocks to the Kimball fire station and hopped into the back of an ambulance, which another paramedic drove toward Gann Valley.
Lloyd and the ambulance driver both pulled over on the side of the country road once they saw each other coming from opposite directions.
“I opened the side door of the van where Jim was and just saw the look on his face,” Konechne said.
“It’s a look I’ll never forget.”
Rural paramedics often have less training and experience than their urban counterparts, Konechne said.
Speaking with a more experienced provider via video gives him peace of mind, especially in uncommon situations.
He estimated that the Kimball ambulance service sees only about three patients a year with injuries as bad as Jim’s.
Arranging for care
Dr Katie DeJong was the emergency medicine physician at Avel eCare’s telehealth centre who took the ambulance crew’s video call.
“What? A bison did what?” she remembers thinking.
After speaking with the paramedics and viewing Jim’s injuries, she realised the rancher had life-threatening injuries, especially to his airway.
One of his lungs had collapsed and his chest cavity was filled with air and blood.
Dr DeJong called the emergency department at the hospital in Wessington Springs – 25 miles (40km) from Gann Valley – to let its staff know how to prepare.
Get ready to insert a chest tube to clear the area around his lungs, she instructed.
Get the X-ray machine ready.
And have blood on standby in case Jim needed a transfusion.
She also arranged for a helicopter to fly him from the rural hospital to a Sioux Falls medical centre, where trauma specialists could treat his wounds.
Konechne said he was able to devote 100% of his time to Jim since Dr DeJong took care of taking notes, recording vital signs and communicating with the hospitals.
Nurse practitioner Sara Cashman was working at the emergency department in Wessington Springs when she received the video call from Dr DeJong.
“It was nice to have that warning so we could all mentally prepare,” Cashman said.
“We could have the supplies that we needed ready, versus having to assess when the patient got there.”
A doctor inserted a tube into Jim’s chest to drain the blood and air around his lungs.
Paramedics then loaded him into the helicopter, which flew him to the Sioux Falls hospital where he was rushed into surgery.
Jim had a fractured collarbone, 16 broken ribs, a partially torn-off scalp and a four-inch-deep hole near his groin.
The rancher stayed in the hospital for about a week and compared the painful wound-packing regimen near his groin to the process of loading an old-fashioned rifle.
“That’s exactly what it was. Like packing a muzzleloader and you take a rod, let’s poke that in there,” he said.
“That was just a lot of ‘fun’.”
Jim survived a fractured collarbone, 16 broken ribs, a partially torn-off scalp and a four-inch-deep hole near his groin, after being gored by his pet bison Bill.
Extending the programme
The video technology that helped save Jim had only recently been installed in the ambulance after Telemedicine in Motion launched in the autumn of 2022.
The programme is financed with US$2.7 million (RM127.1 million) from South Dakota state funds and US federal pandemic stimulus money.
The funding pays for Avel eCare employees to provide and install the video equipment, and to teach paramedics how to use it.
The company also employs remote healthcare professionals who are available 24/7.
So far, 75 of South Dakota’s 122 ambulance services have installed the technology, and an additional 18 plan to do so.
The system has been used about 700 times so far.
Avel’s contract ends next April (2024), but the company hopes the state will extend Telemedicine in Motion into a third year.
Once the state funding ends, ambulance services will need to decide if they want to start paying for the video service on their own.
Patients wouldn’t be charged extra for the video calls, said Avel eCare spokesperson Jessica Gaikowski. – By Arielle Zionts/KFF Health News/Tribune News Service
KFF Health News, formerly known as Kaiser Health News, is a US national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF – the independent source for US health policy research, polling and journalism.
