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Published on December 10, 2018

Nelvin and Linda VanRuler with Daniel Florey, MD

Rural Hospital, Backed by Avera eCARE, Saves a Life in Tyler

Nelvin VanRuler chalked it up to the heat and humidity. After all, and he’d been hauling gravel all week – and feeling clammy and sick.

His actual condition was much more serious. But thanks to the emergency staff at Avera Tyler Hospital, Nelvin is doing a lot better especially considering an electrolyte deficiency stopped his heart.

“He called me as I was coming home from work to say he wanted to go to the doctor once I got there,” said Nelvin’s wife, Linda. “When I got home, I found him on the bed. I told him we had to get him up and dressed, and I helped him sit up, but once I did, he just plopped back down.”

Nelvin’s kidneys were failing, and because they couldn’t process the potassium in his body, it built up. As Linda called 911 to get help, Nelvin was breathing heavily. As the emergency responders rushed to their Lake Benton, Minn. home, Linda went outside to make sure they found the house. The EMTs came in and began to help him.

“When I went back in they said he was unresponsive,” Linda said. “They put him on the floor and started CPR, and then got him ready for the ambulance.”

Help Nearby

Avera Tyler Hospital was not far away, and throughout Nelvin’s journey there, the first-response team used a LUCAS Chest Compression System to maintain his circulation.

Daniel Florey, MD, was the physician on duty that night. He oversaw the treatment, but had welcome support. Avera Tyler, like many emergency departments across the U.S., incorporates Avera eCARE® Emergency. Florey was able to address the things he could in person while Katie DeJong, DO, Avera emergency specialist, provided consult via eCARE interactive video.

“When Nelvin arrived, he had no heartbeat. Before he got to us, we had already reached out to Dr. DeJong and her team,” said Florey, who is a family medicine physician at Avera Tyler Hospital. “Having their help was really the difference-maker in this case.”

After an hour’s work with Nelvin, Florey went to talk to Linda to discuss discontinuing resuscitation efforts.

Yet when he returned to the room, he heard a nurse say, “We have a pulse.” He headed back to Linda to share this amazing news, reversing what he’d said just moments before.

“It was amazing – I went from scared, but then to overjoyed with this news,” Linda said.

Florey said that he felt DeJong and her team saved Nelvin’s life.

“Dr. DeJong was able to determine the potassium level was causing the problem, and when we were able to get it down, we got his heart beating again,” he said. “Then we could work on transferring him to another facility.”

Weather Changes Destination

Thunderstorms in Sioux Falls meant Nelvin was bound for Minneapolis by helicopter. In this case, Avera eCARE again was able to assist the team in Tyler, making the connections needed so everything went smoothly. “It was nothing short of a miracle and I thanked Dr. Florey for all he did. He gave me a hug,” Linda said. “You could see how they really cared about us.”

Nelvin spent 27 days receiving care in Minneapolis, but he and Linda knew exactly where they wanted to get the rest of their care once they were finished with treatment in the big city: back home in Tyler.

“I’m so thankful to all of the doctors and nurses who helped me that night, and I am glad we could come back here to get the rest of my care,” Nelvin said. “We came home because we know we’re in good hands here.”

Sarah Griesse, BSN, RN, is the director of Patient Care Services at Avera Tyler Hospital and Clinic. She said the scenario with Nelvin shows the across-the-board quality of rural health care in the region.

"From the first responders and EMTs to the nursing staff both on and off duty who responded, as well as our providers, I want our community to know they are in good hands," she said. "Critical access hospitals rarely hear how their patients turn out, let alone have them return to complete their care. This was critical situation that was managed with high quality and profound execution. We are honored to continue to help Nelvin on his journey to complete recovery."

Linda and Nelvin realize their journey is not finished. While in the hospital in Minneapolis, a CT scan revealed a spot on Nelvin’s lung. Linda said Nelvin’s stubborn nature – he’s a fighter, she said – made a big difference. His doctor agreed.

“Nelvin’s persistence was critical to his survival, and as a critical access hospital, this is why we exist,” Florey said. “The next-closest hospital is another 20 minutes away. That may have been a life and death difference in his situation.”

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