This summer, 5 million tourists will descend on 200 miles of remote North Carolina coastline. The Outer Banks are idyllic — and popular. But for both those visitors and the area’s 38,000 year-round residents, the vacation paradise has one serious problem: health care access.
Dare County Emergency Management Services evacuates about one person a day by helicopter. In the summer, that number can reach four or five.
Outer Banks Health Hospital in Nags Head, with its 21 beds, is the region’s lone hospital, and its capabilities and equipment are limited. The hospital evacuates another 15 to 30 people per month.
On the island of Ocracoke in nearby Hyde County, for example, a ride in a helicopter or ferry is required to reach any kind of specialty, intensive or emergency care. Travel time to the mainland in a ferry can reach three hours, and that’s if weather permits.
Some parts of the Outer Banks are more well-connected, but even there, travel times, and staffing shortages keep people from getting the care they need.
In an emergency, these limitations can result in life-threatening crises. It can take up to six hours for EMS services to respond to a call.
“We’re a rural area that deals with nonrural problems because of the amount of visitors we have,” Dare County EMS chief Jennie Collins told Carolina Public Press. “The population swells from 38,000 to 300,000 in the summer. Everyone that’s coming on vacation brings their problems with them.”
Tropical weather systems and storm surges create a further threat. The region’s singular artery, Highway 12, can flood, leaving residents completely cut off. Traveling over bridges in high winds poses its own dangers. And for a number of populated islands like Ocracoke, no road connects them to the rest of the world.
In the event of a storm surge, Hatteras residents rely on emergency ferries to transport them to beaches farther north, Roanoke Island or to the mainland.
The last time that happened was nearly 10 years ago, noted Sheila Davies, director of Dare County Health Department. But Atlantic hurricanes are getting more and more severe, due in part to warming ocean temperatures.
The area is popular with retirees, many of whom have cardiovascular diseases, lung cancer or other conditions that can cause moments of acute emergency.
Medical calls from people over 50 are the most common form of emergency calls to Dare County EMS, said Collins.
“A lot of times, someone’s doctor back home will say, ‘you need to go on vacation and rest and relax,’” Collins said. “So those people will come to the Outer Banks. And then they want to go for a walk on the beach. Well, that’s very much like a stress test.” And if it doesn’t go well, help is rarely at hand.
Qualified medical professionals don’t tend to move to the Outer Banks. The seasonal economy makes year-round practice financially difficult. The geographic isolation stunts career growth. Housing costs have skyrocketed due to vacation rentals, making it nearly impossible for physicians and nurses to afford living where they would practice.
For locals, this means that treating chronic conditions like diabetes and hypertension is rife with challenges. Dentists as well are few and far between.
The Outer Banks is defined in different ways, but the heart of the island system spans four counties: Currituck, Dare, Hyde and Carteret. Additional island communities farther south along the coast are less isolated. The health department of each plays a key role for folks living on or visiting the Outer Banks. They coordinate emergency responses, collect data on what services are most urgently needed and treat the uninsured.
But under the administration of President Donald Trump, $230 million in health funding for North Carolina is gone. One of the programs most dramatically gutted dealt with behavioral health for vulnerable populations. That funding cut is felt sorely on the local level.
“Services to Ocracoke are limited, mainly based on manpower and geography,” Gibbs said. “In fact, these services to the mainland are limited now based on manpower and funding.”
And what’s more, Outer Banks locals are plagued with rising instances of mental health problems and substance abuse.
“There is a certain amount of anxiety here all the time,” said Kathy Cooper, of the Outer Banks chapter of the National Alliance on Mental Illness. “Lives depend on how the tourist season goes. The rest of the year depends on May through September. Can they earn enough money this summer to get us through the winter?”
For the region’s youth, the situation can be dire.
“For kids growing up here, the only thing they want to do is get the hell off this rock,” Cooper continued. “There’s nothing here for youth. If you don’t surf or fish, you have a problem. And that problem usually ends up being substance abuse.”
On Ocracoke, alcoholism and substance abuse are of grave concern to the locals, Hyde County health director Luana Gibbs told CPP.
The hospital in Nags Head, Outer Banks Health, has no mental health beds. If someone is sent to the hospital under involuntary commitment, they have to find an open bed elsewhere in the state. And that could be as far as Asheville.
This gloom and anxiety factor disproportionately affects those working to keep the tourism economy afloat, and those service industry jobs don’t typically offer health insurance.
“We are seeing a growing number of mental health issues related to working in tourist related jobs such as restaurant and hospitality jobs,” said Linda Leiser, an administrator at Dare Community Clinic. “The American health care system is broken and puts the uninsured and underinsured at greater risk.”
A dearth of psychiatrists and licensed counselors at the clinic leaves some with a six-month wait to get an appointment.
Six months is a long time to wait for a suffering person on an isolated barrier island.
