Recent media coverage has focused attention on the Emergency Medical Services (EMS) division of the Honolulu Emergency Services Department (HESD). In particular, the focus has been on whether Oahu has enough ambulance units and if it’s wise to purchase backup equipment, such as a fuel truck. With this in mind, I wanted to provide a brief overview of how our 911 system operates, and the challenges faced by the skilled and dedicated people of our EMS division. Above all else, your safety is our primary concern.
EMS is funded by the state of Hawaii, and on Oahu, the state contracts annually with the City and County of Honolulu, specifying the number of ambulance units that will be funded, the number of vehicles that must be available, and the response times that must be met.
When you call 911 during a medical emergency, you are actually activating a systematic response. It begins with our highly trained EMS dispatchers who diagnose the medical emergency and then dispatch advanced life support through our EMS crews. In fact, we consider each ambulance unit an extension of a hospital emergency room.
In 1990, Oahu had a population of roughly 840,000 residents and about 5.1 million visitors arriving by air. Back then, there were 15 ambulance units serving Oahu. Today, 21 ambulance units serve roughly 1 million residents, and last year, nearly 6 million visitors came to Oahu. On Jan. 1, one additional ambulance unit began service in Oahu’s urban core, and we thank the state Legislature for this added resource.
In 2018, EMS responded to 95,935 calls — or an average of 263 calls every 24 hours, 11 calls per hour, or one call every five minutes. For each call, an EMS crew responds, evaluates, treats and transports a patient (if needed). Then, they clean the ambulance, restock and prepare for the next call.
However, 911 calls have been increasing dramatically, due in part to our changing demographics. We are an aging community, and from both private homes and care homes, calls for emergency assistance have been increasing.
Responding to these very high call levels with the same resources is taxing our dispatchers, crews and vehicles. Therefore, as we plan to meet the future needs of our island community, it is clear that we need to be as wise as possible in utilizing our scarce resources. We need to ensure that our ambulances are being sent to the people who need this level of service the most. Unfortunately, nearly 20 percent of the emergency calls received by EMS last year did not require advanced life support or transport to a hospital ER.
In order to ensure our resources are effectively allocated, the Honolulu Emergency Services Department has requested a full and objective review of the statewide EMS system, an effort last undertaken more than a quarter century ago in 1991. We are pleased the state Department of Health is in the process of organizing and conducting this worthwhile review.
Beyond the day-to-day 911 services, HESD is responsible for planning and maintaining our preparedness to ensure adequate medical resources in the event of a civil emergency, mass-casualty event or natural disaster. We need to keep ambulances fueled, where needed, and to have them readily available in various locations to meet the needs of our residents and visitors in the aftermath of a natural or manmade emergency. This is why HESD purchased a fuel truck in 2016 for $185,000. It’s a piece of equipment we hope we never have to use.
Again, your safety is always our primary concern.
Jim Howe is director of the Honolulu Emergency Services Department.
