Another day, another helicopter rescue of a hiker from the Diamond Head Summit Trail on Oahu.

It’s a routine operation for the Honolulu Fire Department, which generally sends up to 17 first responders to rescue sick or injured hikers atop Diamond Head. It’s the same with the Koko Crater Stairs and Lanikai Pillbox hikes.

Most often, HFD will conduct a medical assessment, then airlift the hikers to a nearby landing zone and transfer care to paramedics.

While many might think forbidden hikes or more advanced ones along high, narrow ridges and rough terrain may be the top rescue sites, this popular tourist attraction — the Diamond Head Summit trail near Waikiki — still takes that top spot.

From January to April, Diamond Head required the most hike-related rescues, followed by Lulumahu Falls, Koko Crater Stairs and Lanikai Pillbox, according to the latest HFD statistics available.

These hikes also topped the list in 2023 and 2022, according to HFD. Diamond Head has been consistently in the top for years, including in 2018 and 2019, when as many as a million visitors visited the park annually.

So why are there so many rescues at Diamond Head?

It’s a numbers game, according to Curt Cottrell, who oversees state parks.

The hike has a high volume of daily hikers who are mostly out-of-state visitors who might not be prepared, fit or adapted to Honolulu’s hot and humid climate.

The historic, 0.8-mile hike from trailhead to summit is well established, but requires a climb with an elevation gain of 560 feet on a paved pathway, a tunnel crossing and up several sets of stairs.

Cottrell said Diamond Head is the “safest trail on Earth,” and not technically difficult when compared with ones like the Kalalau Trail along Kauai’s Na Pali Coast.

But hikers who go up along the hot, dry slopes oftentimes find it’s not as easy as they thought, he said. On a day with Kona winds, they could easily get overheated or dehydrated due to the heat and sun.

Twisted ankles and sprains also occur, sometimes due to improper footwear.

“It’s all about lack of conditioning of the patrons, temperature, footwear and water,” said Cottrell, state Division of Parks administrator. “It’s not being prepared, fit or being able to handle heat.”

The new reservation system has reduced the number of hike rescues from Diamond Head due to reduced volume, according to Cottrell, though he did not know by how much.

Before reservations were required among nonresidents in 2022, as many as 6,000 people a day packed the trail, with a huge line for a turn on the stairway to the top for a panoramic view. Now the maximum is at about 3,000 per day, which in turn has reduced the number of hike rescues.

Still, the rescues at Diamond Head continue.

Earlier this month there were four rescues of ill hikers within the same week.

One was a 67-year-old man who suffered a possible fainting episode, and the other an 83-year-old man with a pre­existing injury. The next day, two women in their 20s, each of whom fell ill, needed helicopter rescue from the trail just two hours apart.

Medical-type calls

Dr. Jim Ireland, director of the Honolulu Emergency Services Department, said he evaluates trails by call frequency and severity of resulting injuries.

“When it’s just volume, it’s clearly Diamond Head and Koko (Crater),” he said. “The majority of calls at those two sites are what I call medical in nature — chest pains, asthma, dehydration, heat exhaustion, shortness of breath. So it’s people who probably either weren’t in a good enough condition to do the hike to begin with or didn’t prepare themselves properly.”

This could come from not taking enough water or not dressing in cool clothing — or having been out drinking all night before the hike. Occasionally, people trip or injure an ankle or knee.

But Diamond Head and Koko Crater, which the city refers to as Koko Head Tramway, have low mortality, meaning low occurrences of death.

Olomana, by contrast, is a trail with higher lethality, particularly the third peak, with fatal falls in the past that prompted the posting of warning signs at the trailhead.

State Parks published an online safety video on Diamond Head earlier this year, noting people can often exceed their limitations.

There is little shade on the trail, which makes it more strenuous, according to HFD Capt. and spokesperson Jaimie Song. She recommends not going during the middle of the day — the hottest time of day — and making sure to bring plenty of water and a fully charged cellphone.

At Lanikai Pillbox there is a steep climb over a short distance on badly eroded terrain, with high sun exposure.

Lena Haapala, president of the Kokonut Koalition, says most rescues from Koko Crater are for out-of-state visitors unprepared for the heat and climb up more than 1,000 steps.

“(People) still underestimate the number of steps,” she said, “how far you go up, and how much of a workout it actually is.”

Her advice is to hike the stairs during cooler parts of the day, early in the morning or toward sunset, especially during summer, and to bring plenty of water for hydration.

Also, high heels are not ideal for climbing up Koko Crater Stairs.

