Limited EMS service increases crash danger in remote counties
By Dan Way
Carolina Journal News Service
Tuesday, May 22, 2018
ROBBINSVILLE — A two-wheeled cavalry roars into Graham County every year. The motorcyclists come to vanquish the world-famous Tail of the Dragon mountain pass, and drop some money along the way.
Locals say the secluded mountain county booms as a motorcycle mecca from spring to fall, doubling the normal population of about 8,500. Businesses in the economically distressed county eagerly cater to the tour groups and easy riders.
The N.C. Department of Transportation estimates 240,000 motorcyclists attack Tail of the Dragon annually. Graham County is base camp for many.
But throttles and thrill seekers do not mesh well with wild curves.
Motorcycle crashes rise with the seasonal influx of riders. That contributes to the N.C. Division of Motor Vehicles ranking Graham as the worst North Carolina county for crash rate severity, cost per crash, per person, per vehicle, and per 100 miles traveled, based on the latest three-year average available.
Access to emergency care in this remote part of the state is not always quickly available, which makes the ride that much more treacherous.
The medical plight of rural North Carolina has gotten the attention of lawmakers in Raleigh, and it’s a familiar topic in health-care committee meetings in which the rural/urban divide comes up in discussions of reform or government intervention. It’s the sole focus of the Committee on Access to Healthcare in Rural North Carolina.
But as the debate goes on, the dangers of the Dragon do little to slow riders, and the county is not about to dissuade them.
The Robbinsville Quality Inn has motorcycle parking stalls at the front entrance. Units at the Two Wheel Inn come with an attached motorcycle garage. Promotional signs and memorabilia can be found everywhere for Tail of the Dragon, from which Dragon’s Rest Cabins takes its name.
“Tourism is the only thing that’s keeping this county alive,” said Ron Johnson of Robbinsville. He is webmaster of TailoftheDragon.com, and operates retail and online stores hawking related merchandise.
“We’ve had people from just about every country imaginable that come here and ride,” Johnson said. “There’s no other road like it in the world. It’s 318 curves in 11 miles, and it’s all out in the woods. There’s no driveways, no intersecting roads. No two turns are alike. Some of the curves are actually banked like a race course.”
The winding mountain stretch of U.S. 129 begins in Swain County. Most of the asphalt attraction is in Tennessee.
“Most seem to agree that the Dragon is something to be experienced at least once,” said Oliver Dettman, president of the Michigan-based Ford Motorcycle Club, founded by a group of Ford Motor Company employees. “It’s a challenging road for most riders. His tour group has made several pilgrimages there.
Graham County’s emergency responders cover Swain County’s portion of Tail of the Dragon to the Tennessee line under a mutual aid agreement. They previously provided emergency services for four miles of the Dragon in Tennessee.
“Two years ago we responded to 127 motorcycle wrecks” at Tail of the Dragon, and on the Cherohala Skyway — a mile-high portion of N.C. 143 — said Larry Hembree, Graham County Emergency Services director. There were 71 in 2017.
Bevan Kirley, a research associate at the UNC Highway Safety Research Center, worked on a major study of Graham County’s unique motorcycle crash cluster published in September 2013. It used statistics from 2005-10, and from weeks of on-site data collection.
Graham County had a crash rate per registered motorcycle 17 times higher than the statewide average, and more than four times higher than Swain County, which had the state’s second highest rate. Highways N.C. 143, N.C. 28, and U.S. 129 in Graham County have higher traffic counts than other western North Carolina highways with equal risk factors.
“You expect more crashes … just because there’s more potential for people to crash” due to the high traffic, Kirley said. She said Cherohala Skyway is more dangerous than Tail of the Dragon, and the highest number of Graham County’s motorcycle wrecks occurs there.
Riders typically enter curves too fast and lose control. Riders from nearby states are about 55 percent more likely to crash than North Carolina riders. The likelihood rises to 91 percent for riders from more distant states.
“We get quite a few people. Their (normal) experience is riding down to Hooters on a Saturday night,” Johnson said. Greenhorns lack the skill to conquer Tail of the Dragon, resulting yearly in serious wrecks and a few fatalities.
