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South Dakota Program Adds Telemedicine to Ambulances

Analysis  |  By Eric Wicklund  
   April 14, 2023

A state-funded effort to improve EMS services uses a virtual care platform to connect paramedics with emergency care specialists.

Fire and EMS departments across South Dakota are seeing positive results from an innovative program that gives paramedics on-demand access to emergency care specialists right in the ambulance.

The Telemedicine in Motion initiative was launched in late 2022 by the state in a partnership with Avel eCare, the telemedicine company spun out of Avera Health in 2021. The program, supported by a $20 million investment in EMS programs by the state legislature, equips ambulances with the telemedicine technology needed to enable a virtual connection with a hospital.

"We have a lot of patient care time in the back of an ambulance," says Randy Angermeier, director of the Clark Ambulance Service, which covers a significant swath of rural eastern South Dakota, not far from the Minnesota state line. The telemedicine platform "gives us another person back there [and] allows the medic in back to keep his or her eyes on what is going on."

Angermeier says a typical ambulance call can take 40 minutes for the vehicle to reach the patient, then another 45 minutes or longer to transport that patient to the nearest hospital. That's an eternity for a patient in serious condition and a paramedic trying to administer treatment.

Clark's ambulance is one of about 20 now equipped with audio-visual telemedicine technology supplied by Avel eCare, which connects the ambulance to emergency care specialists working in brick-and-mortar healthcare locations across the state. Rebecca VandeKieft, Avel's vice president and general manager of emergency and EMS services, says the program—one of the first of its kind in the country—offers triage and consulting services, including both basic life support (BLS) and advanced life support (ALS).

"It has a pretty historic monumental value," she says. "There's a lot of 'busyness' that we can take off these care providers in the back" during stressful times.

VendeKieft says the program was piloted at 11 sites in 2022 before going live this year, and she hopes to have 60 ambulances equipped with the technology (out of 122 identified by the state as eligible) by this summer.

Aside from a cabin-mounted tablet with audio-visual capabilities, the platform includes a router and cellular booster and a pair of antennas mounted to the roof to ensure a reliable connection to either Verizon's or AT&T's FirstNet first responder network.

While some larger organizations have been experimenting with digital health tools in EMS vehicles, ranging from ambulances to police units, to enable on-demand access to healthcare services at the site of an emergency, few have put a platform into an ambulance. But as the technology improves, the use cases are growing. Some larger health systems are experimenting with specially designed vehicles aimed at bringing on-site treatment to those suffering from a stroke or heart attack, while rural regions are most interested in adding services to EMS vehicles.

"Right now we can call them and boom—we're online," says Angermeier, who notes the platform gives his paramedics a sense of comfort knowing they have someone to back them up and offer support when needed.

"When you're 40 miles away from an ER, it's nice to have somebody else looking over your shoulder," he says. "You can't put a dollar value on that toolbox."

VandeKieft says more than 100 EMS companies have asked to join the program, and Avel eCare is getting interest from healthcare organizations, state agencies, and others around the country.

"We're hearing that cry for help," she says. "We've gained a lot of attention kind of being the first of its kind."

Telemedicine in Motion, she says, has been involved in more than 90 encounters so far, with positive clinical outcomes reported—even some lives saved. That data and much more will be collected as the program looks to move beyond the state grant and explore further scalability and sustainability.

"We will learn from our EMS partners" how to expand and fine-tune the program, she says, noting the platform could be used for more remote monitoring services outside the ambulance at accidents and emergency care at the scene. "The sky's the limit for that."

VandeKieft says the platform could also be used to not only train paramedics for more complex care such as moving from BLS to ALS), but to attract more paramedics and care providers, especially in rural areas where numbers are thin.

“When you're 40 miles away from an ER, it's nice to have somebody else looking over your shoulder. You can't put a dollar value on that toolbox.”

Eric Wicklund is the associate content manager and senior editor for Innovation, Technology, and Pharma for HealthLeaders.


The Telemedicine in Motion program, funded by the state in a partnership with Avel eCare, equips selected ambulances with telemedicine equipment to give paramedics an audio-visual connection to emergency care specialists.

The program, launched in 2022 and used in roughly 90 transports so far, is seeing improvements in clinical outcomes and has even saved a few lives.

EMS providers say the extra set of eyes gives paramedics clinical decision support and confidence in treating patients.

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