DUNLAP, TN (WRCB) - Sequatchie County is near the bottom of a recent study ranking the healthiness of Tennessee counties. It comes in 91st out of 95.

The county has been without an emergency room for nearly three years. That means critical care is a 25 to 45 minute ambulance ride, but county officials say that's on track to change.

They recently got past their biggest certification hurdle. They have the money and a facility on standby and say there's only one more step left.  

Sequatchie County secured an "Appalachian Regional Commission" grant to help pay for a new emergency room, and Erlanger agreed to open it after the state signed off on a "certificate of need." Well, they just received it. Now they say the last step is getting authorization from the Centers for Medicare and Medicaid Services, which they should find out about any day now.

The one-time emergency room now sits abandoned in Dunlap's North Valley Medical Center as local leaders work to bring it back to life.

"The need has been there for so long, well, since the other one left," Dunlap Mayor Dwain Land says.

Grandview Medical Center closed its emergency room there in 2010, citing financial reasons. Since then, Sequatchie County has been forced to go without.

"Each and every day we have somebody local to need critical care," Sequatchie County Executive Keith Cartwright says.

Every time that happens, the ambulance has to make about a 25 minute drive to Grandview in Marion County, over to Erlanger Bledsoe County, or the 45 minute drive to Erlanger Chattanooga.

"Your estimated time of getting anywhere in the county to the emergency room is around ten minutes, so it cuts it down dramatically which also increases the patients' well being," Sequatchie County Ambulance Director Marty Gipson said.

He says those extra minutes can be critical in saving lives.

"The main focus would be having a main emergency room here that could handle emergency situations to get them stable, and then transfer them over the mountain," Gipson says.

That's along with saving money they've been stretching to cover ambulance upkeep. Their newest, a 2011, has already racked up around 120,000 miles.

Erlanger estimates Sequatchie County residents could generate 15,000 medical visits per year at its new ER. It'll cost $1.8 million. Sequatchie County will contribute its $500,000 grant.

"Some re-tooling, remodeling. It's in pretty good shape at this point," Cartwright says.

They plan to hire 33 employees ranging from maintenance to doctors, nurses and technicians. They say it will be an economic boost across the board.

"To have a 24-hour critical care in recruitment of other industries here, we have to have that. It's vital. We're excited," Cartwright says.

Erlanger-Bledsoe will continue emergency care to the surrounding area and assist Dunlap's ER if needed.

Executive Cartwright says their tentative goal is to open September 1. Again, they expect Medicare and Medicaid to issue final authorization soon.