Increasingly, emergency medical services are becoming conventional help calls. The population of homeless people has grown, especially on Oahu, with reliance on ambulances and emergency rooms for medical treatment.
Further, as the baby boomer generation ages, the number of seniors seeking prompt medical attention, whether or not the “emergency” characteristic is merited, will increase before it starts to abate.
This is an issue requiring an EMS boost in the near term, as well as a longer-term pursuit of ways to reduce the public reliance on the most expensive forms of medical intervention.
That’s why lawmakers should act during the current session to fill a request to fund an increase in EMS capacity, three new units to provide more 24/7 ambulance service. It’s a proposal that was put off last year.
As Dr. Libby Char rightly underscored during a legislative briefing last week, “That need doesn’t go away just because it wasn’t approved last year.”
Char was speaking before a joint hearing of the Senate Commerce, Consumer Protection and Health and the House Health and Human Services committees. She chairs the state EMS Advisory Committee, established by law to advise the state Department of Health and which has been seeking new ambulance units on Hawaii island and Kauai since the 2016 session.
A separate request for Oahu expansion was made on the basis of the growing need on this island.
The total for the three units would be about $5 million each year. That is a justified investment, with the realization that lives are truly at stake.
There’s quite a bit of data that support the two budget bills sitting in the hopper for the expansions. The most persuasive argument: The status quo is overwhelming EMS crews, said Honolulu Emergency Services Director Jim Howe, who added that response times have grown longer as the call volume increased.
State records show EMS responses rising by about 3 percent a year since 2012,with the growth in the rate for elderly patients growing even faster.
Also accelerating are the reports from homeless patients. These calls represented 8.5 percent of the 2016 total, whereas the calls from the homeless in 2012 was a 6.2 percent share of the total — most making multiple EMS calls.
Finding less costly protocols for treating these groups is crucial. Prevention remains paramount as the route to more cost-effective health care, but it can’t quickly displace the need for acute treatment. Fortunately, there are already more-efficient models worth replicating, and policy changes proposed that would help encourage their use.
At the John A. Burns School of Medicine, one form of outreach launched a decade ago — the private nonprofit Hawaii H.O.M.E (Homeless Outreach and Medical Education) Project — has shown success. Enlisting the work of supervising physicians as well as students, its service sites are linked by a mobile clinic. That is a proven means of meeting the needs of homeless populations, many of them including the elderly.
Additionally, a private-sector organization is moving on a plan to convert a four-story building in Iwilei to a complex that will include an urgent-care center, shelter and other services for the homeless. It also would provide a place for treating the most critical patients for up to a month.
These developments are encouraging, but they need support by lawmakers to enable emergency-
treatment reimbursement for facilities that fall short of a hospital emergency room. EMS efforts to get that change in the law deserve full consideration.
These strategies, and others that make sense, must be vigorously pursued in the years ahead. But more immediately, emergency-care advocates have made a strong case for adding to Hawaii’s ambulance corps, and the measures — House Bills 313 and 1313 — should be part of the budget.
