By Devesh Sharma, MD

Working in a rural tertiary care hospital and being the only hand surgeon in an 80-mile radius is both challenging and interesting. After the enforcement of new state laws, prescription drug abuse has decreased significantly. But unfortunately, the use of methamphetamine has skyrocketed. So is the use of intravenous drug abuse with synthetic heroin and other illegal drugs. As a result, the number of patients with upper extremity infections has also increased significantly. Unfortunately, many of these patients go to the emergency room (ER), late in the evening or night. Many of these hospitals have general and/or orthopedic surgery coverage and while these surgeons happily treat elective hand surgery cases but for these hand infections, hand surgery consultation is always recommended. Some of these hospitals are even more than 100 miles away. Once these patients are accepted for transfer, then transportation may take many hours, as these are mostly not a limb or life-threatening emergencies. Transportation delays are also common with other emergencies including gunshot wounds, table saw injuries and coal mining injuries. It keeps me awake, waiting for the arrival of these transfers.