Rural trauma deaths would decline if ambulances could bill insurance companies for delivering blood on way to hospital

A fire-district ambulance on a dirt road after a training exercise near Fruita, Colo., last April. The West and parts of the South pose big challenges for rural emergency medical services. (Photo by Smiley Pool, Dallas Morning News)

In 2020, a traumatic injury killed an American every 31½ minutes, and such injuries are the top killer of children and adults under 45. Those statistics could be better if more ambulances carried blood and could bill insurance companies for administrering it, Lauren Caruba of the Dallas Morning News reports in a package with the San Antonio Express-News focused on rural America.

The problem is worst in the sparsely populated West, but "parts of the South performed worse compared with the coasts," Caruba reports. The package focuses on western Colorado and has an interactive map showing how far every location in the 48 contiguous states is from a trauma center.

"The vast majority of emergency medical providers . . . are unequipped and underfunded, leaving them unprepared to fully treat patients with severe internal bleeding," Caruba writes. "Across the country, bleeding patients receive drastically different care depending on where they are injured and the emergency providers who treat them." Awareness of the issue "has been mostly confined to medical journals and discussions within the medical community, leaving the general public largely uninformed about the extent of the epidemic."

"The solution is straightforward: If paramedics widely carried blood, as military medics have done for years, tens of thousands of lives could be spared annually. But the country’s fragmented health-care system does not allow for an easy fix. . . . Despite repeated pleas from specialists, the federal government has not prioritized or properly invested in the plight of injured Americans."

With each minute that passes after a potentially fatal injury, the possibility of death increases, "especially within the first half-hour, when severe bleeding deaths peak," Caruba notes, citing research. "An estimated quarter of all Americans live further than a 30-minute drive from Level I or II trauma centers, which provide the highest level of care to injured patients."

The Defense Department has greatly improved combat death rates with faster evacuation, "increased tourniquet use and administered blood on the way to the hospital," Caruba notes. "No such overhaul has happened in U.S. health care, and efforts have not been made to broadly adopt the military’s best practices, particularly before patients reach a hospital."

In 2019, fewer that 1% of trauma patients "received blood products of any kind on the way to the hospital, even when they displayed clear warning signs of bleeding out," Caruba reports, citing research by the University of Alabama-Birmingham. She notes that there is relatively little research into trauma deaths, and that the federal government doesn't even track them. But a federal report in 2016 estimated that 20,000 to 30,000 trauma deaths a year were potentially avoidable.

The U.S. has more than 23,000 emergency medical services, but only about 100 ground services have blood, "trauma advocates have found in recent surveys. While most air ambulance companies carry blood products, they treat only a small fraction of injured patients," Caruba reports. "Blood is a costly, limited resource, and most emergency medical providers lack relationships with blood banks. They also face regulatory and logistical hurdles, like maintaining blood refrigeration temperatures in the field and creating a system where unused units do not go to waste."

The Prehospital Blood Transfusion Initiative Coalition is focusing on the servcies' "inability to bill insurers for the cost of the blood and the rules in some states that prevent paramedics from starting transfusions," Caruba reports. "The group hopes to present recommendations to Congress and the National Association of State EMS Officials next year. Their goal is that every patient with major bleeding — including the injured and those hemorrhaging from medical complications — will receive blood if they need it."

Big college campuses can overwhelm rural students, so they have started forming their own support groups

Some universities began hosting leadership meetings with
rural students. (Photo by M. Krupnick, Hechinger Report)

When rural students attend colleges and universities, many face daunting challenges, including the size and scale of campuses, finding where they fit in, and feelings of culture shock, reports Matt Krupnick for the Hechinger Report, which covers education. "Few colleges have clubs for rural students to socialize and help each other through challenges, such as feeling out of place, dealing with crowds or public transportation, and even navigating busy freeways. Fewer still have physical spaces for those students to hang out together."

Rural college students recognized they needed to help each other and organized "their own support networks, mostly in the past two or three years, sometimes even without administration support," Krupnick writes. "Most of these rural student clubs have emerged at Ivy League universities or other highly selective private institutions and often have just a handful of members. But the trend is spreading."

Some administrations took notice and started working to support rural spaces. "It's part of a small but growing effort on some campuses to create a stronger sense of belonging for rural students, who drop out at higher rates than their suburban counterparts," Krupnick reports. Some colleges have set aside library space for gatherings and sponsored Q&As so university leadership members can get to know their rural students.

Having supportive rural peers can help students stand up for their opinions, which their urban counterparts may not understand. "At the University of Chicago, Savannah Doty, a 21-year-old senior from rural eastern Washington, said she felt completely shut down when she brought up rural issues in a class about the histories of infrastructure. 'It got steamrolled by both the professor and the rest of the class,' said Doty, president of that campus's Rural Student Alliance." She added, "I've had that experience hundreds of times in classes, in that my rural identity is downplayed. I think everyone would benefit from hearing about the rural experience."

Krupnick reports, "Many elite colleges are starting to ramp up their recruiting of applicants from rural areas, but students at some institutions say the attention ends there. Rural students, once they arrive on campus, often feel as if their colleges forget about them, noted Ty McNamee, a University of Mississippi assistant professor of higher education who studies rural students."

While there is no official count of how many rural college clubs exist, the trend is catching on. "Educators at Purdue University, Kansas State University and Virginia Tech have said they would like to find more ways to support rural students," Krupnick reports. "Virginia Tech plans to create a physical space for rural students, said Amy Azano, a professor of adolescent literacy and rural education there. Even though the 38,000-student university is surrounded by rural communities, she said, it can still be overwhelming for rural students."

Opinion: Americans must weigh in on how poorly the U.S. Postal Service is run before it's too late

The Postal Service boasts a 'jaw-dropping' 77% approval
rating. (Photo by Victória Kubiaki, Unsplash)

While Americans may not use the U.S. Postal Service as often as they did 20 years ago, it remains "a universally beloved federal agency. . . . second only to the Parks Service in public favorability (a jaw-dropping 77% approval rating, per Gallup ), writes Vishal Shankar in his opinion essay for Common Dreams, "The Public Has a Right to Know Every Detail of Louis DeJoy's Destructive Agenda." The Postal Service is arguably also the most frequently-interacted-with component of the federal government: packages and letters are delivered to Americans' mailboxes six days per week. But many of the Postal Service operations are changing under DeJoy, and critics say his leadership has led to slower delivery, significant price increases and less accountability. With a Postal Board of Governors as the only body that can censor or fire DeJoy, the public must stand up for what they hold dear, according to Shankar. "The future of the people's most treasured public institution depends on public participation and feedback." 

