The Repository Survival Window

Unicoi County Hospital: How 70 People Got Off the Roof

November 4, 2026 · Runtime 11:30 · Watch on YouTube

On 27 September 2024 the Nolichucky River surrounded Unicoi County Hospital in Erwin, Tennessee, a one-story building whose only road was in the 100-year flood plain. Staff took 70 people, 11 of them patients, to the roof. We read the river gauge just downstream, fifteen minutes at a time, the weather service's warnings in the order they went out, and the hurricane center's final report.

Chapters

  1. 0:00 Seventy people on a roof
  2. 0:30 The only federal camera
  3. 1:06 A hospital beside the river
  4. 1:37 It barely rained in Erwin
  5. 1:56 30 inches upstream
  6. 2:47 9:45, the call to evacuate
  7. 3:20 The gauge that went silent
  8. 3:56 Ten feet above 1901
  9. 4:12 Why the boats couldn't
  10. 4:56 54, 70, or over ninety
  11. 5:34 The Black Hawks launch
  12. 6:22 How you empty a roof
  13. 7:42 4:40, everyone out
  14. 7:54 The warning that named Erwin
  15. 9:09 The dam that held
  16. 9:57 How they came down
  17. 11:11 Next: the Seafarer

Transcript

Seventy people on a roof 0:00

This is the Unicoi County Hospital flood, and how seventy people got off its roof. In September 2024, a river surrounded a small hospital in Tennessee. The road was gone, and boats could not get through. How did they come down?

We read the river gauge just downstream, fifteen minutes at a time, the weather service's warnings in the order they went out, and the hurricane center's final report. Here is what that record says.

The only federal camera 0:30

These are Tennessee National Guard Black Hawks lifting off near Knoxville on Friday, September 27th, 2024. The Guard's video says they were going to the hospital. It is the only federal camera we found from that mission. Everything else you see, we will say where it was filmed.

The hospital stood in Erwin, a mountain town in northeast Tennessee, a few miles from North Carolina. By our straight-line measurement, the Black Hawks' base is about ninety-one miles away, and Abingdon, Virginia, where two state police helicopters came from, about forty-six.

A hospital beside the river 1:06

Unicoi County Hospital was a one-story building beside the Nolichucky River, run by Ballad Health. This is the same river in Erwin two weeks later, at the town's wastewater plant, filmed by the Army Corps of Engineers.

Federal flood maps, KFF Health News reported, put the whole property in a flood plain. The building sat in the five-hundred-year zone: a one-in-five-hundred chance of flooding in any year. The only road on and off the property was in the hundred-year zone.

It barely rained in Erwin 1:37

And in Erwin itself, the rain had not been extreme. KFF reports about five inches over several days. By late morning on Friday, the weather service's bulletins said no additional rainfall was expected. These are Guard soldiers digging out Erwin's water plant in October.

30 inches upstream 1:56

The water came from somewhere else. Upstream, in the North Carolina mountains that the Nolichucky drains, the hurricane center's highest total in that state was thirty point seven eight inches, at Busick, in Yancey County. About six times what fell in Erwin.

Helene had come ashore in Florida's Big Bend the night before, as a category four hurricane, the hurricane center says. By Friday morning, its rain was running out of the mountains. This is western North Carolina from an Air Force helicopter, days later.

We read a river gauge up there, on the South Toe River near Celo. On Thursday evening it read about seven feet. On Friday morning it climbed nearly eleven feet in three hours, and peaked at twenty-six feet at 10:30. That water was on its way to Erwin.

9:45, the call to evacuate 2:47

At 9:14 that morning, the weather service warned of flash flooding in Unicoi County: Highway 19 was under water in several places. At about 9:30, Ballad says, the county told the hospital it needed to evacuate. Just before 9:45, KFF reports, staff began moving patients.

Less than thirty minutes later, the river jumped its banks, cut a new channel in front of the hospital, and took out the only road on or off the property. The ambulances could no longer leave.

