The number of cases represents a 54 percent increase since 2000, when EMS provided paramedic and ambulance transportation services to about 42,000 people.

Now, officials say continued city growth and the attendant traffic problems are exacerbating a difficult mission to provide timely medical response to the city's population.

"We work miracles with the resources we have," said Patricia "Patty" Dukes, Honolulu EMS chief. "We may be at a point where we're not able to cover it but

Patricia Dukes

The Honolulu Fire Department has also seen a spike in responses to medical emergency calls.

In 1994, 4,448 calls, or 35 percent of the 12,785 responses by firefighters, were for medical emergencies, according to HFD spokesman Capt. Kenison Tejada.

In 2004, firefighters responded to 33,352 calls, of which 22,904, or 69 percent, were for medical emergencies, Tejada noted.

Fire Chief Attilio Leonardi said the department has been able to handle the rise in calls.

"So far, we haven't had any problems adjusting," Leonardi said. "The capability of departments our size on the Mainland is about 80,000 emergency medical runs a year."

Demands, traffic up

Lee Lenchanko, an ambulance dispatcher as well as an emergency medical technician, talks to paramedics on the radio. Richard Ambo • The Honolulu Advertiser

'Aiea paramedics Jay Hara and Jeffry Kurashima say traffic — with most motorists flouting the law — is their biggest problem.

During rush hour, H-1 Freeway/Moanalua Road turns into an obstacle course when trauma victims must be rushed from Pearl City or 'Aiea to The Queen's Medical Center.

"It's worse on weekends than weekdays," said Hara, whose unit works out of a small room at

Kap'iolani Medical Center-Pali Momi. "You just have to be patient. There's always somebody tailgating just to get 10 seconds ahead of everybody. Safety is the issue. We don't want to cause more patients or worse, become patients ourselves."

On a recent afternoon run from Royal Summit to Tripler Medical Center for a patient suffering from low blood sugar, the ambulance stops at the corner of Ka'ahumanu Street and Moanalua Road before turning right as some westbound motorists ignore the siren and continue through the intersection.

The ambulance is eastbound on H-1 when Hara spots trouble approaching in the lane to his left. A speeding blue pickup truck cuts in front of the ambulance, which is going 65 mph, and up the 'Aiea off-ramp.

"City people are always in a rush to go somewhere," Hara said. "I try not to weave too much because of the people in back (motion sickness is common). The most important thing is to get there safely. As paramedics, we can handle one, two or three minutes more (to get to the hospital) because we're able to do the same thing ER (emergency room attendants) would be doing."

A car that was parked on the shoulder of the 'Aiea off-ramp suddenly cuts across the ambulance's path. On Moanalua Road, about half the motorists do not immediately pull over to the right or left so it's hard for Hara to determine what some are going to do.

State law says motorists must immediately clear an intersection for emergency vehicles by going to the right edge. On multiple-lane highways, motorists should move to the nearest edge or curb.

Communications issue

Another challenge to the system is the lack of a central EMS center, which can complicate communications between ambulance units and the dispatch center.

Dr. Elizabeth "Libby" Char, director of Honolulu's EMS Department, said the EMS administration office is on the fourth level at Airport Industrial Park, 3375 Koapaka St., while its communications center is at the Honolulu airport.

Paramedics, meanwhile, work out of "gifted" space at hospitals and clinics or trailers.

The 'Aiea unit at Kapi'olani Medical Center-Pali Momi can receive a call from dispatch in its basement office but cannot speak to dispatchers until it leaves the garage area because of the thickness of its concrete walls.

"We're exploring options," Char said of locating EMS' operations at one site. "Finding space is difficult and then there's the age-old problem of money."

Response upheld

City paramedic Naomi Smith treats injured motorcyclist Michelle Carwile with pain medication before Carwile is rushed to a hospital. Richard Ambo • The Honolulu Advertiser

EMS works with a state response guideline of 10 to 15 minutes, measuring from the time a call is received to when an ambulance is on scene. "It's not like the clock starts ticking," said Dukes, who noted there's no tracking and there are no penalties.

The suggested times are viewed as a measuring stick and Honolulu EMS' response record is over 90 percent within the parameters, Dukes said. Response times for individual ambulance units were not available.

Officials said changes are made when trouble spots arise.

The EMS system is evaluated annually by the state, said state EMS & Injury Prevention Branch chief Donna Maiava. "We upgrade and try to put resources where they are most needed," she said.

The 2004 evaluation resulted in the addition of new units in Nanakuli and Makiki and transfer of a rapid-response unit to Ka'a'awa.

"The system is not broken, but you need to do assessments every year to identify areas of need as the population shifts," Maiava said. "We know ... Mililani Mauka wants a unit and that Kailua is trying to get a second unit."

Three-tiered system

Providing medical response to O'ahu's residents — almost 900,000 — requires close cooperation among agencies.

The Honolulu city government has a $22 million annual contract from the state to provide emergency medical services.

The system includes 140 paramedics, trained to provide advanced life-support treatment such as intubations and intravenous feeds and 55 emergency medical technicians, qualified to do basic life support.

The system also has 18 ambulances islandwide — 15 of which are manned 24 hours and three for 16 hours — and two rapid-response vans, one at St. Francis Medical CenteriWest and the other in Ka'a'awa behind the post office. The vans are used when emergency units are not available.

O'ahu operates under a three-tier system: Firefighters, police and lifeguards are the "first responders" — typically, the first on the scene. They are trained in CPR and equipped with automatic external defibrillators to provide essential life support.

The next tier comprises EMS responders, who include ambulance paramedics qualified to administer advance life-support treatments and emergency medical technicians, who have intermediate life-support training.

The third tier is hospital emergency staff.

The EMS Communications Center operates 24 hours a day, seven days a week, with 10 people working three eight-hour shifts.