At a time when public trust in government is at near historic lows, the Board and Dejoy have worked to restrict public access to comment or meeting participation. "At least four times per year, the Board "holds an open session meeting, its sole formal contact with the public. In recent years, these meetings have concluded with a well-attended public comment period, where in-person and virtual attendees have excoriated DeJoy for embracing a privatization-friendly agenda," Shankar explains. "Just this year alone, public commenters at Board meetings have decried the mail slowdowns and price hikes, demanded changes to DeJoy's gas-guzzling and union-busting fleet plan, raised serious concerns about transparency of DeJoy's facility consolidation plans, and pushed DeJoy to expand community services offered at the post office."

But in its last open session meeting in November, the Board banned public attendance and comments without explaining why. "This abrupt new barrier to public accessibility led the number of public commenters – which in recent meetings has been a double-digit tally – to drop to 4," Shankar adds. "The decline in attendance was also likely compounded by an unexplained shift in the meeting time: whereas past meetings have been held at 4:00 pm ET, Tuesday's session was held at noon – the middle of the workday."

The Board began suppressing public input before this November's meeting. "At the August 2023 meeting, each public commenter was allotted only 25 seconds to speak, in sharp contrast to the typical 3-minute time limit," Sharkar notes." But next year, the Postal Board's accountability problem will worsen. Postal Board Deputy Secretary Lucy Trout explained that starting next year, the Postal Board will only hear public comments once per year in November. In other words, though the next three Postal Board meetings (February, May, and August 2024) are ostensibly 'public sessions," members of the public will have no opportunity to inform the Postal Board about their concerns until a year from now."

The Postal Board needs to drop its suppressive tactics and "reverse course by allowing both in-person and virtual public comments at all open sessions next year, and take further steps to improve accountability by responding to public comments and posting recorded comment sessions to the USPS website," Sharkar writes. "Congressional Democrats and the Biden administration must publicly call out this shameful barrier to transparent government and fast-track filling Postal Board seats with anti-DeJoy, pro-accountability reformers. . . .The future of the people's most treasured public institution depends on public participation and feedback – that's how public service works."

To read a detailed account of USPS history under DeJoy's leadership and ideas on how to engage with the Postal Service, click here.

The world is full of lonely people -- part of the antidote is changing how people react to this universal emotion

Loneliness is a human experience and an internal
message. (Photo by Kristina Tripkovic, Unsplash)

Being lonely has become so widespread that globally, one in four adults report feeling sad and alone. Medically, continued loneliness can take a severe toll on people's health, yet "pangs of loneliness aren't catastrophic. In fact, they're nearly universal. What's critical is how people respond to these feelings when they arise," reports Allison Aubrey of NPR. Commenting on the best way to respond to feeling lonely, Dr. Jeremy Nobel, a primary care physician and author of the new book Project UnLonely, told Aubrey, "Just like thirst is a signal you need hydration, loneliness is a signal that you need human connection."

Nobel's book creates a path to "using creative expression as a means to communicate," Aubrey writes. "When there's not a prescribed way to 'belong,' finding connection can be tough. Many people are hesitant to put themselves out there, or they have a hard time communicating what's on their minds. 'This is where the arts can be very powerful because they act as a catalyst to make it easier,' Nobel says. . . . Drawing a picture may seem like a solitary act, but it can be a bridge to connection, a way to express what's on your mind."

Viewing or creating art can improve mood.
(Photo by Jill Dimond, Unsplash)

Nobel has long believed in creative expression as a natural partner to medicinal treatment. "Some of his earliest work was with active-duty service members and veterans returning from Iraq and Afghanistan with post-traumatic stress," Aubrey explains. "They gathered in small groups to engage in artistic expression and mindfulness activities." Nobel told her, "People began telling us that not only were they less stressed out, but they felt more connected to each other, something I later realized was addressing a certain kind of loneliness."

From culinary arts to poetry to gardening, there are ways humans can use curiosity and creative discovery as a way to connect. "Project UnLonely now partners with community-based organizations to develop evidence-based creative expression programs, which can include music, painting, drawing and beyond," Aubrey adds. "Research shows making art or even viewing the work of other people reduces levels of the stress hormone cortisol. It also increases levels of the feel-good hormones, including dopamine, endorphins and oxytocin."

While it's hard for loneliness to prevail in the face of curiosity and encouragement, people may struggle to get started. Click here for five ideas that will help overcome those fears.

Monday quick hits: Old school buses now haul crops; outwitting food deserts; are farmhouses too pretty?

Old school buses help get melons from the farm to the
table. (Photo by Edwin Remsberg, Ambrook Research)

"While traveling on Interstate 95 in South Carolina, I noticed a strange sight. . . . A virtual parade of perhaps a half dozen old school buses was headed in the opposite direction. Well, they used to be old school buses. Now they were something different," reports Heath Racela of Ambrook Research. "It turns out that the small caravan of buses I happened to pass is a somewhat hidden lynchpin in the complex process of getting food — melons, specifically — from farm fields to tables. In fact, for watermelon farmers and harvesters, used school buses seem to be the dominant way to transport their delicate fruits out of the fields."

Gas. Electricity. Flintstones footwork. There are many ways to get vehicles going, but some truckers are getting behind hydrogen. The element is "gaining a following among some heavy-duty truck operators who see it as the industry's best path toward zero-emission technology, especially for rigs traveling long distances," reports Paul Berger of The Wall Street Journal. "Hydrogen offers longer trips and faster refueling than battery-cell technology, supporters say, while allowing trucks to haul heavier loads because they aren't carrying industrial-scale batteries."

