Hawai'i Air Ambulance provides lifeline to Neighbor Islands

By Jan TenBruggencate
Advertiser Staff Writer

When Hilo doctors told Mike Lehmann in October that his leukemia-stricken son needed to be transferred to Honolulu immediately, his first thought was that it was 8:30 p.m., and the last commercial flight had already left.

"But they said they were bringing in a plane," he said.

Late that night, Lehmann flew to O'ahu on a Hawai'i Air Ambulance fixed-wing plane, holding the hand of his 8-year-old son Ryan. The boy was weak and covered with bruises, a symptom of the illness.

Lehmann said he has prayed for the families of the three Hawai'i Air Ambulance employees killed in a Jan. 31 crash, because folks like them came to his family's aid in their crisis.

"They were a godsend for me. When the doctors say you can't even wait overnight. ... It was quite frantic," he said.

Ryan has been undergoing chemotherapy and is doing as well as can be expected, he said.

The Hawai'i Air Ambulance flight that crashed was on a similar mission to pick up a sick 9-year-old boy for transport to Honolulu when it went down in a forested area 25 miles northwest of Hilo, killing the three crew members. They were pilot Ron Laubacher, 38, and paramedics Joseph Daniel Villiaros, 39, and Mandy Shiraki, 47. Villiaros was a Honolulu firefighter, and Shiraki was a district supervisor for Honolulu's Emergency Medical Services.

Hawai'i Air Ambulance averages six to seven flights daily, said Andrew Kluger of California, who is chairman and chief executive officer. For Neighbor Island families such as the Lehmanns, the company is a lifeline — and often a life saver.

"For my district, this is vital. My people totally depend on their services," said Sen. J. Kalani English, D-6th (E. Maui, Moloka'i, Lana'i).

The firm provides virtually all of the interisland air ambulance services, said Donna Maiava, chief of the state Department of Health's Emergency Medical Services and Injury Prevention System. "They keep a flight-ready crew for two aircraft during the day and one at night," Maiava said. A normal flight complement is a pilot plus either a nurse and paramedic or two paramedics.

Often, the medical team will consist of hospital, fire department or ambulance service professionals, who make themselves available during time off from their regular jobs. Kluger said 32 of his firm's 100 employees are full timers.

Occasionally, an outside medical team will board one of the planes. For example, Kapi'olani Medical Center for Women and Children has a dedicated transport team for infants and children.

The company had five Cessna 414A Chancellor aircraft until the crash, and Kluger said the company is looking for a replacement plane.

If Hawai'i Air Ambulance is not available, a two-level backup system goes into effect. The Coast Guard may send a C-130 fixed-wing aircraft. If the Coast Guard is not available, the Army's 68th Medical Company from the Department of Defense's Military Assistance to Safety and Traffic system may send one of its UH-60A Black Hawk helicopters from Wheeler Army Airfield.

In either case, Hawai'i Air Ambulance supplies the onboard medical team, Maiava said.

When the Hawai'i Air Ambulance Cessna disappeared early Jan. 31, the Coast Guard was called on to perform its primary mission, search and rescue. So the second backup was activated, and the Army's crew took up the task of transporting the ailing child from Hilo Medical Center.

To launch an air ambulance flight, the treating physician must request the medical evacuation, and there must be an accepting physician at the other end — normally at the Honolulu hospital that has specialists able to treat a patient whose medical condition can't be addressed on the Neighbor Island, said Dr. Linda Rosen, deputy state health director for health resources.

Hawai'i Air Ambulance has its own medical director, who makes decisions about which patient flies first when there are conflicts. There is no government involvement in the decision-making, Rosen said.

Kluger estimated that 5 percent of its flights involve indigent patients, from whom it collects no revenue. Another 45 percent are Medicaid or Medicare patients, for which reimbursements are far below the cost of providing the ambulance service, Maiava said. The firm must make up the difference with insurance payments from the remaining clients.

"It's an appalling situation that their reimbursement doesn't cover the cost" for so many flights, Maiava said.

Kluger bought the company in 1997. He said the company has lost money every year he has owned it, except last year when it made a $64,000 profit. In his first full year of operation, 1998, Hawai'i Air Ambulance lost $500,000, he said.

Rosen said she believes the number of air ambulance flights could be reduced significantly if Neighbor Island hospitals had more specialists, or if the state's medical facilities made better use of tele-medicine — using advanced electronics to allow medical professionals to treat patients from a distance.

Medical evacuation services to transport critically ill or injured patients from more remote locations to their local hospital is normally provided by helicopter. On O'ahu, the Army's MAST system provides all air ambulance services through the 68th Medical Company, at no cost to the state.

"It's a wonderful thing. They treat it as a training program," Rosen said.

The Big Island has a medically equipped helicopter that is 60 percent financed by the state and 40 percent by Hawai'i County.

Maui County is scheduled within the year to get a similar system, with costs shared between the county and state. It will have the capability of flying missions to Lana'i and Moloka'i.

Kaua'i has no air ambulance, and probably does not have enough demand to justify the cost, said Fire Chief Dennis Furushima.

Medical evacuations from Ni'ihau are normally handled privately by Ni'ihau Helicopters, which is owned by the same family that owns the island. Occasionally, Navy helicopters from the Pacific Missile Range Facility assist in medical emergencies on Ni'ihau.

Reach Jan TenBruggencate at jant@honoluluadvertiser.com or (808) 245-3074.