Less than a year after Honolulu Emergency Medical Services (EMS) became the sole concern of the city Emergency Services Department (HESD) following an Ocean Safety and Lifeguard Services Division spin-off, the ambulance service is facing scrutiny on reports of protracted response times due to long-standing staffing issues.

City Council member Val Okimoto, who recently witnessed an inordinate wait time during a family emergency, last month introduced Resolution 272 to establish a task force to investigate the practicality of folding EMS into the Honolulu Fire Department. With an eye on public safety, the group would in part determine whether a consolidation of administration and resources can alleviate growing pressures on both departments. If formed, the task force is urged to include representatives from HESD, HFD, Department of Human Resources, Department of Budget and Fiscal Services, Hawaii Fire Fighters Association, United Public Workers Hawaii and Hawaii Government Employees Association.

In 2023, Oahu 911 dispatchers fielded 106,510 medical-related calls triggering 89,539 EMS responses and resulting in 63,524 ambulance transports to emergency rooms. Handling that glut of emergencies were paramedics and emergency medical technicians in just 22 EMS ambulances (plus one basic life support and one advanced life support ambulance contracted from private firm American Medical Response). There is an obvious need for more staff, but EMS has for decades faced challenges filling slots.

During the Council’s recent Public Safety Committee meeting, EMS Assistant Chief Korey Chock said staffing shortages are such that as many as seven ambulance units are nonoperational during a 24-hour period. That must change, and HESD Director Jim Ireland agrees.

“It is very clear to me that the current 911 workload for our EMS crews is too high,” Ireland told the Star-Advertiser.”Some of our units run up to 18 calls in a 12-hour work shift. Traditionally, an ambulance is considered ‘busy’ if it runs more than six calls in 12 hours.” He added that Oahu needs “at least 25, probably as many as 30” ambulances to keep pace with increasing demand.

Staffing woes must be rectified, but the question is how. Mere reshuffling of administration and organizational charts is unlikely to solve this base issue and could unnecessarily foist new problems on another emergency department. But perhaps a boost from HFD is what EMS needs. The two services synergize well, with ambulances already positioned at fire stations across the island. Careful study is needed.

Timing must also be considered. Ocean Safety splintered from HESD into its own stand-alone entity in May, at least on paper. Behind the scenes, the split is not yet complete, with some personnel still performing integral roles for both departments as reorganization efforts advance. It is too soon to tell what, if any, impact a clean break will have on EMS, and whether HESD can turn the tide when focused exclusively on a singular agenda.

“Now that Honolulu EMS is no longer funded and controlled by the State of Hawaii, we have more freedom to expand and manage our EMS system,” Ireland said. “It is definitely worth exploring all options regarding how to add EMS resources to Oahu, either by significantly expanding Honolulu EMS, developing a public-private partnership with a private ambulance provider such as American Medical Response, or merging with the Honolulu Fire Department. Our Honolulu EMS motto is ‘the needs of the patient comes first,’ and this will always be our goal.”

Like Ireland, the Council’s proposed task force must discuss out-of-the-box solutions. One example is the Nurse Navigator program, which taps rideshare drivers to transport nonemergency patients to an urgent care facility or doctor’s office, reports Hawaii News Now. EMS officials estimate such a system could handle up to 9,000 responses a year, delivering much-needed relief to Oahu’s overburdened paramedics.

Should the task force be assembled, it must contemplate options beyond consolidation. EMS might benefit from integration with HFD, but novel, not-yet-considered alternatives could be much more advantageous.