Thank you American farmers.
(Photo by M. Sullivan Wirecutter)

While not singularly rural, festive cookies are loved by rural folks far and wide, and American farmers can brag that they helped make the cookies! In a nod to all the eggs, flour, sugar, and delightful dairy ingredients that flow from American farms during the holiday season, here's a list of all the loot that can help you make the best cookies.

The Mobile Farm Market gets fresh food to
grocery deserts. (ILSR photo)

Living in a food desert creates grocery challenges, especially for those lacking transportation. "When a new mobile grocery market launched in Wayne County, Pennsylvania, its first stop was Maple City Apartments, a 40-unit complex for low-income, elderly relatives. Maple City's residents have felt the region's lack of grocery stores acutely," reports Kennedy Smith for the Institute for Local Self-Reliance. "The county's residents can now buy groceries from a farmers market on wheels. It started when the Cooperage Project, a regional nonprofit organization, wanted to get fresh, healthy food to people during the pandemic. . . .Cooperage created Mobile Farm Market — a small, refrigerated van — to bring fresh produce, milk, cheese, and eggs to towns and neighborhoods lacking full-service grocery stores."

People with no desire to work the land are purchasing farms. (Photo by Zach McNair, AR)

Take a peek at Instagram, and "you'll be hard-pressed to escape romanticized images of farm life: rolling hills, broad wrap-around porches, oddly clean baby goats," reports Nora Neus for Ambrook Research. "The popularity of the farm aesthetic and farmhouse lifestyle is creating real estate problems among working farmers, especially younger and newer ones who already face challenges in finding affordable land across the country. . . . Farmhouse properties are so pretty, they're getting too expensive to use for agriculture."

The pay gap between rural and urban workers is getting worse, according to new financial data

City workers make about 23% more than rural workers.
(Campaign creators photo, Unsplash)

Workers in urban areas traditionally have made more money than rural workers, but the pay gap is getting worse, reports Elizabeth Trovall for Marketplace.

“In cities, people earn about 23% more than people in rural areas, according to new data from the Federal Reserve Bank of New York,” Trovall reports. “That difference was more like 20% before the pandemic.”

The pay gap hasn’t always been so pronounced. According to Trovall’s report, “Rural areas were catching up to city wages, mostly because of new technology coming to smaller communities. ‘Then, around 1980, this all changed,'’’ said Conor Walsh of the Columbia Business School.

The loss of manufacturing jobs hurt rural incomes.

(Pitti.edu photo, Unsplash)

“That’s when the lucrative business services sector took off in places like New York, Los Angeles and San Francisco,” Trovall reports. “’In particular, finance, tech and professional services,’ Walsh said. . . . “At the same time, manufacturing jobs started leaving rural America, which helped to widen the gap.”

In addition, there's the long-standing difficulty of getting college-educated students from rural areas to return home after graduation instead of taking higher-paying jobs in larger cities.

The Covid-19 pandemic and high inflation have made the problems with income gaps worse in recent years.

"'Inflation impacted people living in rural areas more because they spent considerably more on goods with higher price increases,'" economist Selcuk Eren of The Conference Board told Trovall. "'What goods am I talking about? I'm talking about vehicle purchases, and I'm talking about gasoline."

Expectant moms face OB-GYN deserts; one state is an example of the national problem

A mother holds a newborn baby.
(Photo by Katie Klingsporn, WyoFile)

Wyoming is one of many states where women and families are finding obstetric care harder to find. "More than 15% of Wyoming women had no birthing hospital within 30 minutes of home in 2022, compared to 9.7% of women nationally, a report by the March of Dimes shows," Katie Klingsporn of WyoFile reports. "Such distance from care comes with real risks. Women who live farther from delivery hospitals are more likely to experience adverse medical outcomes. . . . In rural areas of Wyoming, 22.4% of women live over 30 minutes from a birthing hospital compared to 5.2% of women living in urban areas, according to the March of Dimes."

Nestled in west central Wyoming, Fremont County is "not unique, but with one obstetric practice, one midwife and one birthing hospital serving the general population of Fremont County — a New Hampshire-sized area that's home to nearly 40,000 people — the situation here offers a window into the challenges, and consequences, of limited maternal health services," Klingsporn writes. And while Fremont County has a 24/7 delivery center in SageWest Hospital in Lander, women who labor and deliver there will most likely be treated by a traveling doctor, who is also a stranger. 

Map of towns Fremont County women travel to for
obstetric care. (Map by Eda Uzunlar,WyoFile)

Traveling in Wyoming can be both risky and expensive. It "requires money, childcare, work flexibility and other resources that not everyone has. And then there's the issue of winter travel in Wyoming, where icy storms regularly close roads and ground air ambulances," Klingsporn reports. "The OB shortage is not isolated to Fremont County. Hospitals in Rawlins and Kemmerer stopped offering delivery services in recent years. Other counties like Sublette and Weston don't have birthing facilities at all."

Jen Davis, Gov. Mark Gordon's senior policy advisor on health and human services, "said of the dearth of maternal health care, 'It's a huge problem,'" Klingsporn writes. 

While traveling longer distances to see obstetric providers can lead to poor outcomes, more pregnant women in Wyoming are having to take that risk. "The farther a woman travels for maternity care, the greater the risk of maternal morbidity and adverse infant outcomes," Klingsporn reports. 

The loss of labor and delivery care is a national problem. "In 2022, the March of Dimes reported on the problem of 'maternity care deserts' across the United States," reports Stacey Kelleher for Health eCareers. "These communities do not have birthing centers or hospitals offering obstetric care. Outside these maternity care deserts, which affect more than two million women of childbearing age, nearly seven million other women and 500,000 births are also impacted by low or no access to Ob-Gyn care in this country."

We got the milk, but where's the carton? Dairy farmers face an unexpected dilemma.

The USDA requires milk offerings at
breakfast and lunch. (American Dairy photo)

America's dairy industry has a new problem -- not enough 4 oz. cartons to put the milk in before shipping it to "care homes, hospitals, prisons, cruise ships and schools," reports The Economist. "School districts are scrambling." The Department of Agriculture "requires milk to be offered at school during breakfast and lunch. . . . For some pupils, school is the only place they receive dairy food. Districts are reimbursed for each half-pint of milk offered to pupils at low or no cost. Milk can arrive in schools as quickly as 72 hours after leaving the farm."

