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."

Public health officials continue to monitor the spread of bird flu, with it passing from chickens to cows to humans.

A new study found the virus can linger on milking equipment for up to an hour, putting farmworkers at risk. The Centers for Disease Control and Prevention described the risk to humans as low, given the absence of human-to-human transmission but the new study suggested dairy workers are particularly vulnerable to infection.

A handful of those working near cows have become infected but there have not been any positive cases in the Badger State.

Crystal Heath, executive director of the advocacy group Our Honor, found it worrisome, given the high level of dairy production in Wisconsin. She wants industrial operations around the U.S. to embrace testing.

"Not allowing researchers and scientists to investigate this is really concerning for public health," Heath asserted.

Without a public health emergency, the federal government is limited in mandating testing. The Center for Biological Diversity said there is not much motivation for farm operators to voluntarily comply because of the potential impact on livelihoods. But advocates note workers, not farm owners, are exposed to the virus without being able to speak up for themselves. Immigrants make up 51% of all dairy labor.

Heath noted with the potential for infections going undetected, the situation should compel the U.S. to place less emphasis on industrial agriculture for its food production.

"Modern animal agriculture creates the conditions that can lead to the next pandemic," Heath pointed out. "With a lot of genetically similar stressed animals in close contact with human workers."

The U.S. government is working on candidate vaccines for bird flu as part of pandemic preparedness. The CDC said the development of a vaccine is a multistep process, and can take months to complete.

This story is based on original reporting by Julieta Cardenas at Sentient.


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As kids head back to school, doctors say there are a few ways parents can prepare for the transition. One important item on the checklist is getting a checkup at the doctor.

Well child visits allow the opportunity for physicals, if kids are playing sports during year for instance, and mental health check-ins as well.

Dr Ryan Brown is a pediatrician with Oklahoma University Health, in the University of Oklahoma Medical Center. He said doctor visits can help with things parents might forget too.

"You don't want to have a kid that's supposed to be on medication at school and then school starts and you're like, 'Oh, I forgot to get it,'" said Brown. "And now he's going one or two or three weeks during the school year, without the medication that he needs to do well at school."

Brown said scheduling dental appointments and eye exams are also important.

Dr Rhonda Randall - Executive Vice President and Chief Medical Officer at UnitedHealthcare - said re-establishing routines for kids is critical as well, noting that sticking to schedules in the morning and at night is stabilizing.

"Do you have family dinners on a regular basis? I recognize that you can't do that every night," said Randall. "Everyone's busy and sometimes running in different directions, but doing that as often as possible really does create a routine that's predictable and healthy for the child."

Brown said parents should be open and listen to their kids. He said those first few weeks can be awkward and stressful.

"Letting the kids know it's okay to be scared, it's okay to feel like you're not accepted that first week or two," said Brown. "Like, 'Oh, I don't know. They don't like me,' or whatever. Everybody has those emotions, and give it more time."

Heat is a serious threat to people's health and is made more dangerous in Washington state, where many people lack air conditioning. Some tips can help people stay cool, especially if they don't have AC.

The state has already seen record breaking heat this summer.

Dr. Scott Itano is a family medicine physician in Washington for Kasier Permanente.

When temperatures are high, Itano suggested people avoid going outside during the peak hours of 10 am to 4 pm. He also said to use cool water to cool down and drink more water than usual.

"If you don't have air conditioning, consider trying to go to public facilities that have air conditioning," said Itano. "Things like public libraries or shopping centers or things along those lines. Even just a couple hours in air conditioning can really help you survive the day when we have these intense heat waves."

Northwest homes have historically had the fewest air conditioners of any in the country. However, heat waves in recent years have changed that.

In Seattle, for instance, more than half of homes in 2021 had air conditioning - up from 31% in 2013.

Itano said there is a spectrum of heat-related illnesses - starting with heat exhaustion, which includes tiredness, fatigue, or light headedness. He said a more serious condition is heat stroke.

"That's when you get symptoms that might mimic a stroke," said Itano. "So you might pass out, you might have a seizure, you might have altered mental status. So those are definitely more serious symptoms and if you're experiencing them, you'd want to call 911 right away or seek care."

Itano said certain groups of people are more susceptible to heat-related illnesses, including the elderly and younger people. He noted that people with chronic medical conditions should also be careful.

"If you have diabetes, or asthma, or lung disease, or heart disease - heat intensifies and stresses the body," said Itano. "So any stressor to the body is going to make those conditions worse and potentially put you at more risk."