Editor’s note: This article explores health care access in the Outer Banks, originally published on May 19, just before summer vacation season.
Every summer, 5 million tourists flock to the Outer Banks of North Carolina. This beautiful stretch of coastline is a favorite getaway, but there’s a pressing issue: health care access for both the 38,000 permanent residents and countless visitors.
Dare County Emergency Management Services evacuates about one person daily by helicopter, a number that spikes to four or five during the tourist season. The only hospital in the area, Outer Banks Health in Nags Head, has just 21 beds and struggles with limited resources. Monthly evacuations from this hospital can range from 15 to 30 patients.
On the remote island of Ocracoke, getting any kind of specialized care requires a helicopter or a ferry ride that can take up to three hours, depending on the weather. Even where services are better, travel times and staffing shortages make timely care difficult.
In emergencies, these challenges can lead to serious health risks. Emergency Medical Services may take up to six hours to respond to a call, which could be life-threatening.
“We’re a rural area experiencing urban challenges due to the influx of tourists,” says Jennie Collins, the chief of Dare County EMS. “Every visitor brings their own health issues with them.”
Natural disasters compound these problems. Highway 12, the area’s main road, often floods, isolating residents. High winds make ferry travel risky, especially for islands like Ocracoke, which have no road connection to the mainland. In severe storm conditions, residents rely on emergency ferries for evacuation.
Sheila Davies, director of the Dare County Health Department, notes that hurricanes are becoming more intense, a trend linked to climate change and rising ocean temperatures. This is especially concerning for retirees living in the area, many of whom have serious health issues, like cardiovascular diseases.
Interestingly, most medical emergencies involve older residents. “Doctors sometimes recommend vacations to de-stress, but walking on the beach can be a strain,” says Collins. In situations like these, help isn’t always nearby.
Attracting qualified healthcare workers has proven difficult. The area’s seasonal economy makes it hard for professionals to establish year-round practices. Rising housing costs, driven by vacation rentals, leave many unable to afford to live where they work.
For locals, managing chronic conditions like diabetes is a significant challenge. Access to specialists, including dentists, is limited. The Outer Banks covers four counties — Currituck, Dare, Hyde, and Carteret — each with health departments coordinating emergency services and addressing uninsured residents’ needs. However, funding cuts during the Trump administration have severely impacted health services across North Carolina, affecting vulnerable groups like those in the Outer Banks.
“Services on Ocracoke are limited due to staffing and funding,” says Luana Gibbs, Hyde County health director. Mental health issues and substance abuse have risen sharply in the area. Kathy Cooper from the National Alliance on Mental Illness reveals, “Many locals feel anxious about the economy tied to tourism. If the season doesn’t go well, it affects life in the off-season.”
Younger residents often feel trapped. “Most kids just want to leave,” Cooper adds. “With limited activities, substance abuse becomes a common escape.” Issues like alcoholism are particularly severe on Ocracoke, as stated by Gibbs. The local hospital lacks mental health beds, and patients needing involuntary commitment frequently have to be sent hours away to find care.
Service industry jobs, which are abundant in the tourism-heavy economy, often come without health benefits. Linda Leiser from Dare Community Clinic points out the link between job stress in the tourism sector and declining mental health. Many wait months for appointments with scarce therapists, which is a long time for someone in distress.
The Outer Banks showcases stunning beauty but faces significant challenges in health care access. As tourism continues to thrive, ensuring the health and safety of both locals and visitors is an urgent need that requires ongoing attention and support.