How did this happen? Dairy supplier Cream-O-Land and other dairy suppliers source their cartons from Pactiv Evergreen. The company "blames higher-than-usual demand. Dairies use the summer to stock up. This supposedly did not happen this year," The Economist reports. "Dairies disagree, seeing no changes in demand or inventory. Other packaging firms are busy because Pactiv Evergreen's customers are begging for cartons."

Because schools and other businesses are required to serve milk, the USDA and many states relaxed some of their requirements. "Schools can now serve milk out of jugs. Districts are stocking up on cups and lids. Some schools are offering juice," The Economist adds. "To fix things, Pactiv Evergreen says it has upped its output. It has also resurrected a defunct generic brand and will use its design for all cartons, rather than interrupting the line to change logos. This should speed production and increase capacity by 10%. Shipments are expected to begin in early December."

Meanwhile, the U.S. dairy industry is already facing declining sales due to competition from plant-based "milks." Not having enough cartons was yet another challenge. Danielle Wiener-Bronner of CNN reports, "To help ease the burden on schools — and dissuade them from turning to non-milk alternatives — the American Dairy Association North East issued tips to dairy suppliers, suggesting that they offer to help pour milk themselves, donate cups or spearhead a cup donation drive, among other solutions."

Smaller meatpacking businesses struggle to compete with mega processors, USDA grants aren't enough

Greg Gunthorp at his small meat packing operation in
Indiana. (Photo by Chelsi Daley, Investigate Midwest)

Mega meatpackers dominate so much of the market that smaller meat processors are forced to seek contracts and business beyond grocery stores. "Even with $1 billion in federal grants available to them, many still struggle to compete" with slaughterhouse giants Tyson Foods, JBS, Smithfield and Marfrig, reports John McCracken of Investigate Midwest. "The Biden administration has tried to address the concentration, including offering grants to help small processors expand. But it's not enough for many small processors that face proportionately higher operating expenses than the industry giants, according to interviews with small processors and experts."

Greg Gunthorp operates a small meat processing plant in northern Indiana. Over the past 20 years, he has sold niche meats "to chic Chicago and Indianapolis restaurants and to Chicago O'Hare International Airport. He also sold direct to consumers," McCracken reports. "But selling in grocery stores was not an option, as the largest meatpackers often have those contracts. In his circumstances, he found it difficult to compete in the chicken industry, and he recently stopped raising and slaughtering the bird." He told McCracken, "In an extremely concentrated marketplace, it's difficult for a small processor — especially a plant that slaughters — to find a sweet spot somewhere to fit long term."

"When asked about the problems small processors identified, the Department of Agriculture responded that the $1 billion in grants it's invested in expanding small processors 'is a historic investment that will directly combat consolidation in the meat processing sector and help build resiliency in the face of market disruptions,'" McCracken writes. "Just 12 federally inspected plants produced slightly less than half of the country's beef supply in 2022, according to Investigate Midwest's analysis of USDA data. The same year, 14 plants produced about 60% of the nation's pork."

Giant meatpacking companies save money through scale, owning their animals and "contracts with retailers, ensuring their product ends up at grocery stores," McCracken reports. Bill Bullard, the CEO of R-CALF USA, which advocates for independent cattle producers, told McCracken, "They've exceeded any efficiencies associated with economies of scale and are now engaged in controlling the marketplace."

"The funding is a promising sign in addressing the industry's concentration, said Peter Carstensen, a professor of law emeritus at the University of Wisconsin and an antitrust law expert," McCracken writes. "But the administration should also be using its antitrust enforcement capabilities more than it is, he said."

A story of hope: Rosalynn Carter's mental health advocacy 'changed journalism — and journalists'

Carter's advocacy created a framework for much of the
progress on mental illness in America. (Photo by Ric Feld, AP)

One reporter's journey to understanding the role journalism could play in improving Americans' lives began with Roslyn Carter's mental health advocacy. A condensed version of Aaron Glantz's NPR story is shared below.

"So much of who I am today is the result of receiving a Rosalynn Carter Mental Health Journalism Fellowship from The Carter Center 15 years ago.

"When I met former first lady Rosalynn Carter in Atlanta in 2008, I was accomplished — having written one book and under contract for a second — but I was also broken after three years reporting in Iraq and an equal amount of time chronicling challenges veterans faced back home. I wrote without purpose, drifting from story to story and full of rage at what I saw as the U.S. government's failure to take seriously the human consequences of the war it began.

"Mrs. Carter was the first person to ever ask me how my journalism would make an impact. It was such an obvious question that it changed my life.

"These days, the question of impact is regularly discussed in newsrooms, especially on investigative desks. But at the time, considering the purpose of one's journalism was often considered taboo. . . .Her challenge, laid out softly in her gentle Southern drawl, gave me a way to channel my trauma. I could deploy it, and the entire journalism toolbox, into making people's lives better.

"All my work since and the change it has made — the fact the VA now tracks veteran suicides in an effort to prevent them, that 500,000 fewer veterans are waiting for disability benefits, that 100,000 fewer are on government-prescribed opioids, and more — can all be traced back to Mrs. Carter and her vision that journalism should have a greater purpose, to fight stigma and make change.

"As she did with her other fellows, she watched my work closely, sending congratulatory letters when my reporting won major journalism awards. She took me seriously, which made me take myself seriously. . . . Since Carter's death, I've been crying — as I share memories with some of the more than 200 other journalists who have held the fellowship that bears her name. Even those who held the fellowship after Mrs. Carter's health began to slip when she could no longer attend in person and provide notes spoke of the impact she had on them.

"Carter was a visionary. When she established the Rosalynn Carter Mental Health Journalism Fellowship in 1996, the entire conception of mental health as a journalism beat was not well established. Screaming headlines in newspapers and chyrons on the nightly news proclaimed people to be 'crazy' or 'insane.' The idea of reporting with the expressed purpose of fighting stigma and improving conditions for people with mental illness was foreign to most editors and publishers. . . . Through deliberate work over more than two decades with hundreds of reporters; Carter changed that." 

