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Imagine you are driving home from work in late January sleet and wind. Your car starts skidding and slams into a bridge. The driver’s door explodes inward, glass sprays everywhere, and you are walloped by the air bag. When paramedics extract you from the car, your ribs grind and crunch in excruciating pain and you feel like you can’t breathe.

Emergency medicine experts have a term, “the golden hour,” for the window in which major trauma victims must receive care before their chance of survival drops significantly. When someone is severely injured in a car accident for example, it is critical to get them to an emergency department right away. In urban centers, such access is typically a given, but in rural America it can be a different story.

Nearly 20 percent of Americans, approximately 60 million of us, live in rural areas. Yet 54 percent of all US traffic fatalities occur in rural areas. Rural residents also experience unacceptably high fatality rates from agricultural accidents and other rural occupations.


As an emergency department physician in rural Minnesota, this basic fact has shaped my life’s work: to ensure that people who live and work in rural areas, as well as those who travel through or recreate in them, get the best emergency care possible. When telehealth began to emerge in the 1990s, I was a skeptic. I wondered how video access between a patient and doctor could be that much better than a doctor to doctor phone call. I changed my mind when I was asked to be part of a team to evaluate the quality and impact of emergency telehealth programs. Now, I’m a believer.

Clinicians in rural hospitals may not have the same experience with major trauma as their urban counterparts, simply due to the fact that rural emergency departments treat fewer major trauma victims and fewer patients overall.


With the push of a button, a rural nurse, doctor, or other health provider can activate a telehealth system and be instantly connected to a telehealth hub with board-certified emergency medicine physicians, experienced critical care nurses, neurologists, cardiologists, trauma surgeons, and other specialists. Access to such specialists improves the quality of emergency health care in rural areas, facilitates interprofessional collegiality, and reduces the professional isolation experienced by some rural clinicians. As my colleagues and I have shown, it also improves recruitment and retention of rural clinicians.

Back to the car crash scenario I began with: the emergency physician in the telehealth hub confirms your rural physician’s diagnosis of a collapsed lung. She then guides him via two-way video to insert a tube into your chest to re-expand your lung. While it will take weeks for your ribs to heal, this telehealth session has helped save your life.

Since 2009, the telehealth program my hospital works with, Avera eCare’s eEmergency platform, has spread across eight Midwest states, thanks in large part to funding from the Helmsley Charitable Trust, and has recently expanded into Vermont and New Hampshire. Similar programs are cropping up around the country. Even NATO has taken an interest in this model for use in disaster situations across the globe.

In addition to saving lives and improving outcomes, this technology is also reducing health care costs. In its annual report to the Helmsley Charitable Trust, Avera shared that from 2009 to 2014, 70 eEmergency sites avoided 885 unnecessary patient transfers, saving $7.1 million in transfer costs. When patients did need to be transferred to other hospitals, the time they spent in the initial hospitals decreased by an average of 36 minutes.

Thanks to innovative, technology-based health care solutions, rural Americans from North Dakota to New Hampshire have access to expert care that supports their local emergency departments. Telehealth emergency care has proven to reduce health care costs, improve patient outcomes, aid clinician recruitment and retention, and, most importantly, save lives. By expanding telehealth services, we could offer emergency care at a moment’s notice to the approximately 60 million Americans who call rural America home.

Clint MacKinney, MD, is an emergency department physician in rural Minnesota, clinical associate professor in the Department of Health Management and Policy at the University of Iowa, and a member of the Rural Policy Research Institute Health Panel.