The gauge that went silent 3:20

Here is our read of the river gauge at Embreeville, a few miles downstream of the hospital. At midnight it read seven feet. By nine in the morning, thirteen. At 11:30 it read nineteen and a half feet, still climbing. That is its last reading. The gauge was destroyed.

The last flow it recorded, at 11:15, was eighty-eight thousand two hundred cubic feet a second, provisional, and up almost nineteen thousand in an hour. The river's record at that spot, from 1901, is a hundred twenty thousand.

Ten feet above 1901 3:56

Afterward, survey teams flagged the high-water marks. The weather service now lists the crest at Embreeville at thirty-three point eight eight feet, nearly ten feet above the record of 1901. The record does not say what time it crested.

Why the boats couldn't 4:12

At the hospital, the state emergency agency called in swift-water teams. KFF reports the river was so violent, and so full of debris, that the boats could not safely carry patients away. This is Hampton, about seventeen miles away, after the same storm.

And the helicopters could not come yet. Dangerous wind, KFF reports, kept aircraft based east and west of Erwin from flying in that morning. This is a Guard crew from the same battalion, getting ready a few days later.

So the staff took everyone to the only place left above the water: the roof of a one-story building. KFF writes that the river stood twelve feet deep against the walls, on every side.

54, 70, or over ninety 4:56

How many people? That afternoon, the hospital system counted fifty-four on the roof and seven more in rescue boats. The hurricane center's final report says staff moved all seventy people to the roof, eleven of them patients. The Guard's video caption says over ninety. The count rose, and we keep all three.

The Tennessee Guard writes that at about noon Central time, one in the afternoon in Erwin, the state emergency agency was told that more than fifty staff and patients were trapped at the hospital. A state report timed 11:55 already called the hospital inundated.

The Black Hawks launch 5:34

Shortly after one o'clock Central, the Guard says, the weather cleared and the mission was approved. Three UH-60 Black Hawks from the 1st Battalion, 230th Aviation Regiment, lifted off from McGhee Tyson. This is that takeoff.

From the north came two Virginia State Police helicopters, requested through a mutual-aid compact between the states. A flight nurse aboard one of them, KFF reports, texted her husband at 1:41, just before takeoff: I do not feel good about this.

Just after two in the afternoon, according to Congresswoman Diana Harshbarger, quoted by Fox Weather, the helicopters began lifting people off the roof. Two state police aircraft from Virginia, and three Guard Black Hawks from Tennessee.

How you empty a roof 6:22

How do you take seventy people off a roof? Mostly not with a hoist. KFF reports most were carried aboard, or climbed in, while the helicopters touched down lightly on their skids. Some patients stranded in boats beside the hospital were hoisted up.

This is an Air Force rescue crew practicing a hoist over Tennessee on October 2nd, during the Helene response. A hoist lifts one person at a time. A helicopter resting on a roof can take several.

Four or five people at a time, KFF reports. The pilots flew round trips between the roof and the local high school, then back for the next group. This is a Guard Black Hawk at a landing field in East Tennessee, days later.

And no one knew how long the building would hold. One of the state police pilots, KFF reports, was told the hospital was weakening. They were not sure how much longer it would stand.

At 3:35, the Virginia State Police said twenty-three people had been rescued. The Guard says its part of the mission ended at 3:08 Central, 4:08 in Erwin. The Guard reports about sixty aerial rescues by its three Black Hawks that day, across the region, the hospital included.

4:40, everyone out 7:42

At 4:40, Ballad Health said, every patient and staff member was off the roof. The hurricane center writes that everyone was rescued by helicopter, and nobody was injured.

The warning that named Erwin 7:54

Now the warnings, in the order they went out. The first flash flood emergency touching Unicoi County came at 10:02, for Embreeville. Another, for the town of Unicoi, at 11:51. The one that named Erwin came at 4:45 in the afternoon.

That is five minutes after the last person left the roof. To be fair to the forecasters, Erwin was inside the 9:14 warning, and parts of the county were under flash flood emergencies from 10:02 on. But no bulletin we read names the hospital.

