Doctor (video) call: Rural doctor receives remote help treating man stabbed by bison

A rustic doctor's aid in action: Remote assistance saves South Dakota man from bison attack

There was indeed an ambulance doctor on board, keeping an eye on things, as they transported Lutter to the hospital.

The ambulance doctor was stationed in an office building 140 miles away in Sioux Falls, South Dakota. Through a recently installed video system in the ambulance, they participated in the treatment.

"I'm convinced that Jim got the best possible care in the back of that ambulance," said Ed Konechne, a volunteer EMT with the Kimball Ambulance District.

The ambulance service acquired the video system as part of a state initiative by the South Dakota Department of Health. The project "Telemedicine on the Move" supports medical personnel across the state, particularly in rural areas.

Telemedicine has become commonplace in hospitals and at home during the Covid-19 pandemic, and the technology is now beginning to make its way into ambulances as well. Similar programs have recently been launched in Texas and Minnesota, but officials from South Dakota claim that their partnership with Sioux Falls-based telemedicine company Avel eCare is the only statewide initiative in the state.

Lutter, 67, and his wife Cindy are among 12 residents of Gann Valley, a small town east of the Missouri River in the center of South Dakota. They ran a hunting lodge and a ranch and raised over 1,000 bison.

Last December, Lutter visited a sick bison calf. The three-year-old bull lived in the same enclosure as Bill and had become like a family pet.

"We raised him as a calf and I always told everyone he thought I was his mother," Lute recalled. "He followed me everywhere." Lute climbed into the enclosure and saw Bill approaching calmly.

"What did Chuck Norris say? ‘Expect the unexpected.’ ‘Well, I didn’t do that.' ‘I didn’t account for the unexpected,'" he said.

Suddenly, the bull charged with his horns, knocked him into the air, and then butted his horns against Lute's back. Lute thought he would die, but somehow managed to escape the enclosure and lay heavily bleeding on the ground.

"The snow is just beginning to fall," he said.

Lutter was unable to call 911 with his phone. But he managed to climb into a tractor-like front loader and drove a few miles to his brother Lloyd's house.

Only once Lloyd pulled Lutter from the loader and into a minivan did his injuries become apparent. Lloyd called 911 and drove to a nearby fire station, approximately 29 miles away.

Rural EMS services, like those in Kimball, are hard to sustain, as insurance reimbursements for a limited number of patients often fail to cover operational costs, and most of their personnel consists of aging volunteers. Some 84% of rural areas in the United States still lack access to an emergency medical station, according to a study by Maine Rural Health Research Center[1].

Konechny, a volunteer EMT, was working as a hardware store manager when a dispatcher over the radio called for help. He walked two blocks to the Kimball Fire Department and climbed onto the back of an ambulance, with another EMT driving it to Gann Valley.

Lloyd Lutter and the ambulance driver pulled to the side of the road after seeing each other coming from opposite directions.

"I opened the side door of the pickup in which Jim was, and saw his expression," Konecny said. "I'll never forget that look."

Konecny said rural EMS personnel tend to have less medical education and experience than their urban counterparts. But conversations with more experienced professionals via video can be reassuring in unusual situations. Kimball Ambulance Service sees only about three patients a year with injuries as serious as Luter's, according to Konecny.

Katie DeJong, an ER doctor with Avel eCare Telemedicine, answered the video call from the EMTs.

"What? What did the bison do?" DeJong recalled.

After speaking with medical personnel and examining Luter's injuries, she realized that the injuries posed a serious threat to Luter's life, particularly to his lungs. One of his lungs had collapsed and filled his chest with blood and air.

DeJong contacted the emergency room at Wessington Springs Hospital, which was 25 miles away in Gann Valley, to inform them of how to prepare. She advised them and began preparing to insert a chest drain to clear the area around Luter's lung. Have the X-ray machine ready. And have blood on hand, in case Luter needed a transfusion.

DeJong also arranged for a helicopter to transport Luter from a rural hospital to a medical center in Sioux Falls, where trauma specialists could treat his wounds.

Konecny said that DeJong was able to give Luter the full attention he needed, as she took care of notetaking, recording vital signs, and communicating with the hospital, while EMT Sara Cashman worked in the emergency room of Wessington Springs [1].

"It's good to have that heads-up so we can mentally prepare," Cashman said. "We can make sure all the necessary materials are ready, instead of having to assess the patient on-site."

Doctors performed a chest tube to drain blood and air from Luter's lung. EMTs then transported him to a helicopter and flew him to Sioux Falls Hospital, where he was quickly taken to the operating room. Luter suffered a broken collarbone, broken ribs, a partially torn scalp, and a 10-centimeter wound in his backside. Luter spent about a week in the hospital and compared the painful treatment of his injuries to firing an outdated rifle.

"That's it." "It's like reloading an old gun and then smacking a stick into it," Luter said. "That was really fun."

The video technology that saved Luter's life was only recently installed in the ambulance, after telemedicine was introduced in the fall of 2022 [1]. The program is funded with $2.7 million in state and pandemic emergency funds.

With Avel eCare's funding, Medics provide and install the video equipment and train the medical personnel on its use. The company also employs telemedicine experts who are available around the clock.

As of now, 75 of the 122 ambulance services in South Dakota have installed the technology, with 18 more ambulances planned for installation. The system has been used approximately 700 times so far.

Avel plans to extend the contract beyond its April expiration, but will depend on the state government to renew Telemedicine in Motion for a third year. Once state funding expires, ambulance services will have to decide if they want to pay for the video services themselves. Jessica Gaikowski, spokesperson for Avel eCare, said patients will not be charged for video consultations [1].

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