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The Honolulu Advertiser
Posted on: Tuesday, April 10, 2001

Medical transport system must be helped

When UH football coach June Jones crashed his car near Honolulu Airport, he was — oddly enough — quite lucky.

Emergency rescue personnel were soon at his side, and in less than an hour he was in the capable hands of the Queen's Hospital trauma center — the most up-to-date and experienced emergency medical unit in the state.

If Jones had his accident on a Neighbor Island — particularly in a remote part of that Neighbor Island — he might not have been as fortunate.

As Advertiser staff writer Beverly Creamer reported this week, the emergency medical transport system available to Neighbor Islanders is a patchwork that — at best — cannot hope to match the service available in urban Honolulu or in many Mainland states.

The backbone of the Neighbor Island service is a commercial air service, Hawai'i Air Ambulance, that operates a fleet of fixed-wing aircraft. Because costs are high and reimbursements, particularly from Medicare and Medicaid, are low, the service is barely making a profit, according to its owners.

The military, particularly the Coast Guard, serves as a backup. But its helicopters are not always available. In fact, all military assistance for emergency evacuations is provided on a case-by-case basis, when it does not interfere with other operations or training.

The reason Hawai'i does not have a first-rate, all-encompassing medical transport system, obviously, is money. Ideally, the subsidies to the commercial providers would be increased so they could expand service. In addition, it would cost at least $8 million to establish three state-of-the-art helicopter air ambulances on the Neighbor Islands.

Then there would be operating costs.

All of this is daunting if it is treated simply as an expense that must be balanced against the other priorities facing the state budget. But the answer is to think of spending on medical transport services not as an expense, but rather as insurance.

And it could be some of the best insurance the state or the public could buy. Quick delivery of an injured person to a fully equipped trauma center is the best possible guarantee of recovery.

As Creamer pointed out, Maryland reached this conclusion and decided to build its air ambulance system around a surcharge on automobile registration fees, since auto accidents provide the bulk of the demand for such services.

In Maryland, the service adds about $8 a year per vehicle, a small price to pay for "insurance" that could save many lives and prevent needless suffering.

Because of its geography, Hawai'i has an extraordinary need for this form of flying ambulance. The Legislature must seriously consider backing up the private providers with a state helicopter service that could be financed out of a vehicle registration surcharge. In addition, Hawai'i's congressional delegation must continue to fight for increased Medicaid and Medicare reimbursements for such services. Alaska has already accomplished this while higher reimbursements for other states are on hold pending review by the new Bush administration.

Creating a first-class medical transport system for Hawai'i is an investment that will pay off in huge savings in medical costs and in avoided trauma and grief. There is no excuse for waiting.