Air ambulance crunch a 'crisis'
Some neighbor isle doctors demand the state act to address ever-longer delays
WAILUKU » Some neighbor island doctors have declared an emergency, urging the state to step in to provide additional air ambulance services to fly the severely injured to Oahu hospitals.
"I think the system needs an overhaul," said Dr. David Nelson, in charge of transferring patients from Maui Memorial Medical Center. "I believe an emergency exists."
Maui emergency physicians spokeswoman Sharlee Dieguez said response times have gone downhill in the past several years and have deteriorated even more since the fatal crash of a Hawaii Air Ambulance plane in Kahului on March 8.
PATIENT NO LONGER
Dr. David M. Nelson, in charge of transferring patients from Maui Memorial Medical Center, says the waiting times for air ambulance service have increased since the March 8 crash of a Hawaii Air Ambulance plane that killed three people:
» The average time between a transport request and departure from Maui was about 5-1/2 hours.
» In March after Hawaii Air Ambulance grounded its planes, the average wait was about 12-1/2 hours and the longest wait was about 50 hours.
"The service is unacceptable," said Dieguez, who represents more than 10 emergency room physicians at Maui Memorial.
Nelson said before the March 8 crash, the average time between a transport request and departure from Maui was about 5-1/2 hours.
But after Hawaii Air Ambulance grounded its planes in March, the average wait was about 12-1/2 hours and the longest wait was about 50 hours, he said.
Hawaii Air Ambulance has four airplanes, but only one has been certified to fly by the Federal Aviation Administration since the crash on Maui that killed three employees.
Hawaii Air Ambulance also is using a charter airplane for nonemergency flights.
During the voluntary grounding, the Coast Guard provided transport, but later had to cut back because the aircraft was needed for other missions.
Anita Lucas-Legg, the chief flight nurse and program director for Hawaii Air Ambulance, said two of its airplanes are close to being approved for service.
Lucas-Legg disagreed with the emergency physicians' assessment about the hours of wait.
Lucas-Legg said it isn't practical, because of the cost, to base an emergency air ambulance airplane on each island.
She said on many occasions, people don't have the means to reimburse the business because of a lack of medical coverage.
"We never turn anyone away," she said.
Lucas-Legg said Maui Memorial also has an emergency helicopter that can transport patients to Honolulu. Dr. John Funai, chief of cardiology at Wilcox Memorial Hospital on Kauai, said emergency air ambulance service was "minimally acceptable" prior to the March 8 crash, with waits of four to 40 hours.
Funai said the service has deteriorated further since the crash.
"We have been behind the eight ball," he said. "The process is very slow and cumbersome."
Funai agreed with emergency physicians on Maui who support having more help from the state to get additional emergency air ambulance services.
Nelson said a study conducted by the American College of Surgeons last year found the lack of emergency air transport resources on the neighbor islands was among "the greatest threats to the lives and limbs of injured Hawaiians."
Dr. Richard McDowell, chief of the emergency department of Kona Community Hospital, said the organization had important recommendations calling for analyzing the air medical transportation system and creating a committee to check into it.
McDowell said the waiting times for air ambulance service obviously have increased since the crash, but noted there are many possible solutions to the problem.
Nelson said that under the Hawaii system, there is no other fixed-wing provider designated for emergency air ambulance services and none of the other airlines is equipped to transport a patient.
Nelson said under the current "emergency," the state should allow other providers to augment the air services for patient transport.
Under the current state system, the Hawaii State Health Planning & Development Agency approves business proposals to provide emergency air ambulance service by issuing a certificate of need.
The business, in this case Hawaii Air Ambulance, operates the service for profit with no state subsidies.
The agency has received four formal applications and one pending request from businesses interested in providing air ambulance service.
The five businesses indicated they are filing "emergency applications" that could be decided by the agency with no public meeting.
ACI Pacific LLC, Big Island Air Inc., AirMed Hawaii LLC, and Premier Jets Inc. have made formal requests, and Pacific Medical Assets Inc. has filed an application but not paid the filing fee, said Darryl Shutter, the agency's regulatory branch chief.
Shutter said under state health administrative rules, the agency has until April 20 to make a decision regarding the first three applicants.