* Sequatchie County population - 14,521 (expected to grow to 15,652 by 2017)
* Ratio of primary care doctors to patients - 4,782 to 1
* State health ranking - 80 out of 95
* Uninsured residents - 18 percent
* Obesity rate - 35 percent
* Nearest ER to Dunlap - 22 miles
Sources: U.S. Census Bureau, 2014 County Health Rankings, and Erlanger Health System
Emergency-room services are finally going to be revived in Sequatchie County, Tenn.
A year after Erlanger Health System gained state approval to open a satellite emergency department in Dunlap, wheels are in motion to have the facility up and running by late summer.
The signs of progress after years of discussions are a relief to residents who say they have been anxious for emergency room services to return ever since the North Valley Medical Center ER was shuttered four years ago.
"This is so, so needed, and so overdue. It's been first and foremost on our agenda for several years now," said Sequatchie County Mayor Keith Cartwright, adding that he is the third county mayor to work on the project.
The new $1.8 million department - which will occupy the now vacant, county-owned North Valley building on the north end of town - is set for a July opening, said Joe Winick, Erlanger vice president of planning.
Last month, the Sequatchie County Commission passed a resolution to lease the building and financially partner with Erlanger to pave the way for the ER. The actual lease agreement will be signed sometime this week, Cartwright said.
It has been a long journey to reach that point.
The ER was operated by Grandview Medical Center from 1993 until August 2010, when it was downgraded to an urgent care center due to financial losses. But a large part of the building has been vacant for four years.
Kevin Wohl, a Realtor who moved with his wife to Dunlap from Florida in 2006, has been following potential developments with the North Valley center closely since it closed in 2010. He's spoken with many people who said they were interested in relocating to the area, but were hesitant because of the distance to medical care.
"There have been so many talks, meeting sand rumors ever since it closed," he said. "Too many potential residents had turned away from this wonderful spot because [the ER] was not open."
Erlanger and the county have been in talks since the original ER closed, Cartwright said, and the hospital announced last year that the project had been approved by the state. But coordinating approval from other regulatory agencies has been the main delay in the last year, Erlanger officials say.
Sequatchie has struggled with some of the lowest health rankings in Tennessee. Its premature death rate is double the average U.S. rate., about 35 percent of residents are obese and the ratio of primary care doctors to patients is 1 to 4,782.
"If people have limited access to care, that limits people from getting appropriate care," said Dr. Phillip Burns, a Chattanooga surgeon who has lived in the Sequatchie Valley since he was a child and has advocated for Erlanger to expand its facilities there.
"Oftentimes the ability to get treatment isn't about whether patients can or can't pay, whether they do or do or not have coverage. It is about proximity," Burns said.
Since Erlanger announced it would reopen the ER, he has heard from patients, friends and relatives that "they will feel a lot more secure."
Winick said the hospital aims to improve the county's health outcomes with a variety of tactics. He hopes to bring health coaches to the facility, and said the hospital has held Affordable Care Act enrollment events to get more people signed up for insurance.
"The goal is to make health care more accessible for that community and improve their health status," he said.
Erlanger projects by 2017, it will treat 13,075 patients annually at the facility.
The agreement with the county stipulates that the county will lease the 10,000-square-foot building to Erlanger for $1 a year.
The county is putting up $500,000 from an Appalachian Regional Commission grant and other grant money to help pay for medical equipment. The hospital will cover the remaining costs.
The commission also voted to hand over its county ambulance services to Erlanger, which is contracting with Puckett EMS.
That decision has been the most controversial part of the agreement, the mayor said, but that contract stipulates that county EMTs will be hired by Puckett as long as they pass a drug test.
The ER itself will employ about 20 people, Winick said.
Whenever the facility opens, it will be the latest of a series of recent moves by Chattanooga hospitals to expand into nearby rural counties.
Erlanger opened its Erlanger Bledsoe campus in Pikeville, Tenn., three year ago, and Parkridge Health System bought Grandview Medical Center in Jasper, Tenn., earlier this year.
Any improvement to medical services bodes well for attracting more residents and businesses to the area, Wohl said. In the meantime, he says, the ER gives him peace of mind.
"I know that my wife and I and all of the residents of Dunlap can breathe a sigh of relief knowing that we will have access to this all-important emergency medical care," he said.
Contact staff writer Kate Harrison at firstname.lastname@example.org or 423-757-6673.