“The bad part about it is that help is 35 to 40 minutes away. You can bleed out,” said Johnson, a retired firefighter from South Florida.
That is Hembree’s challenge in remote mountains cloaking a medically underserved county without a hospital.
“We’re all taught the golden hour: Try to get the patients treated within an hour’s time,” Hembree said. “There’s some places it takes us 25, 30, 35 minutes just to get to the patient after they call 911, and then have to come back to town to go to a hospital” — about 45 minutes away.
Motorcycle and car crashes account for many of the annual average of 87 medical helicopter evacuations to the University of Tennessee-Knoxville Medical Center or Mission Hospital in Asheville, the two closest trauma centers.
There are landing pads at the EMS headquarters, the Swain County-Graham County line, and below Fontana Dam near N.C. 28. Sometimes highways are sealed so choppers can land on bridges.
Erlanger Life Force has a helicopter in Andrews 10 air minutes away. UT-Knoxville has several helicopters based 15 minutes away. Mission Hospital’s helicopter in Franklin has a 12-minute flight time.
“We run just two ambulances, so if you have a car wreck with four or five patients, and if it’s cloudy where you can’t get a helicopter, you’re really pushed to the max,” Hembree said. Two volunteer rescue units with lower levels of training than Hembree’s paramedics provide backup service — if they’re available.
Heart attack and stroke patients are high priority for airlifts when a helicopter is available. If not, an ambulance could be out of service a half day or longer transporting patients to hospitals.
Mike Stevenson, just-retired CEO of Erlanger Murphy Medical Center, which treats many Graham County residents, said the hospital faces the same challenge.
Each ambulance crew transporting patients to Asheville, Atlanta, or Chattanooga is gone for more than half a day.
“That means there are fewer resources for 911 calls, and sometimes it gets too thin,” Stevenson said.
If medical helicopters are all in use, and ground transportation is needed, the lost time can make the difference between surviving a stroke or even recovering properly.
Murphy Medical Center is too small to have a specialist for every need. Stevenson said telemedicine could be part of the solution. Specialists hours away can communicate with local doctors by electronic tablets or mobile devices. He expects telemedicine to increase since the hospital was acquired by Erlanger in April.
Of the 1,800 calls the Graham County ambulances make every year, about 75 percent are sick calls, Hembree said.
Graham County Manager Rebecca Garland said officials hope to relieve that pressure. They are talking with Harris Regional Hospital in Sylva to develop a community paramedicine program, and seeking a grant from the Appalachian Regional Commission to make that happen. Harris already operates such a program.
A paramedic in a quick response vehicle routinely would check on the elderly and disabled, people recently released from a hospital, or with ongoing diabetes issues, for example. The paramedic would ensure patients are taking medication, are safe in their homes, and get doctor’s appointments if needed.
That would cost less than an ambulance trip, and avoid more expensive hospital care.
“We’re just having to think outside the box,” Garland said.
State Sen. Ralph Hise, R-Mitchell, said under the state’s Medicaid reform, statewide managed care organizations will be more responsible for reducing medical transportation costs.
Medically underserved counties are clustered in the eastern and western corners of the state. They use large passenger vans to transport people to medical appointments, Hise said. Medicaid managed care organizations should deploy more efficient passenger vehicles.
Graham County Transit Director Juanita Colvard said 29 percent of county residents are Medicaid eligible, and about 50 percent of trips are medical-related. Given the county’s sparse makeup, she said, a single passenger often travels a long distance.
In 2017 her agency ran 25,548 trips Monday through Saturday serving about 1,500 people and spent $487,602. The transit system is call-demand, with four minivans and five 11-passenger vans with wheelchair lifts.
“You’ve got to go out of county for every specialist, any kind of extensive testing,” Colvard said. “There’s no vision centers, there’s no hearing centers, there’s no kind of specialty heart rehab, heart specialists, cancer specialists.”
The agency doubles as public transit.
“There’s no taxis, no buses, no rails, no trains, no Ubers,” Colvard said. “Somebody called one time and said, ‘We need the nearest Uber,’ and we just started laughing.”