When this rancher was gored by a bison, ambulance telehealth helped save his life

Video systems on ambulances let medics get help from more
advanced providers. (Photo by Arielle Zionts, KFF HN)

When severe ranch injuries happen, having experienced medical care on hand can mean the difference between life and death. But in many cases, rural medics don't often treat life-threatening wounds. Some ingenious South Dakotans figured out how to overcome that dangerous knowledge gap.

"Rural medics who rescued rancher Jim Lutter after he was gored by a bison didn't have much experience handling such severe wounds," reports Arielle Zionts of KFF Health News. "But the medics did have a doctor looking over their shoulders inside the ambulance as they rushed Lutter to a hospital. The emergency medicine physician sat 140 miles away in a Sioux Falls, South Dakota, office building. She participated in the treatment via a video system recently installed in the ambulance."

Ed Konechne, a volunteer emergency medical technician with the Kimball Ambulance District, told Zionts, "I firmly believe that Jim had the best care anyone has ever received in the back of a basic life support ambulance." Zionts adds, "The ambulance service received its video system through an initiative from the South Dakota Department of Health. The project, Telemedicine in Motion, helps medics across the state, especially in rural areas."

The pandemic years helped Telehealth become more accepted, and the "technology is starting to spread to ambulances. Similar programs recently launched in regions of Texas and Minnesota, but South Dakota officials say their partnership with Avel eCare — a Sioux Falls-based telehealth company — appears to be the nation's only statewide effort," Zionts reports. "Rural medics often have less training and experience than their urban counterparts, Konechne said. Speaking with a more experienced provider via video gives him peace of mind, especially in uncommon situations. Konechne said the Kimball ambulance service sees only about three patients a year with injuries as bad as Jim Lutter's."

Katie DeJong was the emergency medicine physician at Avel eCare's telehealth center "who took the ambulance crew's video call," Zionts writes. "After speaking with the medics and viewing Lutter's injuries, she realized the rancher had life-threatening injuries, especially to his airway. . . . . DeJong called the emergency department at the hospital in Wessington Springs — 25 miles from Gann Valley — to let its staff know how to prepare. DeJong also arranged for a helicopter to fly Lutter from the rural hospital to a Sioux Falls medical center, where trauma specialists could treat his wounds."

To read more about Lutter's rescue or how South Dakota is funding its program, click here.

Money for clean-energy projects goes to former coal towns

Boston Metal will make clean-energy metals at the old Weirton
Steel location in W.Va. (Photo by Luke Sharrett, The New York Times)

From Weirton, West Virginia to Vernon, Texas, to Vandergrift, Pennsylvania, the Department of Energy is funding projects designed to help medium-sized manufacturers "bring clean-energy jobs to former coal communities," reports Hiroko Tabuchi of The New York Times. The infusion of cash is part of the Biden administration's effort to gain support for its climate agenda in regions that have long depended on the fossil fuel industry. The administration hopes that funding new jobs in energy can help coal workers and regional economies transition.

Hard work for decent pay and good benefits once defined U.S. coal mining jobs, but over the past decade, those jobs have disappeared. "These energy workers haven't been finding clean-energy jobs despite the rapid growth in industries like solar and wind," Tabuchi writes. "Coal workers, in particular, have struggled in the transition, a recent study found. "Less than a quarter of a percent of workers who left a fossil fuel job in West Virginia moved onto a job in renewable energy, said E. Mark Curtis, an economist at Wake Forest University who led the study. Education was another factor: Fossil fuel workers without a college degree were significantly less likely to find clean energy jobs."

Curtis told Tabuchi: "In places like Texas or in the middle of the country where there's a lot of solar and wind, fossil fuel communities are relatively well positioned to take advantage of renewables. Coal communities generally don't have that, especially when you think about Appalachia." Tabuchi reports, "He said it made sense for government funding to target former coal regions and to focus on manufacturing projects because data showed that former fossil fuel workers most frequently sought to switch to manufacturing jobs."

The DOE grant program aims to help the U.S. become more competitive in the clean-energy manufacturing sector while using the $275 million investment to revitalize former coal towns' economies. The companies building the new plants said "they are eager to tap local expertise," Tabuchi reports. Tadeu Carneiro, the chief executive of Boston Metal, told him: "The most valuable asset for the project is a legacy workforce that has played a significant role in the U.S. metals industry." Tabuchi adds, "Its new West Virginia plant expects to hire 200 to 250 people and will manufacture ultra pure chromium metal and high-temperature alloys that are critical materials needed for clean power, fuel cells, and steel. Currently, foreign manufacturers dominate those materials."

A live call-in radio show aims to give the Midwest a 'place at the table' in national conversation about issues facing U.S.

Jeremy Hobson with Cynthia Wang during The Middle’s
first episode. (The Middle courtesy photo)

The voices of middle Americans can sometimes go unheard in discussions about problems and opportunities facing the United States. But Jeremy Hobson, a former NPR host, has found a way to highlight those voices. He's the producer and host of a live-caller radio show aptly named The Middle, which highlights midwestern opinions, reports Corbin Bolies of the Daily Beast. "Each episode of The Middle, which airs live on Thursdays on nearly 400 radio stations across the U.S., revolves around a singular topic, with Hobson, two expert panelists, a journalist-turned-DJ — and hundreds of live callers — weighing in with their perspectives."

An Illinois native, Hobson felt that most radio shows "rarely considered those who lived where he was born — residents whose states’ electoral politics often shift presidential elections," Bolies writes. Hobson told him, "I’ve been in public media for over 25 years. What I have seen, and I grew up in central Illinois, I feel like these voices need to have a part in our national conversation. . . . That’s what we’re trying to do. So it’s about bringing these voices in that are not typically heard, allowing listeners to take part.”

Stephanie Curtis, the content director of Minnesota Public Radio, told Bolies: “I thought it’d be more of a program where, like, ‘What are those people in the middle of the country thinking?’ But it isn’t. It sounds like it’s led with real curiosity. It’s about the biggest issues that are facing the U.S., but then highlighting the voices of people from the Central Time Zone, from Middle America.”

