The ‘Golden Hour:’ How telemedicine is bridging the gap between life and death in rural communities

By Rebecca VandeKieft, BSN, RN, CEN May 01, 2024

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In her current role, Rebecca oversees the Avel eCare Emergency, EMS and Avera SANE (Sexual Assault Nurse Examiner) programs. She improves patient outcomes via telemedicine, streamlined operational efficiency and expanding upon quality metrics.

In 2022, Jim Lutter, a Kimball, South Dakota resident, began his day tending to the bison on his ranch. Unexpectedly, he was maimed by a 2-ton bison and sustained severe, life-threatening injuries. Although he managed to get into his tractor to alert his family and call 911, the nearest hospital was more than 30 minutes away and it would require meeting the ambulance en route.

On the other end of the 911 dispatch was community member and volunteer EMT Ed Konechne, who responded within minutes. With his education, he was able to recognize the severity of the injuries and initiate care. Upon placing Lutter in the ambulance, Konechne knew he had a new resource at his disposal. That’s where we came in.

Through telemedicine technology, our nurse and physician, Casie Hunter and Dr. Katie Dejong, were able to connect with Konechne from Sioux Falls, South Dakota, over 140 miles away, and assist him with further evaluation of the injuries and stabilization. In parallel, they could also communicate with the nearest hospital to help prepare staff for the incoming trauma patient.

The first 60 minutes, known as the Golden Hour in medicine, is vital in an emergency of this kind. Because of Lutter’s life-threatening injuries, time was already working against him. View the full story.

Who We Are

Avel eCare is one of the first telemedicine care providers in the nation to offer provider-to-provider services virtually. For nearly three decades we’ve been serving communities with telemedicine support. Avel eCare EMS, one of our 10 service lines, is quickly becoming a necessity in rural America.

The Problem

Telemedicine in EMS is working to solve the difficulties with rural emergency care because of the inherent rural nature and recruitment/retention of EMS personnel. A few facts supporting this problem:

  • Fifteen percent of the U.S. population lives in rural America but accounts for 60% of trauma-related deaths.
  • More than 30 million Americans live more than one hour from a Level I or II trauma center, which means 14% are more likely to die following a traumatic injury.
  • Current response time for 911 calls is 14 minutes in a rural setting, although notably 10% of rural calls to the scene are greater than 30 minutes.
  • Rural EMS agencies have fewer EMTs and paramedics, and are likely to be staffed by volunteers.

The reality in the medical field today is burnout. Healthcare workers are experiencing burnout physically with the demand for longer hours in addition to their overall duties. They are also experiencing burnout mentally as the number of unsuccessful calls, the volume of calls and the hours of being on call are overwhelming.

Burnout leads to turnover and eventually staff shortages. The dwindling numbers arguably affect rural areas the most.

Our Solution

Telemedicine does not replace the need for EMS volunteers, EMTs and paramedics, or disrupt the workflow of local nurses and physicians. It simply helps the process of caring for patients and providing expertise in times of crisis.

In this story, our physician, via a two-way audio/video connection, evaluated the extent of Lutter’s injuries within minutes of him being placed in the ambulance. This process allowed for recognition of the severity, notification to the receiving hospital of the incoming trauma patient, and early activation of the trauma system, including additional caregivers at the critical access hospital as well as earlier activation of a flight team.

“Just having Avel there was help enough to allow me to focus on what I was doing to help me stay calm. Having someone there, so quick, giving advice, calling ahead; the camera seeing everything … I was able to focus on Jim, focus on controlling the bleeding and saving the life of someone I knew,” Konechne said of his experience with us.

Our goal with telemedicine, especially in EMS, is to effectively decrease the time between response and action in a medical emergency. It allows for education and mentorship for EMS personnel in real time and in post-action review.

For example, one aspect of EMS that has been brought forth over the years is the need for education on airway management. Over eight years ago, we began to track traumatic airways via telemedicine assistance and have had over 1,460 airway interventions requiring intubation. In the first year of this focus, we were able to assist bedside providers to attain a success rate of 96.1%, with 75.3% on the first try.

Overall, our staff provides an extra, virtual hand in saving the lives of others in an emergency. We use the telemedicine staff’s experience to help EMTs and paramedics keep the patient stabilized throughout transport.

Avel EMS Outcomes

Currently, we serve over 100 EMS agencies and have connected to over 1,100 EMS calls. Of these, 24% of our calls have been trauma-related. We can expedite care, assist with an initial assessment, triage, help stabilize and coordinate overall care if the EMS provider requests it. At the same time, we can also call patient report to the receiving hospital.

In October 2022, Avel eCare was selected as the telemedicine provider for the state of South Dakota’s new EMS program, Telemedicine in Motion. EMS agencies that participate can install a robust telemedicine-enabled tablet in the back of their ambulances and use it to call Avel eCare’s board-certified emergency physicians, experienced paramedics and emergency nurses. Based in Sioux Falls, South Dakota, this program is the first of its kind in the nation and is helping to sustain the future of EMS in our state. We have also expanded to Minnesota and Nebraska, with more states to come.

Our goal with telemedicine is to provide additional access to experienced clinicians to care for and support those who are responding to emergency calls. We want to make sure people who may not have immediate access to hospital care can still feel they have the support of physicians, nurses and medics in rural America, and therefore we help save patients’ lives.

Note: All persons mentioned in this article gave Avel eCare written permission for media use.