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Telemedicine Gets a Doctor’s Eyes in the Ambulance in S.D.

South Dakota’s new Telemedicine in Motion program mitigates a critical shortage of experienced paramedics by connecting a doctor or nurse via video and audio to the paramedic in the back of the ambulance.

An ambulance driving with blurry surroundings to indicate motion.
Shutterstock/Annette Schaff
It can be a long ambulance ride to the hospital for an EMT or volunteer in rural South Dakota when transporting a critical patient for more than an hour, trying to keep both the patient alive and the hospital abreast of the situation.

It becomes easier now with the newly deployed Telemedicine in Motion initiative, which provides virtual triage and consulting in the back of an ambulance with two-way audio and video to aid the ambulance worker and help the hospital prep for the incoming patient.

It’s one of three funding initiatives that resulted from Gov. Kristi Noem’s request to infuse up to $20 million into EMS in South Dakota. The other two are for equipment and regional or legislative structure.

Telemedicine in Motion equips ambulances — the state Department of Health has identified 122 as eligible so far — with the audio and video equipment, which is provided and monitored by Avel eCare, a telemedicine service.

During transport, Avel eCare can turn on the camera and audio and answer questions for the EMT or connect with the hospital so that it can arrange for the patient’s care ahead of time.

The initiative began in fall 2022, and the qualifying ambulances will continue to be connected into the spring.

“It’s really that health-care provider peer-to-peer support,” said Rebecca VandeKieft, vice president and general manager of emergency and EMS services at Aval eCare.

“There’s a good sense that when you’re in the back of that ambulance that is short-staffed, in the middle of South Dakota, there’s upward of a very long transfer time, especially when you don’t do it every day,” VandeKieft said.

“So reaching out with added expertise — maybe we’ll double check their medication, maybe we’ll help them triage, maybe help with decision-making, maybe I want to consult to see what the nurse or doctor thinks,” she said.

The long distances the ambulances can travel, sometimes more than an hour of transport time, is one thing, but the personnel shortage makes it even more of a challenge.

“There’s a dwindling number of volunteers and even paid people,” said Matt Hardwick, operations supervisor at American Medical Response in Pierre, S.D. “Before we’d have two paid paramedics in the back.”

Now, the state requires just an EMT and a driver for an ambulance to be legally licensed. “So it’s that extra help in the back of the ambulance and extra set of eyes and ears, especially since the long-time EMTs and paramedics are no longer around and you have newer people just out of school and training,” Hardwick said.

When you think about an ambulance driving an hour or more transporting a critical patient, it evokes the term “the golden hour” — that period of time that can mean the difference between life or death for critical patients.

“Everyone talks about the golden hour for the stroke or trauma victim, so you’re cutting down that time and getting them treatment,” Hardwick said.

Hardwick added that in these rural areas, the hospitals aren’t equipped to handle some of these critical patients and may need to fly them elsewhere. This initiative can get that process moving more quickly. “If [the hospital] can already see what’s going on before we get there, the flight team or receiving team will already have accepted the patient and be ready for them.”