The Middle began with a "series of self-funded pilot episodes that aired just before the 2022 midterm elections — and a yearlong, individual pitching process to radio stations nationwide. Hobson officially launched the show in September out of WILL-FM, the Illinois Public Media station in Urbana, Illinois," Bolies reports. "It currently airs across 380 public radio stations nationwide. Hobson believes it is the only national public radio program in the U.S. that takes live calls."

Hobson aims for The Middle to give the Midwest a voice that genuinely reflects the region. He told Bolies: "One of the things we’re trying to do here is to dispel the stereotypes of the geographic middle and say no, actually, it’s incredibly diverse, it’s incredibly dynamic, it’s incredibly interesting, economically and in so many other ways. . . . It’s a time that people from all walks of life in the middle have a place at the table and the national conversation.”

Opinion: To prevent holiday loneliness from setting in, follow this 5-step 'prescription'

Intergenerational contact helps lessen loneliness.
(Washington Post illustration, iStock)

The holidays can be a source of joy and celebration, but for many people the time is marked by severe loneliness and depression. With some inspiration from the U.S. Surgeon General's 5-for-5 connection challenge, Dr. Trisha Pasricha gives her 5-step "prescription to combat loneliness during the holidays" in her medical opinion for The Washington Post.

Day 1: Reach out to a former mentor and thank them.
I was recently at a wedding reflecting with others about all the teachers, friends and colleagues who have no idea how much they meant to us. Would they find it strange that we messaged them simply to express gratitude? I called my high school French teacher. She was as delighted as she was delightful. I found out she had retired but still loved to volunteer at my old school. She couldn't believe I was a physician. Today, thank someone. . .  .and tell them how they influenced your life for the better.

Day 2: Join a group activity.
Whether you go into it with a friend or alone, sign up for a group activity to do for a few weeks. Get a ClassPass for aqua aerobics, plan a month of yoga in the park, or find a neighborhood book club. Choose something that gets you outside the house for part of your day. And if you're debating what to give someone this holiday, consider gifting an activity you'll do with them. It opens the door to a new community and is more valuable than any pair of cozy socks.

Day 3: Call a relative or friend you haven't spoken to in a while.
On my last birthday, a widowed uncle I've honestly never had much contact with called out of the blue to wish me happy birthday. It became one of the loveliest conversations I had that day as he asked all about my kids, and I learned he had an adorable new dog. Now, he and I text every month. Today, think about someone you've drifted away from and wish them a happy holiday season.

Day 4: Ask for help.
Reflect on some of the areas in your life where you could use more support. Ask your grandmother to walk you through your favorite recipe and teach you tricks in the kitchen one-on-one. Or ask the neighbor's kids to help you walk or play with your dog. You get bonus points if you make a bridge with someone from another generation. There have been many studies on intergenerational contact to improve loneliness. For children, such opportunities lead to higher self-esteem, better academic performance and improved social skills. For adults, they reaffirm value and lead to greater life satisfaction in addition to other mental health benefits.

Day 5: Tackle screen time.
It's hard to give up screens entirely. But at your next meal, try this compromise. Put all the phones in a basket on the table and schedule a 30-second phone check for later in the meal. Using your phone during a face-to-face gathering not only reduces conversation quality but lowers your own enjoyment of time spent together.

What I want my patients to know.
The public health costs of loneliness are clear. In one meta-analysis, loneliness increased the odds of early mortality by 26 percent. Depression as a consequence of loneliness is linked to heart failure and even getting a cold. Loneliness modulates stress hormones, contributing to low-level inflammation and gene expression.

The people at greatest risk of loneliness are adolescents and older adults, those with poor physical or mental health, people living alone and single parents. Seek help if you are struggling during the holiday season and talk to a trusted friend, family member or physician, or call or text the 988 crisis line, which provides 24/7, free and confidential support for people in distress.

Nature bits 'n bites: Unearthly fish; plant memories; forest tardigrades; gray wolves return; a very hungry beetle

(Photo by Dante Fenolio,
Science Photo Library via Hakai)

Creatures that dwell in the deep ocean may look like inedible Star Wars characters, but fish industry experts are looking into their potential. Scientists are also studying these fish in an attempt to protect them. "Mesopelagic fish are not yet commercially exploited, though projects are underway to investigate the marketability of the species and the best methods for harvesting them," reports Moira Donovan for Hakai magazine. "Scientists working in this area are, therefore, in the rare position of being able to assess potential impacts from fishing before they happen. But with so many unknowns, the question remains: can they do it in time — for the fish's sake and our own?" The telescopefish, above right,  has large tubular eyes to maximize light collection and a highly extensible jaw with needle-sharp teeth that ensure a firm grip on prey.

Plants aren't normally considered "learners," but maybe they should be. "In the study of the plant kingdom, a slow revolution is under way. Scientists are beginning to understand that plants have abilities, previously unnoticed and unimagined, that we've only ever associated with animals. In their own ways, plants can see, smell, feel, hear, and know where they are in the world," reports Sarah Laskow for Atlas Obscura. "Of the possible plant talents that have gone under-recognized, memory is one of the most intriguing."

Do dairy calves need more love to keep them from unhealthy oral habits? A new Florida study suggests that more pets can keep young calves happier and less likely to chew on everything out of boredom or frustration, reports Shea Swenson for Ambrook Research. "The presence of somebody scratching and having some contact with them reduced the duration of those pen-directed sucking behaviors, particularly for the individual housed calves."

Tardigrades are part of a forest's dynamic life forms.
(Photo by Oliver Meckes and Nicole Ottowa, Nat Geo)

Mary, Mary, quite contrary, what makes a forest grow? Tardigrades! "A photographer and biologist put microscopic fungi, roots, and slime molds from Germany's Black Forest under a scanning electron microscope—and found creatures like this astounding tardigrade among the forest's essential, and often overlooked, life forms," report Oliver Meckes and Nicole Ottowa for National Geographic. "This discovery in the moss on a tree trunk, magnified 2,400 times, marked a newfound species among the 1,300 known types of tardigrades."

