'The closest thing to healthcare for miles': Mountain EMS crews strain to keep pace as call volumes surge
Part one of WNCW's three-part series on rural healthcare access in western North Carolina
SPINDALE, N.C. — When something goes wrong in the mountains of western North Carolina, the first call most people make is 911 — and in many communities, the ambulance that answers is the closest thing to healthcare for miles.
That reality is the focus of part one of "More to the Story," a three-part WNCW series examining rural healthcare access across the region. The episode features Henderson County EMS Director Mike Barnett, Buncombe County EMS Division Manager Jamie Judd and Buncombe County Emergency Services Director Van Jones.
Demand is climbing in both counties. Henderson County EMS now runs about 17,000 calls a year, Barnett said — roughly 45 calls a day, with busy days reaching 60 — and the county is trending about 500 more calls each year.
Buncombe County's growth has been steeper. The county ran 28,664 ambulance calls in 2020, Judd said. Last year, it ran 49,539.
"We never came back down from that spike during COVID," Judd said. "It's continued to grow."
Both counties say the calls themselves are changing. Barnett said most are still medical — falls, heart attacks and strokes, driven in part by a large retirement population — but crews are responding to a growing number of calls involving mental health, homelessness and substance use.
Geography compounds the workload. Judd said visitors from the eastern part of the state often underestimate the terrain until they see that reaching a home 5 miles away can mean 10 miles up a dirt road. In winter weather, ambulances running tire chains cannot exceed 35 mph — a challenge the county has answered in part by adding four-wheel-drive ambulances to its fleet.
No event tested the system like Hurricane Helene. When the storm hit in September 2024, floodwaters severed roads and bridges across Buncombe County, cutting off entire communities.
"Especially on the east and north sides, there's areas we couldn't get into at all," Judd said, adding that crews spent days managing helicopters to drop supplies and bring victims out. At one point, roughly 50 mutual-aid ambulances from across the country were running calls in the county.
Jones said the danger did not end when the water receded — a phenomenon emergency planners call the disaster cascade.
"After you have an event like this, your environment's permanently changed," Jones said. "We have a higher risk now for additional landslides. We have additional risk for wildfires. We have a lot of rivers that were damaged and rerouted, so they don't have banks any longer — so you have increased flood risk."
The safety net is uneven across the region. Henderson County is unusual in having two hospitals within its borders, Barnett said.
"There are counties that don't have any hospitals, and they have to drive a long way," he said. "They could be an hour away from the closest hospital."
Looking ahead, Buncombe County is preparing to launch a mobile integrated health program — community paramedics managing chronic disease in patients' homes to reduce repeat emergency room visits.
"We're a healthcare service," Judd said. "And how do we provide that the best way — at the right time, the right place, with the right person."
Part one of "More to the Story: Rural Healthcare Access in Western North Carolina" airs Friday at 7:51 a.m. on WNCW, 88.7 FM, and streams at wncw.org. The full episode will be available on the station's website and wherever you get podcasts. Parts two and three, airing the following two Fridays, examine rural hospital finances and the region's healthcare workforce.