KFF found a disconnect: strong warnings from federal agencies for the region, and low expectations of flood risk among many people there, including Ballad Health's leaders. Two days earlier, the forecast office had warned of life-threatening flash flooding near the state line.

It was sunny, KFF notes, when the last people were taken off the roof. The water around them had fallen as rain on North Carolina, upriver.

Not everyone in Erwin got out. The hurricane center counts at least nine people drowned in the town. This is the Nolichucky's bank at Erwin's wastewater plant, two weeks later.

The dam that held 9:09

That night, the same water reached Nolichucky Dam, downstream. Its operator, the Tennessee Valley Authority, called a condition red, an imminent breach warning. The dam held. These are Guard engineers clearing a bridge downstream, in Cocke County.

The hospital never reopened. In January 2026, Ballad said engineers had found the building unfit for repair, and that demolition would begin in February. A new hospital is planned in the town of Unicoi.

Helene was the deadliest hurricane in the mainland United States since Katrina, the hurricane center says: at least two hundred fifty deaths, at least a hundred seventy-five of them direct. Fifteen direct deaths were in Tennessee.

How they came down 9:57

So, how did they come down? Not by the road, which the river took first. Not by boat, through a river full of debris. By helicopter, four or five at a time, once the wind allowed: two state police aircraft from Virginia and three Guard Black Hawks from Tennessee.

The clock in Erwin was not the rain. It was the river, carrying North Carolina's rain into a valley where little had fallen, past a gauge that went silent at 11:30, still rising.

What the record does not settle: what time the river crested, how many people each aircraft carried, and why the count rose from fifty-four to seventy. We found no published official review of the evacuation. Neither will we guess.

Off the Bounty, the clock was the sea. In Houston, the rising water. On the Alaska Ranger, the raft. Off Virginia, the last few feet to a basket. On Sanibel, the road. At Esther Island, fifty yards. At El Faro, the storm. On the Sea Ranger, the hull. In Erwin, a river from somewhere else.

Next: the Seafarer 11:11

Next: March 6th, 2013. The fishing boat Seafarer was lost under tow, fifteen miles off Assateague Island. One man reached a life raft, and the Coast Guard helicopter that lifted him filmed it. We read what that day's record says.

Description and sources

In Erwin it had rained about five inches; upstream, in the North Carolina mountains, the hurricane center recorded 30.78 at Busick. Less than 30 minutes after staff began moving patients, the river took the only road; boats could not cross the debris, and wind kept helicopters away. Our read of the USGS gauge at Embreeville: 19.56 ft at 11:30 a.m., still rising, then nothing -- the gauge was destroyed. From just after 2 p.m., two Virginia State Police helicopters and three Tennessee Guard Black Hawks took people off four or five at a time; all were out by 4:40 and nobody was injured. The flash flood emergency that named Erwin went out at 4:45.

PRIMARY SOURCES

Survival Window reads a rescue through the record it left: the crews' own cameras, the instruments nearby, and the reports listed above.

About the material. The only federal video we found of the hospital mission itself is the Tennessee Air National Guard's footage of the Black Hawks taking off from McGhee Tyson on 27 September 2024 (DVIDS 938230). The other footage is public-domain DVIDS video from other places and days, declared in the narration: Erwin's wastewater and water plants in October 2024 (940028, 940079), Hampton, Tennessee (939088, 940984), Tennessee Guard Black Hawk crews days later (942415), an Air Force rescue crew training over Tennessee on 2 October (939185), western North Carolina from an Air Force helicopter (940932), and Guard engineers in Cocke County (940578). The river readings and the distances are our own read of USGS public data. Every diagram is drawn in code from the sources listed. Nothing in this video is AI-generated imagery.

The appearance of U.S. Department of Defense visual information does not imply or constitute endorsement. This channel is independent and not affiliated with the U.S. military, the National Guard or Ballad Health.

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