State and city officials have no concrete plans to replace the military evacuation flights that ferry the most critically injured victims to the island's only trauma center an average of 135 times a year.

The Army last week notified the city and state that the flights would be suspended from April 1 through at least October 2007, and officials yesterday said their main hopes lie in a private company bidding to take over the flights. But after 34 years of the military's program, private contractors are not rushing to take over the Army's service.

"If there are any substitute companies that wish to provide that service, I urge them to give our office a call," said Dr. David T. Sakamoto, administrator of the State Health Planning and Development agency, the office tasked with approving private contractors. "We try to be very reasonable on this and we are very cognizant of what the community needs but we don't want a bad company to come in, either."

Short of a private contractor stepping up, officials said the city's 18 ambulances and their crews will be constantly shuffled around O'ahu to provide coverage for areas left exposed by emergencies. But the problems really arise when more than one person needs immediate care at Honolulu's sole trauma center, The Queen's Medical Center, said Patricia "Patty" Dukes, chief of City Emergency Medical Services.

"The big impact will be multi-casualty incidents where patients have to be transported at once (by air) to facilities," she said yesterday. "We'll have to work faster at the scene and ambulances may be out of the area for a while. The Army providing this service to the state has been a blessing."

City emergency medical service and state health officials have known that military assistance would end one day, as it has in most Mainland markets, but now the state has to find a way to fill the void and fast. On Friday, the Army announced that after providing Military Assistance to Safety and Traffic, or MAST, service to the city since 1971, its entire fleet of Black Hawk helicopters would be sent to Iraq.

Service cannot be resumed until at least 2007, the Army has said.

"It is certainly a high concern for our department," said Janice Okubo, spokeswoman for the state Department of Health.

Officials with the Honolulu Fire Department declined to comment yesterday about the termination of MAST service and the possible problems that could arise. A message left with the Honolulu Police Department was not returned yesterday.

Sakamoto said the loss of the Army's MAST service "may be a huge problem."

Approving an application from a private air ambulance service can take up to three months, he said. An emergency provision that allows for an expedited application process can be enabled but any company that passes state muster also would have to seek approval from the Federal Aviation Administration.

Since 1999, the state has received zero applications for new service, Sakamoto said.

Officials with the Hawai'i-based American Medical Response, a private ambulance provider, did not return calls seeking comment yesterday.

The cost of private medical emergency air service is difficult to quantify. Neither city EMS or state Department of Health officials had cost estimates available yesterday, but prices from Mainland jurisdictions point to an expensive service.

Last week, the Army announced that 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.

The Black Hawks are more powerful than the Hughes 500 helicopters that are flown by the Fire Department and normally used for rescues, and are capable of servicing multiple victims. The Hawai'i Army National Guard, which has eight Black Hawks and has helped fly emergency missions in the past, does not have enough full-time aviation crews to take on the MAST role.

Lt. Col. John Williams, spokesman for U.S. Army Pacific, yesterday said the loss of the Black Hawk fleet also hurts Army operations.

For each live-fire exercise the Army conducts, military guidelines require that a Black Hawk medevac helicopter be on standby. Williams said the Army is also considering looking to private contractors to provide emergency medical air service.

"It's not only affecting the state but it is affecting us here," he said.

Reach Peter Boylan at pboylan@honoluluadvertiser.com.