My mother-in-law, Philomena, died doing something she loved. She was picking puakenikeni from the branches of the family tree to make lei for a church function when she stumbled on a tree root and fell. The family did not know what had happened to her initially because she was in the backyard and it took a few moments to find her.

When they found her in pain and semi-conscious lying on her side, they called for an ambulance. Although she lived five minutes from Castle Medical Center, the ambulance took more than a half-hour to arrive. The family called twice. Firefighters came and put her on a gurney, but because they are not certified as paramedics, they could only offer first aid and wait with her in the driveway for the ambulance to arrive.

When she at last made it to Castle, the family, in consultation with the doctors there, determined it was best that she be taken to Queen’s Medical Center for more specialized treatment. It never occurred to me that the ambulance transporting her would arrive well after we did. She slipped into a coma and died two days later at age 92 after a happy and full life.

Although the ambulance shortage might not have affected the outcome of Philomena’s life, I am sure it does affect many others — particularly the elderly, children, tourists and those with chronic medical conditions.

Honolulu, which has a population of 992,605 plus 5,461,880 visitors annually, has 20 ambulances (18 full-time, two part-time). Boston, which has a daily population of 1 million, has 50. Response time, which has a direct relationship to survival, for Priority 1 calls in Boston averages 6-8 minutes. The response time in Honolulu has been going down and can be 30 minutes or more. My neighbor in Kailua told me that to protect his young family, he now has no alternative in an emergency but to drive himself.

This crisis could be eased somewhat if Honolulu firefighters were cross-trained and paid to be paramedics and could provide medical aid while they wait with the patient. This is done in certain places in Hawaii and California.

In the 2018 state Legislature, $4.5 million was set aside for three ambulances: one each for Honolulu, Kauai and the Big Island. The Honolulu City Council appropriated $2.5 million for two more.

Unfortunately, the need in Honolulu is for 30 ambulances, not just three more. Legislative bills to pay for more and improve EMS services fail regularly. Not a single county or state official or candidate has come out in a meaningful way on this issue. This represents a certain mindset: The health and safety of Hawaii’s people is not a priority.

For this generation of Hawaii politicians, funding is easily found for rent-a-bikes and an expensive rail system — but little for ambulances, pothole repair or even for the soon-to-be-discontinued No. 70 bus route line, on which so many elderly and disabled in Philomena’s neighborhood depend.

This is very different from the days of leaders like the late Gov. John Burns (1962-1974), when the basic needs of ordinary people were considered to be a priority. And — at his insistence — never to be taken for granted.

Philomena, who was intensely interested in local politics, understood this. It’s too bad she never became a candidate, for she came from a generation of Democrats who felt real responsibility for the people they served. Had this issue been brought to her attention, you can bet she would have cared.

Michael Markrich is the owner of Kailua-based Markrich Research.