In South Dakota's small towns, being prepared for cardiac emergencies is a matter of life and death

With a 15-mile distance to the nearest hospital, neighbors' quick action is key in Iroquois
In Iroquois, South Dakota, population 300, the nearest hospital is a 15-mile drive away.

With no local clinic or medical facilities, residents face a stark reality: in a cardiac emergency, their neighbors' quick action and preparedness could mean the difference between life and death.

Recognizing this critical need, Iroquois has taken a proactive step to safeguard its residents' health. The town recently achieved the designation of "Cardiac Ready Community" from the South Dakota Department of Health, becoming the fifth in the state to do so.

The initiative to make Iroquois cardiac ready was spearheaded by Daphne Moeller, a special education teacher and Health Occupation Students of America (HOSA) advisor at the local school, and Jim Lynch, a first responder on the Iroquois Fire and Rescue team. Moeller, who works in Iroquois, recognized the critical need for such a program in a town where the nearest medical center is 15 miles away.

“In rural areas, time is our greatest challenge,” Moeller said. “Being cardiac ready is crucial for us.”

According to a 2017 study, the median wait time for emergency medical services in rural areas is more than twice the national average —14 minutes compared to seven. For those experiencing a cardiac emergency, the chances of survival drop by 10 percent for every minute that passes without intervention.

Nationally, initiatives like the Cardiac Ready Communities program aim to bridge the gap in cardiac care disparities between rural and urban areas.

"Survival rates from sudden cardiac arrest improve significantly when communities are prepared," said Tim Nikolai, the American Heart Association’s rural health director.

The primary aim of the Cardiac Ready Communities program is precisely that: to equip ordinary residents with the knowledge, tools, and equipment needed to effectively respond to cardiac events through education.

According to Nikolai, only 51 percent of Americans feel confident in their ability to perform CPR in an emergency.

"Time is critical when it comes to heart attack and stroke," Nikolaid said. "Having trained bystanders ready to deliver care until EMS arrives gives individuals in rural areas a chance at survival that they otherwise wouldn’t have."

To achieve the Cardiac Ready Community designation, Iroquois had to develop and will need to implement a comprehensive action plan. This will include providing CPR and Automated External Defibrillator (AED) training, educating the community on recognizing the signs and symptoms of heart attacks and sudden cardiac arrest, and promoting the use of CPR and AEDs when medically appropriate.

“There needs to be a system in place,” Nikolai said. “We want to build a nation of lifesavers for when a rural resident experiences a heart attack.”

Moeller has a vision for the future development of Iroquois as a cardiac-ready community.

“I would like to have community outreach opportunities, for example, blood pressure screenings, CPR and AED training events, and obtaining additional AEDs for local businesses is really big one for me,” Moeller said.

Moeller first learned about the program through a Facebook post discussing Plankinton, South Dakota's designation as a cardiac-ready community. As a certified CPR instructor, Moeller immediately saw its potential for Iroquois and believed it was feasible to implement there too.

"Too often the small towns in rural areas resign themselves to believing that things like this are unachievable, therefore there is no need to try," said Iroquois Mayor James Hulbert. "With cardiac health being such an important issue, I am incredibly proud that they took it upon themselves to the need for cardiac awareness."

According to Moeller, the process of becoming a Cardiac Ready Community has been streamlined thanks to the town's dedicated ambulance team. Iroquois' fire and rescue squad, comprised entirely of volunteers, includes nine EMTs and 22 first responders.

Iroquois has already begun taking proactive steps towards broader heart health initiatives. HOSA members have been particularly active in raising awareness. They've hung posters from the South Dakota Quit Line in various local businesses, highlighting the dangers of tobacco use. Additionally, the community is planning to offer free blood pressure screenings during their upcoming Community Days event.

One of the critical components of the Cardiac Ready Communities program is mapping out the locations of AEDs in the community. Nikolai says schools should always be included in readiness planning and have AEDs placed in visible locations.

“There’s dozens or hundreds of students there, day in and day out, there’s dozens of staff members, there’s often parents and other volunteers visiting during the school day. And then you think about athletic events and community events that are often housed in schools,” Nikolai said.

Currently, Iroquois has three AEDs in the school, one in a church, and the fire hall. However, these locations are not accessible 24/7. As part of the program, the town plans to obtain additional AEDs to be placed in locations with round-the-clock access, such as city hall, ensuring that an AED is available at all times in case of an emergency

"We want to ensure that an AED is available at all times," Lynch explained. "Having one in a location that is always open could make a significant difference in an emergency."

Moeller acknowledged that while some people may worry about using CPR in a real-life emergency, she emphasized that those who have received basic training will intuitively know how to respond when the situation demands it.

Moeller cited one of her HOSA students, Zoei Schmidt-Ellman, as an example. She has competed in a HOSA-sponsored life support skills competition for the past two years, achieving first place each time despite worrying that she will forget what to do.

"If people know the skills, they'll know how to use them even during an actual emergency when adrenaline is rushing," Moeller said. "Our goal is to ensure that no one stands by helplessly when someone is in need of help."