A
report to the
WEST
MAUI TAXPAYERS ASSOCIATION
By
Scotty Schaefer MOBILE INTENSIVE CARE TECHNICIAN, PARAMEDIC
FACILITATOR,
MAUI EMSAC
JULY
31,2003
Purpose
of the Maui County EMS Advisory Committee:
The Maui EMSAC
re-organized in 2000 to give input from Maui County to the State of Hawaii
Department of Health Emergency Medical Services System and Injury Prevention
Branch. It is apparent that we need
to keep the State aware of the growing needs of Maui County.
A
simple questionnaire was circulated in July 2000 asking, “what are the top
emergency medical needs in Maui County?” Replies were collected and
prioritized. These issues emerged:
Emergency
Medical Radio Communications
Aeromedical
services
Better
utilization and integration of private ambulance resources
24
Hour Emergency Ambulance service in Kula
Emergency
Ambulance service for Wailea- central Maui
Hana
Medical Clinic’s staffing and medical care
Over time,
other issues have surfaced:
County Lifeguard communications
Weapons
of mass destruction and bio-terrorism
HAZMAT
incidents
Critical
Incident Stress Management
The
theme of this year’s legislative session was “no
more money.” 
Due
to the hard work of Maui County Legislators (and some help from their friends)-
The House and
the Senate provided funds for an emergency medical helicopter for Maui County
when they passed Senate Bill 745. In a time of severe economic struggle, Maui
County received $1million dollars for this project.
No
other county received any monies for EMS. There were no other new projects that
had funds appropriated.
It
became clear from the first days of the Legislature’s opening that the State
was facing a huge financial shortfall. From the beginning, Legislators from both
houses and parties were speaking of the need to do things differently in regards
to EMS. There was a strong sense that a new or different source for funding was
needed to help EMS catch up to increasing demands. “We cannot keep doing
things the same way” was heard from every corner and every level of State
Government. There was a tremendous balancing act by the Legislature trying to
keep essential services while dealing with a shortfall of over $100 million
dollars.
The
NEED:
The
optimal time for survival is when a critically injured patient reaches
definitive treatment within one hour. Many people are now familiar with the
descriptive term “golden hour”. It describes that window of time that starts
from the moment of injury until the victim reaches surgery.
On
Maui, with its large land mass, one surgical hospital, and 5 islands, most of
our population lives, works, or plays outside of a “golden hour” or response
and transport by ground ambulance. The result is needless death and disability.
Trauma centers cost millions and millions of dollars and need a high volume of
patients to keep the skills of the staff at peak level.
Since
there is neither the patient volume nor untold billions of dollars another
solution is needed. That solution is to get patients to definitive care quickly
via helicopter.
Initial
costs to operate an emergency helicopter for Maui County ranged from $3-6.5
million dollars per year!!!
There
was no way that the State could afford the service no matter how critical the
need. In a bold venture led by Senators Baker, English, and Tsutsui, a
partnership began to form. Help came from the private sector, State Government,
County Government, and the medical community. A true public-private team became
dedicated to reducing costs while addressing the need for high quality emergency
medical services for our residents and visitors.
What emerged was “The Plan”
for the emergency helicopter
Use
911 paramedics in a dual role.
911
paramedics could be used to expand ground ambulance resources and at the same
time provide the primary staffing for an emergency helicopter. The primary
mission would be for scene calls and time-dependant transfers that could not be
handled in a timely manner by HAA. The SDOH EMSSIP Branch estimated 125 flights
per year.
The monies appropriated by SB 745 were to be used to expand the SDOH contract
with American Medical Response for ground services to include the staffing of
the helicopter. Decisions on procurement for the helicopter were not made. One
plan was to have AMR procure the helicopter component privately. The SDOH has
not finished planning the details.
2 options were discussed for ground ambulance placement: Kula or Wailea.