“Not high heels, not kitten heels,” said Haapala. “A lot of people will just wear their regular tennis shoes, and you need something with more grip — we use trail runners or hiking shoes.”

For any hike, she recommends wearing proper shoes, sunscreen and letting someone know where you are going.

Lulumahu Falls

The Lulumahu Falls trail, meanwhile, is emerging as a top hike rescue spot, and even surpassed Diamond Head as the top rescue spot in 2023.

The Nuuanu-area trail is in the Honolulu forest reserve and actually requires a day-use permit because it’s in a restricted watershed. But many hikers are hiking it without the permit daily.

Unlike Diamond Head, Koko Crater and Lanikai Pillbox, which are exposed climbs, it traverses a forest, involves stream crossings and has multiple splits and routes.

Hike rescues at Lulumahu generally involve a combination of slips and falls, and oftentimes, hikers who are lost.

Ireland said the volume of EMS calls for Lulumahu have picked up and are a mix of medical calls as well as serious injuries.

Aaron Lowe, Oahu trails and access specialist for the Department of Land and Natural Resources, said it has been challenging for the state to enforce compliance with the permit system.

Due to social media posts, Lulumahu, which used to be lesser-known and has an impromptu dirt parking area, has grown quickly in popularity among visitors.

Eventually, Lowe said, DLNR will explore the use of of reservation systems on high-volume hikes like Lulumahu Falls and Lanikai Pillbox to limit the number of people on them per day.

What can be done?

Cottrell says State Parks has explored the possibility of a ranking system for hiking trails similar to ski slopes to help inform visitors.

But that has proved difficult. Diamond Head is the perfect example, as some people would consider it easy while others might find it rather strenuous. The variables include the weather, pace and fitness level.

“There is no universal performance metric you can impose on any single trail that would determine if it’s advanced, intermediate or beginner,” he said.

Since reservations and payment from nonresidents are required for Diamond Head, there is a single entry point where hikers can be informed not only of the trail’s history, but of safety tips.

He was exploring whether the safety video could be played at the visitor center or perhaps be shared when people make online reservations.

There are informative signs and access to water at the entrance — including a free water bottle refill station and water sold at the visitor center.

But that doesn’t necessarily mean people read the signs or take water on the trail, he said.

The Hawaiian Trail and Mountain Corp., Oahu’s oldest hiking club, does not organize hikes to Diamond Head, opting for lesser- known trails instead, according to lifetime member Ralph Valentino.

As to why so many need rescue on the relatively easy trail, Valentino says perhaps there needs to be clearer messaging of the 560-foot elevation gain over a short distance.

Signs, for instance, should convey that going up Diamond Head is equivalent to climbing 60 or so stories up the Empire State Building in a short time.

“If you don’t exercise, if you don’t get out often, that’s a lot of elevation in one afternoon,” he said. “Your heart is not ready to push your weight, especially if you’re overweight, to deal with that.”

Hotel rooms could repeatedly play PSAs on hike safety, he suggested, or have a mascot like Smokey the Bear talk about basic hike safety guidelines and share it on social media.

And it’s always OK to turn around, he said, if a hike turns out to be too steep or it’s too late in the day to finish.

“We should remind people they can turn around, stay on the same trail, get back down,” he said, “and think about it for another day.”

Oahu’s top hike rescue sites

Jan. 1 to April 30*

>> Diamond Head (11)

>> Lulumahu Falls (9)

>> Koko Crater Stairs (8)

>> Lanikai Pillbox (5)

2023

>> Lulumahu Falls

>> Diamond Head

>> Lanikai Pillbox

2022

>> Diamond Head

>> Lanikai Pillbox

>> Koko Crater Stairs

* More rescues have since occurred at all four hikes.

Source: HFD

Hiking safety

>> Bring enough water for the length of the trail, time of year, weather. HTMC recommends 2-3 liters for a day hike.

>> Check weather conditions before you go.

>> Know your own capabilities and limitations.

>> Hike informed. Research the trail before you go.

>> Wear sturdy footwear, appropriate clothing for sun, rain, insects.

>> Establish a hike plan and share it with two people, including your planned route, estimated start and return time, and emergency contacts.

>> Stay on the trail; set a turnaround time, and allow yourself enough time to get back.

>> Bring a fully charged cellphone for emergencies, with location access turned on. Backup battery charger recommended.

>> HTMC does not encourage solo hiking.

>> Visit htmc1910.org/hiking-safety for more tips.

Source: Hawaiian Trail and Mountain Corp.