The golden hour: How telemedicine is bridging the gap between life and death

In 2022, Jim Lutter of Kimball, S.D., began his day tending to the bison on his ranch. Unexpectedly, he was maimed by a two-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 Avel eCare came in.

Through telemedicine technology, Avel nurse Casie Hunter and physician Katie Dejong were able to connect with Konechne from Sioux Falls, S.D., more than 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.
 

Providing telemedicine support

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

The problem

Telemedicine in EMS is working to overcome challenges with rural emergency care due to the inherent nature of rural places and recruitment and retention of EMS personnel. 

• Fifteen percent of the U.S. population lives in rural America but rural residents account for 60 percent 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 percent are more likely to die following a traumatic injury.
• Current response time for 911 calls is 14 minutes in a rural setting, while 10 percent of rural calls to the scene take more than 30 minutes.
• Rural EMS agencies have fewer EMTs and paramedics and are likely to be staffed by volunteers.

EMS workers are also impacted by burnout. Health care workers are experiencing burnout physically with the demand for longer hours in addition to their overall duties. They are experiencing burnout mentally as the number of unsuccessful calls, volume of calls, and on-call hours are overwhelming.

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

The 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, Avel’s physician evaluated the extent of Lutter’s injuries via a two-way audio/video connection within minutes of him being placed in the ambulance. This 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 and 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,” Konechne says. “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.”

The 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 post-action review.

For example, one aspect of EMS that has been frequently discussed is the need for education on airway management. More than eight years ago, Avel began to track traumatic airways via telemedicine assistance and have had more than 1,460 airway interventions requiring intubation. In the first year of this focus, Avel was able to help bedside providers attain a success rate of 96.1 percent, with 75.3 percent on the first try.

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

Avel EMS outcomes

Currently, Avel serves more than 100 EMS agencies and has connected to over 1,100 EMS calls. Of these, 24 percent have been trauma related. Telemedicine can expedite care, assist with an initial assessment, conduct triage, help stabilize the patient, and coordinate overall care if the EMS provider requests it. At the same time, Avel can also call in a 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, this program is the first of its kind in the nation and is helping to sustain the future of EMS in South Dakota. Avel has also expanded to Minnesota and Nebraska, with more states to come.

Avel’s goal with telemedicine is to provide additional access to experienced clinicians to care for and support those who are responding to emergency calls. This allows people who may not have immediate access to hospital care to feel they have the support of physicians, nurses, and paramedics in rural America.

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

NRHA adapted the above piece from Avel eCare, a trusted NRHA partner, for publication within the Association’s Rural Health Voices blog.

About the author: Rebecca Vande Kieft is Vice President & General Manager of Emergency Services at Avel eCare. She has previous experience in nursing leadership, education, and management at Avera Health.