What a Bison Goring Can Teach Us About Rural Emergency Care

Millions of Americans live in “ambulance deserts” — areas that are more than a 25-minute drive to the nearest emergency medical services (EMS) station. The most rural areas can be more than an hour away from help.  

These sparsely populated communities can have trouble sustaining ambulance services, if small patient volumes and low reimbursements rates don’t cover operating costs.

They also struggle with staffing. Most medics across the country are paid, but 75 percent of those who do volunteer are based in rural areas. However, their ranks are aging, and the younger generation isn’t showing enough interest in volunteering.  

Why do ambulance deserts matter? Even though rural Americans are older and sicker than urban Americans, they have less access to health care. They have a higher risk of dying from certain diseases, like strokes and cancer, and are more than twice as likely to suffer accidental deaths, such as fatal car crashes and opioid overdoses.

And they’re way more likely to get gored by bison.

“What does Chuck Norris say? ‘Always expect the unexpected.’ Well, I didn’t do that. I didn’t expect the unexpected,” South Dakota rancher Jim Lutter told me. 

Bill, a 3-year-old bison Lutter had always considered docile, attacked him last December, inflicting a 4-inch-deep puncture wound, a fractured collar bone, 16 broken ribs and a partially torn off scalp. Lutter benefited from a technology showing up in a smattering of ambulance services nationwide: video telehealth.

Ed Konechne, a volunteer medic, treated Lutter with the help of Katie DeJong, an emergency medicine physician who watched and spoke with Konechne and Lutter inside the ambulance from 140 miles away in a Sioux Falls office building. 

“I firmly believe that Jim had the best care anyone has ever received in the back of a basic life-support ambulance,” the medic told me.  

The video technology, Konechne said, lets him focus 100 percent of his time on his patients. 

Just as rural Americans can live far from ambulance bases, they can also face long drives to the nearest hospital, which are struggling to survive in remote areas. 

So during Lutter’s ambulance ride, DeJong made sure the rancher would get help as soon as possible by arranging a helicopter transport and telling the receiving hospital how to prepare.  

The technology doesn’t directly address the financial and staffing strains that lead to ambulance deserts. But by improving treatment, speeding up care and handling logistics, the remote provider may help rural medics reach their next patient more quickly.  

DeJong thinks the technology could also help with recruitment: people in rural areas might be more interested in volunteering as emergency medical technicians if they know they’ll have remote backup.

Ambulance-based telehealth programs recently launched in parts of Texas and Minnesota, but South Dakota officials say their program appears to be the nation’s only statewide effort. It’s funded with $2.7 million in state and federal pandemic relief money, state officials said.

But when funding dries up, ambulance services that want to continue using the technology will need to foot the bill. An official with South Dakota’s contractor, Avel eCare, says there is “not a standard cost” for its service.

Another increasingly popular idea to address ambulance deserts is to declare EMS an “essential service,” like police and fire departments, so states or municipalities have to fund them. Other recommendations include creating new reimbursement models and for the federal government to offer grants to designated ambulance deserts.

Lutter was fortunate. And bison gorings, thankfully, are uncommon. But more deaths in rural America could be prevented if ambulances and emergency departments were more accessible.

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