Imagine calling 911 for an ambulance and it breaks down as it's rushing someone to the hospital. Or imagine that the one defibrillator aboard that ambulance, purchased in 1997, fails. It could happen to you or your loved one.

The state Constitution obligates the state to provide emergency medical services in Hawai'i. In Maui and Kaua'i counties, the state has a private contractor. The Hawai'i County Fire Department provides emergency medical services on the Big Island.

On O'ahu, the most populous island, the state pays the city to provide emergency medical services. Sadly, as Mayor Mufi Hannemann told legislators the other day, the state continues to shortchange EMS on O'ahu.

A half dozen of our 30 ambulances have logged more than 200,000 miles on the road. The majority of our ambulances have more than 100,000 miles on their odometers. Five of them were purchased in 1998. These are vehicles that are driven hard, 24 hours a day, seven days a week. They are not at all like the car your grandma drives once a week to the market.

Honolulu EMS responds to emergency calls morning, noon and night. That means each ambulance racks up miles quickly, especially as the number of calls for help continually increases. We should be replacing four or five ambulances annually just to keep up with wear and tear, but budget limitations have kept us from doing this.

Last year, EMS was able to purchase just one ambulance after the emergency appropriation we worked so hard for was severely cut by more than $2 million at the last minute. We have purchased a total of just five ambulances over the past four years. Not only are we not keeping up, we are falling further and further behind in our replacement schedule.

In addition, we have been unable to make a major equipment purchase for 10 years. The defibrillators on our ambulances were purchased in 1997, and we finally had to use grant money to refurbish, recondition and upgrade them last year.

Wear and tear is hard on equipment when we're responding to approximately 70,000 patients per year. IV pumps purchased in 2000 are unreliable and often out for repairs, as are carbon dioxide detectors and the monitors that keep track of patient oxygen levels. Needless to say, we are inadequately prepared for the surge of patients that we would expect in a mass casualty incident.

State officials think they are being generous by increasing funding 5 percent over the previous year. But EMS has been underfunded for so long that a 5 percent budget increase is not enough to allow us to catch up. The city is only allowed to bill the state up to the state's budgeted contract amount. State officials, therefore, don't have to suffer the consequences when the budget falls short, as it did last year, by $800,000. The city covered the difference.

In 2005, the cost of providing emergency medical services on O'ahu was over budget by $1.5 million, despite the fact that no equipment and no ambulances were purchased. It wasn't because of wasteful spending, but because the state's budgeted amount was unrealistically low.

It has been reported that the state has a $700 million budget surplus. We understand everyone wants a piece of that surplus. You'd think EMS might get a fair share, if you believe the state's rhetoric about public safety first-responders.

Public safety and common sense demand that we have enough ambulances and equipment to respond to the ever-increasing number of people we care for. The public expects to be cared for in times of disaster, be it manmade or natural.

Honolulu's EMS paramedics include some of the most experienced and highly trained, best in the nation. While they're serving on the front line of public safety, their ability to provide a high standard of care is hampered by a lack of proper, basic equipment.

The public needs to have confidence that when they call 911 for a life-threatening emergency, a reliable, working ambulance with modern, dependable equipment will respond.

The state is in a position to properly fund emergency medical services on O'ahu, and it needs to help us now more than ever.

Dr. Libby Char is director of the Honolulu Emergency Services Department. She wrote this commentary for The Advertiser.