People might picture a defibrillator or stretcher when they think of a first responder. But what about an iPad?

South Dakota says a new program shows promise in combining telemedicine with ambulance crews.

Next week is National Emergency Medical Services week, and South Dakota officials are touting an initiative that fits first-responder units with technology that allows them to consult with hospital staff while enroute to the Emergency Room.

The state's Department of Health EMS Director Marty Link said they hope this addresses recruitment and retention issues for staffing the many volunteer first responder crews in rural parts of the state.

He said it's also a response to the "regionalization" of healthcare.

"Those patients in the smaller communities are transferred to the larger facilities to be cared for," said Link. "And while that happens, we see EMS providers are on the road for a longer period of time, doing those inter-facility transfers."

Last year, the state set aside up to $20 million to bolster Emergency Medical Services. Nearly two million goes toward the telemedicine service for rural first responders.

The state partnered with Avel e-Care to implement the program, and the company says they're live in nearly 60 EMS agencies - adding that it has helped with coordination of care.

Avel e-Care's Vice President and General Manager of Emergency and EMS Services Rebecca VandeKieft said when a patient is put into the ambulance, medical staff are interreacting with EMS crews in 20 seconds or less.

"Very quick activation," said VandeKieft. "We're live with audio and video in the back by a tablet. And really, it's just conversational based, so we make it very easy."

The American Heart Association's National Director of Implementation Science and Strategy for Quality, Outcomes, Research, and Analytics - Gary Myers - added that it paves the way for better outcomes for stroke and heart attack patients from remote areas.

"The key to this is not necessarily how fast you get from A to B," said Myers. "It's how fast care starts and the activation of the downstream care teams."

More than 20% of nursing positions in the Commonwealth remain vacant, according to the Kentucky Hospital Association - and combined with workforce shortages in other medical professions, the state is facing a massive health-care workforce crisis that could have crippling effects.

Ben Chandler, CEO of the Foundation for a Healthy Kentucky, said the shortages are both straining overworked existing providers and making it more difficult for residents to access quality care.

"We're seeing shortages, really across the board. We're certainly seeing shortages in nurses," said Chandler. "We're also seeing shortages for primary-care physicians. These are important entry points into the health-care system."

The state needs at least 16,000 additional nurses to meet demand by 2024, according to data from the Kentucky Healthcare Collaborative.

State Sen. Stephen Meredith - R-Leitchfield - will be the keynote speaker at the Foundation for a Healthy Kentucky's Bost Forum next week in Lexington, highlighting the challenges facing the medical community and proposing potential solutions.

He said the health-care system is the backbone of rural economies.

"If the health system in rural Kentucky collapses, then it's just a chain-reaction event," said Meredith. "It's going to cause a crisis throughout the state. It's something we need to take seriously, and it needs solutions today."

According to the Bureau of Labor Statistics, nationwide around 1.8 million job openings are projected yearly between now and 2032, driven by increased demand and the need to replace workers who have permanently left health-care occupations.




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In rural Arkansas, access to healthcare can be a distant dream - literally - as almost 60 counties in the state do not have enough providers to serve their populations. A new initiative with the Health Resources and Services Administration is working to improve access in these areas, through telehealth.

Heather Dimeris, director, Office for the Advancement of Telehealth at the Health Resources and Services Administration, said delivering care remotely online fills a crucial gap. Arkansans can visit telehealth.hhs.gov to explore their options, including behavioral and mental-health services.

"You can look at anxiety or depression screening through telehealth," she said. "You can also receive treatment for your anxiety or depression and other mental health needs, through one-on-one therapy as well as group therapy. And telehealth has also been extremely helpful in treating patients with substance-use disorders."

Dimeris noted 40% of all behavioral healthcare is now done virtually, including therapy, addiction counseling, and mental-health screening. She adds HRSA also provides telehealth services for treatment of chronic diseases, like diabetes, and information for healthcare providers.

However, the growth of telehealth spotlights another challenge for rural Arkansas - the lack of reliable, affordable internet service. Dimeris added some people can use their cell phones for telehealth services. Or they can apply for discounted internet access through two programs offered by the Federal Communications Commission.

"The Affordable Connectivity Program, as well as the Lifeline Program," she continued. "Both of these programs have eligibility requirements. But if you meet them, you really are able to access either free or reduced cost for broadband services and cell phone services."

Lower-income households can get up to $30 a month off their internet service bill, or $75 a month if they live on tribal lands, according to the FCC.

California's medical aid-in-dying law is back in court. Three patients with disabilities and two doctors are asking to intervene in a lawsuit challenging the law - and they want the judge to dismiss the suit.

In April, a coalition of disability rights groups and people with disabilities sued to stop the End of Life Option Act, claiming it is discriminatory and "coerces" people with disabilities into using medical aid in dying.

Jess Pezley is the senior staff attorney with Compassion & Choices, which supports the bill.

"It's not discriminatory to offer an additional end-of-life option," said Pezley. "And there's a lot of safeguards built in within the act to make sure that this law is not being used by people who do not want it. The only people who qualify for it are terminally ill with a prognosis of six months to live, and who have the capacity to make the decision."

California is one of ten states - plus Washington, D.C. - that allow doctors to prescribe medication that would allow mentally capable, terminally ill adults to peacefully end their suffering if they choose to take it.

Peter Sussman is a retired journalist and author from the Bay Area who said he lives with constant and disabling pain after a series of spinal surgeries. He said he supports medical aid in dying, and has joined the motion to intervene in the lawsuit.

"When my time comes and I am certified by doctors to be dying within six months, I do not want to die suffering needlessly," said Sussman. "The government shouldn't be able to tell me the manner of my own death."

The State of California, the defendant in the lawsuit, has also filed a motion to dismiss.

Earlier this year, the same judge dismissed a different challenge to the suit brought by the Christian Medical and Dental Association - after it reached a settlement with the state that said doctors who have a religious objection don't have to record a patient's request for medical aid in dying on their chart.