Next month, Colorado will begin its planned reintroduction of gray wolves, with the release of about 50 wolves captured in Oregon, reports Trevor Hughes of USA Today. "The exact [release] locations will be kept secret, but the wolves will generally be released on state or private land in a rural area of west-central Colorado. . . . Backers of Colorado's reintroduction plan say that wolves are a natural and important part of the ecosystem. . . . They argue that safety concerns are wildly overblown, and that ranchers and farmers who lose livestock will be fairly compensated by taxpayers. . . . But farmers and ranchers consider wolves a dangerous threat to wildlife and stock alike."

The Miami tiger beetle has 'big, serrated mandibles.'
(Photo by Joel Sartore, National Geographic, Photo Ark)

Meet the Miami tiger beetle, named for its 'highly voracious predatory behaviors, it's the 15,000th species in National Geographic's Photo Ark. "The beetle was rediscovered in 2007 after a more than 60-year absence," reports Rachel Fobar. "With its iridescent blue-green exterior and round, expressive eyes, some would call the Miami tiger beetle beautiful. . . . But when photographer Joel Sartore looks at one, he also sees carnage. . ."

Many small post offices are struggling with mail delays, in part because of delivering Amazon packages

A postal worker loads Amazon packages for delivery to
rural areas. (Photo by Dan Koeck, The Washington Post)

It's not the most wonderful time of year for some small post offices facing multiple mail delays when stacks of Amazon packages get delivery priority. "When Delbert Mikelson's mail started showing up late — and sometimes not showing up at all — he blamed it on the opening of deer season," report Caroline O'Donovan and Jacob Bogage of The Washington Post. "But it wasn't the buck hunt delaying the mail in Bemidji, Minnesota, a small town 100 miles south of the Canadian border. . . . Since early November, Bemidji has been bombarded by a sudden onslaught of Amazon packages — and local postal workers say they have been ordered to deliver those packages first."

Shouldn't first-class mail be delivered first? Not necessarily. "The U.S. Postal Service has had a contract with Amazon since 2013, when it started delivering packages on Sundays," the Post reports. "But in recent years, that business has exploded as Amazon has increasingly come to rely on postal carriers to make 'last-mile' deliveries in harder-to-reach rural locations."

In Bemidji, "chaos has ensued," with packages stacked so high the town's fire marshal tried to intervene. Meanwhile, the town's regular mail routes are neglected, leaving residents waiting for "checks, credit card statements, health insurance documents, and tax rebates," O'Donovan and Bogage write. "Routes meant to take eight or nine hours are stretching to 10 or 12. At least five carriers have quit. . . ." One Bemidji post office employee, speaking on the condition of anonymity to protect her job, told the Post, "If we keep getting this volume. . . .We won't survive. We aren't equipped for this."

The Bemidji post office is one of many facing challenging piles of Amazon packages. "Carriers and local officials say mail service has been disrupted in rural communities from Portland, Maine, to Washington state's San Juan Islands," the Post reports. Bemidj's mayor "has complained to local members of Congress, who say their ability to control the post office is limited. Last week, Sen. Tina Smith (D-Minn.) sent a letter to Postmaster General Louis) DeJoy to ask about reports that 'Amazon is interfering with timely deliveries and stretching the agency's already-overburdened workers too thin. . . . As Postmaster General, you are responsible for ensuring that the Postal Service meets its service standards, and it is clear right now that things are not working as they should. . . Entering into contracts that your system cannot support is a breach of your responsibilities.'"

Postal Service spokesperson David Partenheimer told the Post, "'Like any prudent business, we do not publicly discuss specifics of our business relationships.' . . . After this story was published, he added that the agency 'does not prioritize the delivery of packages from Amazon or other customers.'"

Some 'ghost' newspapers owned by large companies no longer have even one local reporter

The Gleaner in Henderson, Ky., used to have a newsroom
staff of about 20. (Photo by Donna Stinnett via WSJ)

With the severe cutbacks at some news organizations, your local newspaper may not have any reporters, writes Alexandra Bruell of The Wall Street Journal. "The Gleaner, the local newspaper in Henderson, Ky., has sections focused on features, sports, news and opinion. What it doesn't have: a single reporter on staff."

How could a once-bustling, energetic community newspaper like The Gleaner, which employed about 20 staffers, now have zero reporters? "The publication is one of the 'ghost newsrooms' that increasingly dot the American media landscape — newspapers that have little to no on-the-ground presence in the localities whose name they bear," Bruell writes. "It is a sobering development in an industry that has been brought to its knees by the rise of digital media and large technology companies."

Penny Abernathy, a visiting professor at Northwestern University and lead author of a recent report on the state of local news in the United States, told Bruell: [Many newspapers] "are so depleted in staff, or maybe have no staff, that they're not able to provide the sort of communication the residents in that community need to make wise decisions."

The surge of free internet news alongside online advertising behemoths such as Google and Facebook have continued to "hollow out local newsrooms as waves of consolidation and layoffs significantly changed the country's news landscape," Bruell reports. "Smaller outlets were hit particularly hard by sharp declines in circulation and incursions into their online advertising businesses."

Northwestern's study about "the state of local news cited research showing that about half of the 70 smallest papers owned by Gannett and Lee Enterprises — two of the nation's largest local news publishers — had no listing of any local journalists on staff," Bruell writes. "Abernathy said the study only looked at extremely small publications and that there are likely to be ghost newsrooms among larger local papers."

Roughly 2½ newspapers close each week, according to the study, and "the country has lost almost two-thirds of its newspaper journalists since 2005," Bruell reports. "The decline of local news is having an outsize impact on the entire media industry because the study said that until recently, as much as 85% of the news that ultimately made national headlines was first published in a local newspaper."

Missouri's rural teachers are among the lowest paid in the country; lack of state tax revenue is partially to blame

 Missouri's rural teachers are 'second-worst paid' in the
U.S. (Photo by Tristen Rouse, St. Louis Public Radio)

American teacher salaries have not kept pace with other college graduate professions, and for rural areas, the wage disparities continue to grow. In Missouri, a new report on rural education found that the "state's rural teachers are paid better only than those in Arkansas," reports Kate Grumke of St. Louis Public Radio. "Missouri also has one of the lowest rates of state tax revenue, meaning the burden for funding schools falls heavily on local taxpayers."

The study "collected salary expenses in rural school districts across the country and divided those by the number of teachers in the district to calculate teacher pay, "Grumke explains. "They found Missouri's rural school districts spend less on each teacher than every state except Arkansas. The researchers used a cost-of-living adjustment to more accurately compare compensation."