Every family and visitor in Maui
County would benefit from the helicopter and from ANY increase in ground unit
hours no matter where the ground ambulance is placed!!! It is our hope that there might be other funds available so that ground
ambulance hours can be further expanded.
SB
745 appropriated
·
$611,500 for provision for an emergency medical helicopter for Maui County
which “shall use triage protocols and be based on national aeromedical,
triage, and transport guidelines established by the Association of Air Medical
Services, the American College of Surgeons, and the National Association of
Emergency Medical Services Physicians.”
This
money is only to be appropriated if there is-
$611,500
in matching funds from the County of Maui. This money is for helicopter
operations, but not for the medical staffing.
Maui
County has appropriated $100,000.00 for fy 2003-04 to facilitate start-up and
planning. Maui County has also budgeted the $611,500 for matching funds for
fy2004-05.
Additionally:
$388,500
was appropriated to integrate additional ground ambulance services with the
emergency aeromedical helicopter services.
SB 745 directs
the monies to go to the State Department of Health EMSSIP Branch. The proposed
funding is for July 1 2004.
Important considerations-
1.
The EMSAC’s top priorities have always been to enhance ground
ambulances for Maui’s citizens.
2.
Any impact that would reduce Hawaii Air Ambulance’s ability to do
business would kill the project at the State level. The Maui EMSAC has always
partnered with HAA to improve services and provide a forum for education. There
has never been any intention to “compete” for patients.
3.
State money is severely limited.
4.
Safety will be a top priority.
5.
National Standards have been
established for appropriate helicopter safety and usage.
6.
The law that gave the oversight and structure to begin this project has
more impact than the money at this point.
Then
there was the VETO
Governor
Linda Lingle vetoed SB 745 saying that the language in the bill was flawed and
would leave the State liable. There were also concerns about the tight financial
situation that faced Hawaii.
Then
there was the OVERRIDE
The Hawaii
State Legislature convened a special session to consider the effects of Governor
Lingle’s vetoes. In a highly emotional atmosphere, the Legislature heard from
people who would be affected by each veto. Then both houses voted to override 6
of the bills that had been vetoed. The veto of SB 745 was overridden and became
law: ACT 2 of the special session.
Where do we
go from here?
Even though
the bill has now become law, there is no guarantee that the Governor will
release the money.
The
Public/private partnerships are being explored for all EMS resources including
the emergency helicopter.
There are
proposals to examine potential new Funding Sources-e.g.- proposed license plate
fee, community conscriptions
There have
been reports that Governor Lingle has restricted monies to all departments by
20%. For the first time EMS is not exempt. This represents a potential loss of
$7.6 million dollars from an already lean department. This could potentially
lead to ambulance closures on each island.
Stay tuned and
be ready to write, call, and/or testify. It is only by working together that we
will be able to provide for the safety and health of our Ohana in Maui Nui.
GIANT MAHALOS
Senator
Roz Baker
Senator
Kalani English
Senator
Shan Tsutsui
Representative
Joe Souki
Representative
Sol Kaho’ohalahala
Representative
Bob Nakasone
Representative
Kika Bukoski
Representative
Brian Blundell
Representative
Chris Halford
Mayor
Alan Arakawa and staff- Mele Carroll and Jan Yagi Buen
The
entire Maui County Council
Danny
Mateo
Charmaine Tavares Dain Kane
Bob
Carroll
Joe Pontanilla
Michael Molina
JoAnne
Johnson
Riki Hokama
Wayne Nishiki
Donna Maiava- Chief EMSSIP Branch
Dr
Chiyome Fukino- Director SDOH
Speedy
Bailey -American Medical Response
Andy Kluger- Hawaii Air Ambulance
Tom Hauptman- Pacific Helicopters
Every
Community Association, special thanks to Kula
Every
petition signer and letter writer in Maui County
MICT
Paramedics-Lin Watkins and Doug Van’t Groenwout
Home
| Important Announcements