I was fortunate to rotate at the Block Island Medical Center at the end of August through Labor Day weekend 2020. A vibrant time on the small island whose economy heavily relies on tourism, the clinic was the sole refuge for all medical care from primary care to emergency services. Day one I arrived to the clinic fresh off the ferry immediately jumping to cae for two altered carbon monoxide poisoned patients and from that moment on, for the next two weeks, I helped stabilize sick patients and facilitate immediate transfer off the island, to providing reassurance over simple urgent care concerns. The facility itself was staffed by a sole phenomenal physician, Dr. Mark Clark, and nurse, armed with iSTAT labs, bedside ultrasound, an EKG machine, and a self-manned X-Ray machine. It was a unique experience to work in a place where 24/7 you are the only medical provider care available for anywhere from 1,000 to 9,000 residents on the island with minimal resources at your fingertips to diagnose and treat. If someone came in with an ankle deformity after a moped accident I would receive them from the volunteer BLS-trained EMS providers, shoot the X-rays, perform a hematoma block, reduce and splint myself, at the same time using bedside ultrasound to diagnose flash pulmonary edema on another patient hypoxic to the mid 80s, placing him on BiPAP while calling LifeStar in order to quickly and safely transport this patient to the mainland for further care. My experience working on the island pushed me to use what limited resources I had and trust my clinical Gestalt in order to quickly and safely diagnose, treat, and transport patients, as well as exposed me to rural emergency care where you are not only have limited resources, but take care of a unique isolated, sick population where your management can be hindered by weather patterns and the community’s prioritization of supporting the tourism economy commonly triumphs over their own health. An absolute amazing experience involving rural emergency medicine, as well as an awesome time exploring the island and being welcomed in by the close community!
Alex Herndon, MD - PGY3
