This post contains a link to and excerpts from The most remote emergency room: Life and death in rural America, November 16, 2019, By , from the Washington Post.
Here are excerpts:
SIOUX FALLS, S.D. — A flashing red light summoned Dr. Brian Skow to his third emergency of the afternoon, and he hurried to a desk in a suburban office building. He sat in front of an oversize computer monitor, which showed a live video feed from inside a hospital room in eastern Montana. Two nurses were leaning over a patient on a stretcher, checking for a pulse, and squeezing oxygen out of a bag and into the patient’s lungs.
“I’m Doctor Skow,” he said, waving into a camera attached to his computer, introducing himself as the presiding emergency physician even though he was seated more than 700 miles away. “How can we help you today?”
“We have a female patient, comatose and unresponsive,” one of nurses in Montana said. The nurse was short of breath, and she looked up at the camera mounted to the wall of the exam room as she attached monitors to the patient’s chest. “She’s a known diabetic. Blood sugar over 600. I — I don’t really know. I haven’t seen a whole lot of this.”
“You’re doing great,” Skow said. “We’ll walk through it together. That’s why we’re here.”
As hospitals and physicians continue to disappear from rural America at record rates, here is the latest attempt to fill a widening void: a telemedicine center that provides remote emergency care for 179 hospitals across 30 states. Physicians for Avera eCare work out of high-tech cubicles instead of exam rooms. They wear scrubs to look the part of traditional doctors on camera, even though they never directly see or touch their patients. They respond to more than 15,000 emergencies each year by using remote-controlled cameras and computer screens at what has become rural America’s busiest emergency room, which is in fact a virtual ER located in a suburban industrial park.
“If she’s in respiratory failure, we need to take over her airway,” Skow told the nurse. “Let’s get all hands on deck.”
He watched on the monitor as a few more nurses and a physician assistant came into the hospital room to prepare for an emergency intubation. They needed to insert a tube down the patient’s throat to put her on a ventilator, but first that would require sedating and temporarily paralyzing her with medication, which meant she would no longer be capable of breathing on her own.