No long-term fix in medevac crisis
By Peter Boylan
Advertiser Staff Writer
By Peter Boylan
After a 30-year free ride from the military, local and state officials are scrambling to find the millions of dollars necessary to continue emergency medical helicopter flights on O'ahu.
Although the Hawai'i Army National Guard has extended a temporary deal to provide seven helicopters until September, no permanent solution has been found. The National Guard flights originally were to end Saturday.
"We never had a community-wide discussion about providing and funding an island-wide emergency helicopter service for O'ahu," said Dr. Linda Rosen, deputy director for health resources with the state. "It is only now that we look at replacing what (the Army) provided that people are becoming aware of the value of the service we had for years and it is (going to be) expensive to replicate."
O'ahu has been without 24-hour emergency medical flight coverage since March 31, after the Army notified the city and state that its Black Hawk helicopter crews were needed for a deployment to Iraq. Schofield used 12 helicopters for the medevac flights.
Seven National Guard helicopters began providing the temporary service May 1, but a permanent contract with another provider has yet to be secured, state officials said.
A lawmaker who represents rural O'ahu and the medical director at the state's only trauma center said it is critical that 24-hour emergency medical flights are restored on O'ahu.
State Sen. Colleen Hanabusa said the Wai'anae Coast that she represents is just one of many rural areas on O'ahu that need medevac service. She said getting into the area during rush hour is difficult enough, and if a major traffic accident clogs Farrington Highway, it's impossible.
"We have to have (the emergency flights). Not only us but all rural areas. This is a major expense to have a helicopter that can do medevac but we're not going to have a choice," she said.
Dr. Hao Chih Ho, director of trauma service at The Queen's Medical Center, said O'ahu may not be able to pay for 24-hour-a-day coverage, but it is impossible to determine when the service might be needed.
"For the patients that need it, the extra 30 minutes (if transported by ambulance) could mean a lifetime," he said. "You don't need it 24 hours a day, you may only need it for an hour, but the problem is you don't know which hour you need it. I don't know how you calculate the cost effectiveness of that."
Funding has been a roadblock. The state Legislature approved $1 million to search for and secure permanent medevac service for O'ahu. It also approved $2.3 million to pay for the temporary Guard flights, but replacing a fleet of Black Hawks with comparable aircraft from a private contractor will be expensive.
But paying for a private service will cost much more. Private proposals made to the state have topped $5 million a year.
One proposal, from Pacific Medical Assets, is for $5.25 million a year. Carson Helicopters, another firm, said it can provide a helicopter for $3.5 million a year. The City and County of Honolulu has not received any proposals, according to a city spokesman.
Joseph Rice, director of operations for Carson Helicopters, an Oregon-based international aircraft company, said he has submitted more than two dozen proposals to DOH, Gov. Linda Lingle, the Guard and members of the state's congressional delegation.
Carson is offering a Sikorsky F-61 chopper, the same model aircraft as the President's Marine 1, which is capable of transporting eight patients lying down or 15 ambulatory individuals. The helicopter can be used for disaster relief and comes with a crew.
The company sent eight aircraft to the Gulf Coast to aid in Hurricane Katrina relief efforts.
"Funding is an issue but we're looking for some kind of communication from the state. We can't even get a returned phone call," Rice said. "The only response we've had is from the county departments asking us what the state said. The island as a whole does need the resource."
Details of the Pacific Medical Assets proposal were not immediately available.
Neighbor Island counties contract medevac service in a partnership with DOH, which pays half the costs. O'ahu relied on the Army, which provided the service free. The state is not liable for providing air service for O'ahu, according to DOH. However, DOH and the Hawai'i Army National Guard are heading the search for a medevac provider.
"We're very pleased that the National Guard is able to extend their support while we continue to discuss long-term options for medevac services on O'ahu," said state Department of Health director Dr. Chiyome Fukino.
12 HOURS OF SERVICE
Currently medevac service is provided on O'ahu from 11 a.m. to 11 p.m. daily, leaving the island uncovered for 12 hours a day.
But after September, the service will end, Guard officials said.
"We're not going to be able to do it indefinitely," Maj. Charles Anthony, spokesman for Hawai'i National Guard, said yesterday.
The unit handling the flights is based in Hilo and the assignment not only diverts crew members from their primary mission but also takes them away from their families for long periods.
'HAVEN'T BEEN TESTED'
Emergency response officials worry about the impact of losing the flights.
"We have not been tested and we hope it stays that way, and I'm talking about a mass casualty or a disaster," said Patty Dukes, head of the city's Emergency Medical Services.
"In EMS, if there is no business that's good business but I don't think we'll ever be able to say that we won't need a service or a backup," Dukes said. "We continue to hope people remain safe and conscious and cognizant of what they're doing."
Since taking over for the Army, the Guard has flown seven missions and transported eight patients.
The military flights, previously provided by the Army's 25th Infantry Division, numbered about 200 a year during the past 30 years.
In January, the Army notified the city and state that the Military Assistance to Safety and Traffic, or MAST, service would be suspended through at least October 2007.
All 12 Black Hawk helicopters with Charlie Company of the 25th Infantry Division's combat aviation brigade, along with 85 to 100 soldiers, are deploying to Iraq this summer.
Approving an application from a private air ambulance service can take up to three months, and the state has not received any new applications since 1999. The military is handling the procurement process.
An emergency provision that allows for a speeded-up application process can be put into motion, but any company that passes state muster also would have to seek approval from the Federal Aviation Administration.
Reach Peter Boylan at firstname.lastname@example.org.