WARNER, S.D. — The University of South Dakota Medical School and Agtegra Cooperative, a major grain and agronomy company in the Dakotas, are working together to improve rural emergency health care.

The entities have partnered in creating a "ditch kit" that puts lifesaving training and equipment into the hands of more rural South Dakotans — a way to get basic lifesaving skills to more rural residents but also a way to expose more people to and perhaps recruit them into emergency medical training.

And Agtegra allows USD Medical School students who are seeking rural careers a close-up view of rescues, drills and practices. They were on-site at an Aug. 31, 2022, “high-angle” grain bin rescue drill, at the co-op’s grain location west of Warner, South Dakota.

Dr. Matthew P. Owens, a family medicine doctor at Redfield, South Dakota, is a key promoter. Owens is affiliated with Community Memorial Hospital at Redfield, which has a role stabilizing trauma victims and then transfering them to a larger facility, he said. Owens also teaches disaster training at his alma mater, the University of South Dakota School of Medical School in Vermillion. He is the medical director for the Upper (Missouri River) Basin Disaster Training Center.

The need for improved rural medical training is great.

Owens cited a 2016 study commissioned South Dakota Department of Health study that said about one-third of all Emergency Medical Systems were not able to respond in a “timely” fashion to a critical incident.

“We’re looking to change that model up,” he said.

The USD School of Medicine is known throughout the country for training individuals for disaster response, Owens said. Some of its medical students are members of a group called FARM (“Frontier and Rural Medicine”), which allows special practices in rural South Dakota communities. Seven of the students in the program attended a training session for Agtegra grain disaster training.

Cody Bonn, Agtegra’s maintenance and special operations manager, who oversees the co-op’s technical rescue team, spoke with students as he coached a group includes various occupations from maintenance, grain operations and truck drivers.

The drill involved “high-angle” rope rescue drill, simulating someone having a heart attack, putting them on a “patient-pack” and lowering them down via rope. The rescue drill teaches anchors, knots, “patient packaging” and patient care, as well raising and lowering. Everyone on the team is certified and participate in at least four drills per year.

“We’ve had to do a fair number of grain bin rescues” on farms, Bonn said. So far haven’t had to use the high-angle rope rescues in their commercial grain facilities.

One observer who said he was impressed was Conrad Mohr-Eymer, 24, a medical student who grew up at Reliance, South Dakota, on a farm that raised cattle, sheep and dairy goats. Conrad’s father, Chris Eymer, a farmer and Agtegra board member, had cancer when Conrad was growing up. Conrad pursued medicine because he came to admire the doctors who “literally give families their loved ones back.”

Similarly, Hannah Trierweiler, 24, also a third-year medical student grew up on a hobby farm near Hinton, Iowa, near Sioux City. She is hoping for a career in northwest Iowa or South Dakota said being present at the drill “gives us an idea of what’s going on out here and how they get the patient to us,” she said.

Trierweiler said she had been unaware that there were teams of grain disaster responders, and said ambulance crews don’t have that kind of equipment.

Farmers have helped Owens shape the Dakota Responders program. Owens knows of no other similar course being taught across the country.

Owens said the impetus for the project started by talking to his patients, including clients, Steve Masat, whose family farms and feeds cattle near Redfield. Masat, also an Agtegra board member, encouraged his efforts to train lay people for immediate medical emergencies.

“The population has decreased, the number of EMS, EMTs, etc., is also decreasing,” Owens said. “So, you know, farmers think about it: What happens if I’m out in the field and I have a bad laceration, or I get pulled into a piece of equipment? So, we’re allowing for this sort of training, so at least there’s some early intervention that really improves outcomes. Definitely.”

About four years ago Owens was talking with a group of rural family physicians at a meeting with the South Dakota State Medical Association. Conversations like this led to the Dakota Responder Program, funded by a $2.2 million U.S. Department of Labor grant, covering four years.

So far, Dakota Responders has produced 120 EMTs from across the state in the first of up to six cycles.

Owens has also taught the three-hour training and equipment program. They started teaching their first courses in January 2022 and so far have about 130 graduates. They have done pre-course and post-course testing to determine that the training offers a “durable” and measurable improvement in their ability.

Since starting in January 2022, about 80 of the Ditch Kits have been dispensed. It includes a face mask for doing CPR and some “ Stop the Bleed ” equipment, including a tourniquet and a Mylar blanket for thermal injury. The equipment also includes Narcan, a brand of nasal spray to counteract an opioid overdose.

Owens teaches the courses himself, sometimes assisted by local nurses and EMTs. Courses typically go January, February and March, when participants are not in the field. They’ve covered much of eastern South Dakota, including the Agtegra footprint.There have been 130 graduates so far, and Owens thinks that number will double next year. He thinks it could cross state lines.

“We’ve also started doing some other community-based training. We’re also looking at school districts and rural fire departments for this training," he said.

Agtegra is paying employees to take the training, Owens said. Grants cover many of the kits, which are $80 each. A few kits have gone to feed mills.

“The idea is, the more people we have taking Dakota Responder, from that group we will be able to recruit more EMTs,” Owens said. So far, the “data looks pretty good,” indicating that about one-third of those who take the course are looking at taking an Emergency Medical Responder or Emergency Medical Technician training.

The program employs the American College of Surgeons’ “Stop the Bleed” protocols. The kit includes the tourniquet and wound packing material.

“Part of the training is to explain to them (the patient) that this is going to hurt when they put it on that person,” Owens said. “And no matter how much the person is yelling, ‘Hey, this hurts,’ they can’t release it. Not until they get it to a surgeon.”

And don’t worry. The doctors will take it from there, Owens said.