By Brian Fives
Ask the average person what a rural community looks like and you are likely to hear responses about livestock in people’s backyards, being hours away from major medical institutions and big box retailers, main streets with shuttered stores, and abject poverty.
Sugarloaf, Colorado — situated in the picturesque foothills of Boulder — is not what people generally think of when they picture rural America. Rather than being hours away from medical facilities and modern luxuries; on a sunny summer day, it is just a few minutes’ drive to get to whatever you need.
And, unlike the gripping poverty that impacts many rural communities, Sugarloaf is a more gentrified area with housing costs rivaling those of major cities.
But, the fact that rural looks different here in Sugarloaf does not mean that we are immune from the rural health challenges that are seen across the United States. I see this every day as a member of our community volunteer fire department. In the wintertime, when an emergency dispatch call comes in, I know that this often means that we will be navigating icy, treacherous switchbacks at up to 9,000 feet with our custom-built engine, designed to tackle our unique geography.
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This geography is only the beginning of our challenges. For long minutes, we are the sole first responders providing critical care and stabilization waiting for either a medevac helicopter — which is often grounded from our extreme winter weather — or an EMS crew to make the circuitous climb up from Boulder. And, in those interminable ticking seconds, we are often the only difference between a crisis and a tragedy.
The lessons learned in these moments — holding the hands of my friends and neighbors — have illuminated so many of the rural health challenges that communities both similar to and very different from Sugarloaf face, and have also filled me with some degree of optimism as states and communities across this country think about how to most effectively utilize Rural Health Transformation Program (RHTP) funding.
Admittedly, much still remains to be learned about what RHTP will look like in practice — many states are still in the request for proposal stage and much of the funds are largely unallocated; and for funds that have been allocated, it is too soon to reach any meaningful conclusion about successes and failures. But, even in these early stages, there are three hopes that I have for RHTP — rooted in my experiences in tenuous mountain emergencies where the difference between life and death is often whisper thin and reinforced by my professional work for a healthcare IT company committed to building solutions for the most vulnerable patient populations.
These hopes are:
- That there is a growing realization that rural is not a monolith. The solutions that work for us in Sugarloaf, Colorado, may look very different than the solutions that are effective for a rural farming community in Iowa or a mining town in West Virginia. Recognizing this discrepancy requires decision-makers at the state- and national-level to be good listeners, willing to bring diverse stakeholders together. We cannot solve problems until we agree on what the problem is.
- That there is a dawning understanding that better healthcare is not always about what happens inside the walls of the hospital. It is often about what happens before a patient gets there — or what happens when they cannot get there. This understanding requires devoting thought and resources to supportive infrastructure outside of the hospital. In some communities, this may mean building better, more accessible roads or investing in a fire engine — like ours — that can navigate existing roads. In other communities, it may mean a commitment to comprehensive broadband Internet connectivity, allowing both seamless telehealth connections between patients and providers, and rural first responders and physicians to easily connect with remote specialists for critical cases.
- That we recognize foundational technology infrastructure must come first, especially in rural dead zones where traditional cell signals simply do not exist. Outfitting emergency vehicles with satellite connectivity, such as Starlink, turns isolated mountain switchbacks and remote valleys into connected lifelines. Once that basic connectivity is established, open interoperability platforms can stream critical prehospital data, from real-time vital sign telemetry and cardiac monitoring, to live mobile telehealth, directly into receiving hospital systems. By prioritizing RHTP investments in both vehicle-mounted satellite connectivity and seamless data integration, we empower local first responders with remote specialist support and give receiving ED teams actionable clinical intelligence long before the patient ever arrives through the door.
Our choice of zip code should not determine the outcome of a medical event. It should not — but too often it does. My sincere hope is that effective use of RHTP funds will change this reality for millions of rural residents.
ABOUT THE AUTHOR
Brian Fives brings over 30 years of experience to his role as the VP of Strategy & Growth at J2 Interactive, a healthcare IT consulting firm specializing in interoperability, integration engine modernization and custom application development. Outside of his day-to-day work, Fives is a volunteer firefighter for the Sugar Loaf Fire Department, serving his rural Boulder County, Colorado community.