Nationally, Missouri falls lower on teacher pay, but "this report highlights the acute issues in rural parts of the state," Grumke writes. "Low salaries in rural districts often lead to high turnover, as teachers move to nearby suburban districts that often pay significantly more, said Phil Murray, president of the Missouri National Education Association and a former teacher."

Like many rural schools searching for low-cost teacher retention fixes, some Missouri schools have implemented a 4-day school week. Jon Turner, an associate professor at Missouri State University who studies rural schools, told Grumpke: "We've now passed the 30% mark of the number of schools that are on the four-day school week, and almost all of them are rural schools. One of the primary factors of that is because rural schools struggle to hire and retain high-quality teachers."

Grumpke reports,"Missouri also had one of the lowest rates of state tax revenue compared to local revenue; the state contributes about 75 cents for every dollar of local funding. This heavy reliance on local property taxes creates significant challenges in rural school districts and other districts where property values are low.

"Missouri is really an outlier here in that we put all the burden of operating rural schools on the local taxpayer," Turner told Grumpke. "And sometimes the teachers and the kids pay the price because there's not as much tax revenue coming in at the end of the year to support those rural schools." 

New study shows grass and shrubs -- not trees -- help to spread many catastrophic wildfires

Researchers built data sets that show where wildfires burned homes and indicate if those homes were rebuilt. (Map by Radeloff, UW, from Census Bureau, NASA, Forest Service data)

Grasses and shrubs are more often the cause of extensive wildfires, not forest fires "jumping from tree to tree," a new study published in the journal Science shows. "When people think of wildfires, they often think of huge forests burning," Elise Mahon of UW News reports. "But according to new research led by Volker Radeloff, a professor of forest and wildlife ecology at the University of Wisconsin, in the United States, the largest areas near humans burned by wildfires are grass and shrublands, not forests."

To look at the primary cause of catastrophic wildfires, Radeloff looked at areas "where people and wildlands meet, which are known as the Wildland Urban Interface, or WUI, these areas cover about 10% of land in the United States but are home to about one-third of the population," Mahon reports. "As Radeloff explains, many people enjoy living in these places because they like to be near the amenities of nature. But these areas are also hot spots for environmental conflicts like wildfires, the spread of diseases from animals, habitat fragmentation and loss of biodiversity."

In areas with population growth "such as the American sunbelt, more human development is expanding the WUI. Add to that a changing climate with warmer, drier conditions, and the likelihood rises that wildfires will affect humans more frequently," Mahon explains. "While the total area burned by grass and shrubland fires is much larger than forest fires, grass and shrublands are also much more widespread than forests. They burn and move faster than forests, meaning grassland fires can spread to a larger number of homes than a forest fire might."

Regardless of risk, many communities choose to expand. "Researchers found that the risk of wildfire in any kind of WUI vegetation is not deterring the development and rebuilding of homes in areas that have burned in the past," Mahon reports. "That's especially concerning for homes in grassland and shrubland because the vegetation, which can become fuel for fire, recovers much more quickly than a forest would. That means there's more fuel for a fire to burn again in the same grass and shrubland area more frequently."

To help build safer homes in these areas, "Radeloff believes learning from the homes that don't burn would be a step in the right direction for people that choose to rebuild after a fire," Mahon writes. "However, Radeloff says this burden shouldn't be entirely on the homeowner. He believes there is room for policymakers to influence how prepared a community is and where zoning should allow new housing developments."

Opinion: Amid hospital closures and soaring costs, medical centers should offer affordable care, not luxuries

Some hospitals look more like 5-star hotels.
(Photo by Jared Rice, Unsplash)

An anticipated "getaway" or "a journey of a lifetime" is often tied to a vacation that offers time away from the stress of daily life. But these traveling words are now being used to rebrand disease treatments. "Spin doctors are marketing getting sick as an adventure," writes Elisabeth Rosenthal in her opinion for KFF Health News. "It's not."

Rosenthal has always enjoyed travel and, for a time, lived in Rome. Her more recent "trips" were nothing like a vacation or living abroad. "I'm told, I've been on a journey. Two journeys, actually: First, a 'traumatic brain injury journey,' experienced at Johns Hopkins Hospital after I banged my head and developed trouble with my balance and gait," she writes. "More recently, I've been a traveling companion on my husband's 'cancer journey' at Memorial Sloan Kettering in New York City."

While her care was excellent, the profoundly severe element of many illnesses "has been rebranded in American health care as a kind of adventure," Rosenthal adds. "Experts speak of stroke journeys. Hospital systems invite people on kidney transplant journeys. The language has trickled down into advertising: Take a hair loss journey or a weight loss journey (newly popular because of Wegovy and similar drugs). The heart failure journey even comes with a map."

"A map?" Rosenthal asks. You don't visit anywhere exotic during disease treatment, and none of the treatments are glamorous. She writes. "In recent years, tight budgets, staffing shortages, and burnout have hit American hospitals. At the same time, many health centers in the U.S. — including the most prestigious ones, and even some community hospitals — have morphed into seven-star hotels. New hospital buildings, such as recent projects at the University of Michigan hospital system . . . . A hospital might now boast about its views, high-thread-count sheets, or food provided by a Michelin-starred chef."

In a nation where rural hospitals face towering debts and closures, and many Americans opt to delay treatment because of cost, "Is it worth it?" Rosenthal wonders. "Room charges in many hospitals can exceed $1,000 a night. . . . A hospital's function is to diagnose and to heal at a price that sick people can afford. I dream of a no-frills Target- or Ikea-like hospital for care. . . . The best hospitals in Europe are utilitarian structures resembling urban high schools."

Rosenthal suggests: "Instead of providing free coffee and a piano in a soaring, art-filled marble lobby, how about focusing on the very basic things that health systems in the U.S. should do, but — in my experience — in many cases do not, like making it easier for patients to schedule appointments? Shortening the now lengthy wait times to see physicians who take insurance plans? Or paying for adequate staffing on nights and weekends? Or ending those two-day stays in emergency rooms when all inpatient beds are full?"