• WAGNER, S.D. (AP) -- Fifty years in farming had given Tom Soukup a few brushes with his own mortality, but after a cow pinned him against a wall, death felt closer than ever. He lay on the muddy ground and began to pray, every gasp feeling like a stab to the chest.
• Although the nearest clinic was just a 10-minute drive from Soukup's South Dakota ranch, the doctor on duty did not have much experience treating such injuries. He had rarely inserted chest tubes and wanted guidance from another physician without having to consult a medical reference book.
• So the clinic in tiny Wagner connected by video to doctors in Sioux Falls, who talked him through the steps to stop the bleeding and drain the blood collecting inside the 72-year-old man back in March 2010.
• It's a system that's gaining wider use across the rural U.S., where there are often few primary care doctors and even fewer emergency rooms. Although so-called telemedicine has been around for at least two decades, the practice is fast becoming a standard feature in many small communities, even as other public services such as police and fire protection decline.
• Soukup watched the monitor on the wall as the "doctor in Sioux Falls was telling the doctor down here how to do that procedure."
• A growing number of South Dakota health care providers are being assisted by a

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