The main medical facility on St. John, the Myrah Keating Smith Clinic, was destroyed during Irma and remains closed. Services were consolidated and pressed into a second, much smaller clinic that received less damage. Consistent availability of emergency medical transportation to the nearest full-service hospital, Schneider Regional Medical Center in St. Thomas, remains severely limited for island residents and visitors alike.

Emergency care has been consistently noted as the most important medical service to residents of St. John and the one most in need of improvement. The emergency medical services on St. John are linked to St. Thomas because an ambulance is needed to transport patients from the boat to medical facilities once they arrive on St. Thomas. Several residents have reported extremely long wait times due to either the lack of or lack of ability to coordinate a transport ambulance on St. Thomas, often extending what could be a 30- to 40-minute trip into one that takes hours. This project aims to ensure that basic emergency care is available at key locations across the island at all times and to improve emergency care services as the Myrah Keating Clinic is rebuilt. It also seeks to improve emergency transportation/evacuation both inter-island and to the mainland.

IMPLEMENTATION STEPS: 1. Determine methods for community involvement in rebuilding of Myrah Keating Clinic. 2. Identify locations for small-scale emergency clinics in Coral Bay and other locations across the island 3. Work at the territorial level to determine feasibility of additional/ alternative options for emergency evacuation by boat/air. 4. Procure funding for smaller ambulances that are more appropriate for the terrain than the current fleet. 5. Convene a focus group to identify challenges and opportunities regarding emergency care in St. John. This effort may be informed by the work of a Johns Hopkins evaluation.

Key Players: Dept. of Health - Emergency Medical Services; St. John Rescue Alignment: IS, HHS RSFs Cost: > $1 Million Timeline: < One - Three Years