Devils Lake, North Dakota

Monday morning, and I’m dragging my suitcase, travel bag, file box, and cooler down the three stories of my apartment building and to my car. I’d spent half my Sunday preparing for this trip — mostly identifying, purchasing, and preparing groceries that would keep during travel. This was a necessary endeavor. I had no intention of leaving my room between check in and check out at the hotels I’d booked for the week. Last week when I was told by the providers I’d be interviewing to “please travel safe,” I knew that there was actual meaning behind those words.

At this point I would like to say that I am not purposefully being overly dramatic. I was and am extremely nervous traveling to the communities I’ve scheduled for the week. Although my most immediate concern isn’t the same one that’s keeping me locked down in my hotel room. It’s an unavoidable threat for me this week — oil traffic.

Rugby, North Dakota. The geographical center of North America.

To understand the rationale behind my concern, you probably need to know a little bit about North Dakota oil. North Dakota is second only to Texas in US oil production, pumping out over 1,000,000 barrels of oil per day. That many barrels of oil is the equivalent of 42,000,000 gallons, or if you like to think in terms of weight, roughly 302,400,000 pounds. Per day. Someone’s got to move all that oil, and while oil companies still use trains (71%)and pipeline (22%) to move the majority of their product, commercial vehicles (read: semis, tractor-trailers, big rigs) are commonly used to move oil from the field to the tracks. These trucks often are pulling “heavy,” or above weight limit, and are manned by exhausted drivers working more than 80 hours a week with little to no experience. This has led to a leap in traffic fatalities. The national fatality rate in 2012 involving “Large Truck and Bus” was 0.14. North Dakota’s was 0.44. The state with the next highest rate was Wyoming, at 0.28. I think I can stop belaboring this point.

When looking at the state accident rate & including all types of vehicles, an accident occurs in North Dakota every 27 minutes, and a traffic fatality occurs every 2.5 days — in a state of less than 800,000 people. Population growth and increase in commercial traffic aren’t the only factors contributing to a spike in traffic fatalities: North Dakota residents consume more alcohol per year than any other state, and North Dakota has the highest rate of binge drinking. You probably won’t be surprised to hear that North Dakota also has the highest rate of drunk driving, with an alcohol-related crash occurring every eight and a half hours.

Oil field outside of Plentywood, MT with active flare. Many fields “flare off” gas as a safety measure to prevent accumulation of gases.

This week I’m on the road to meet with providers at rural hospitals who subscribe to telemedical services from a provider located in South Dakota. Telemedicine may be the future of rural medicine. Without going too far into it, rural hospitals have major issues with recruitment and retention of providers. Not a lot of medical or nursing school graduates are willing to spend their careers in rural areas serving communities this size with their student debt load. They’d never make back what they owe. These hospitals see a low volume of cases, most of which are low acuity (non-emergent) and they have a difficult time stocking the medicines, purchasing the devices necessary, and keeping staff up on training for providing adequate medical response in low volume, high acuity (emergent) cases. Some good examples of a low volume, high acuity case is a trauma (most often resulting from a car accident), any cardiac event (e.g. chest pain, acute MI, STEMI, cardiac arrest), or neurological event (stroke).

Subscription to a telemedical service connects rural providers by dedicated line to a hub of emergency medical doctors and registered nurses in an urban setting. The hub providers operate within hospitals who see a high volume of high acuity cases, and can provide rural providers with guidance, a second opinion, or documentation, transfer, and pharmacological assistance. Another service that subscription provides is reducing pauses in patient care; doctors at the hub can initiate care and order labs in cases where patients present at the hospital when no provider is in house.

Yes. I just said that at many rural hospitals, and particularly at night, there is no doctor present in the emergency room. Maybe you’re thinking what I thought at first — How is that possible? How is it legal? Who is going to help people? Well, like I said before — rural hospitals have major issues with recruitment and retention of providers. Often rural hospitals employ one doctor, who is not present 24 hours a day. Some hospitals employ only locum providers and/or “travelers,” doctors who serve one community for a few days and then another the next set of days. Several of the states I work in have made concessions that allow hospitals to not have any medical doctor present for defined amounts of time. Depending on the state & hospital, a provider may not be physically present overnight, or for an entire day, or for up to three days. This only happens in extreme cases, in the smallest and most remote communities. So what happens if you have a heart attack or stroke at night, when most rural hospitals staff one or two nurses and a tech? What happens if you find yourself in a car accident in one of those communities that is without providers for days? Well, what happens is you hope they have telemedical services.

Thankfully for medical providers (not so much for oil workers) the fields in Northeastern Montana have slowed production. Multiple hospital administrators I spoke with today said that their trauma numbers have dropped by 25% or more in the last six months. They’re welcoming the reprieve, and I’m glad to hear that this leg of the trip might be a little safer travel-wise than it would’ve been this time last year. I know that pattern won’t hold for the rest of the week, as I travel to Culbertson, MT and then further south, back into North Dakota.

Storms coming in outside of Sidney, Montana

I’m writing this on Tuesday night, from my hotel room in Sidney, Montana. You may recall a story that made national news in 2012 about a math teacher who went missing after going for a jog, and whose body was discovered nearly three months later in Williston, ND. That woman’s name was Sherry Arnold, and she was abducted from Sidney, Montana by two oil field workers. Sherry’s story is one of the many reasons I’m locked up tight in my room tonight. As I stressed in my first post, being a woman in this part of the country is dangerous. This was illustrated to me earlier today outside of a gas station bathroom in Plentywood, MT when a man walked up to me and said “I just finished work for the day.”

Uh……. ?

But it’s late, so let’s leave something to write for Saturday’s post. In the meantime, please let me know what (if anything) you want to hear more about.

Good night.