Local officials who are fretting over the cost of providing emergency medical helicopter flights on O'ahu must recognize that, high price or not, there really is no choice but to provide this crucial service.

A prudent and long-term decision on a state or state-county backed service has been put off for years, largely due to the generosity of the military.

For years, the Army provided the service through its helicopter fleet at Schofield. When that service was withdrawn because the choppers were needed in Iraq, the Hawai'i Army National Guard stepped in.

But the Guard says it can continue to help only through September.

It should have been obvious from the beginning that there was no guarantee the military assistance would last.

The Legislature has approved $1 million to search for a permanent medevac service for O'ahu, but that clearly is far short of what will be needed. The thought is that the $1 million would go to the military to help offset its costs of providing medevac services.

While there is still hope that some kind of arrangement can be made with the military, that option is becoming less and less likely.

At least two private firms have made preliminary inquiries about providing services at costs that run between $3.5 million and $5 million a year. That's a lot of money for a service that, in fact, is not frequently used.

But the cost-analysis must go beyond frequency of use.

In some cases, the ability to take injured people by helicopter to a medical facility makes the difference between life and death. In addition, officials worry about a mass disaster in which efficient helicopter evacuation service would be absolutely critical.

Ideally, an arrangement with the military may be worked out. But this is far from certain; it is time to begin serious discussions on alternatives. One option might be to purchase the helicopters as part of the Fire Department's first-responders fleet, which would be staffed by city paramedics.

Today, the state splits the cost of medevac service 50-50 with Hawai'i and Maui counties. Kaua'i does not have a regular service, and O'ahu has depended on the military.

If a commercial service is engaged for O'ahu, it seems only proper that the City and County pick up half of the cost. The time to begin negotiations on this is right now.