Up in the Air

Patient transport raises larger concerns about Hawai’i’s medical system.
The transport is provided by the military, but patient care onboard is given by Honolulu’s EMS department. photo: courtesy of the Queen’s Medical Center

With the March 8 crash of a Hawai’i Air Ambulance flight on Maui, and the April 1 pull-out of the Army’s medevac helicopters—which O’ahu has relied on to transport critical patients since 1974—we wondered, who is going to fly us to a hospital if we get into a car wreck?

The Army’s service is officially called mast, for Military Assistance to Safety and Traffic. It was run out of the 68th Medical Detachment, which has been deployed to Iraq and will be unavailable until the fall of 2007.

"This community doesn’t realize what a service they were providing," says Elizabeth Char, M.D., the director of the Honolulu Emergency Services Department. "They had the flight crews and did the maintenance of the aircraft."

The Hawai’i National Guard has stepped in for limited medical transports, using five Blackhawk helicopters and crews, until July 1, when the military is expected to establish contract services. Janice Okubo, of the state Department of Health, says both the military and the state would like to continue the MAST arrangement when the team returns from deployment.

Unlike the 24-hour availability of MAST, the interim medical service will run from 11 a.m. to 11 p.m; during nonpeak hours, ground ambulances will provide support. The state is required to provide ambulances, but not airlifts. Still, no one doubts the necessity of the service.

"There’s that Golden Hour, where if you get someone into the emergency room within an hour of a trauma, they have a much better chance of surviving—and reducing long-term damage, so it also makes economic sense," points out state Sen. Fred Hemmings.

On O’ahu, there are only about 100 helicopter transports a year, primarily to the Queen’s Medical Center’s Level II trauma center (it receives 1,500 patients a year, total). Maui County has similar numbers—12 lifts in February—and uses a government-subsidized helicopter for its three islands, bringing patients to Maui Memorial or to O’ahu. The Hawai’i County Fire Department has a helicopter for medical emergencies, but it is not rated for travel over water.

Hawai’i Air Ambulance, founded in 1979, operates fixed-wing medical transport flights. "They do about 200 lifts a month," says state Department of Health director Chiyome Fukino, M.D. "They bring anyone that needs to come to O’ahu for a procedure, or is in critical condition—it’s a range. The Neighbor Islands have smaller populations, so they are unable to sustain certain kinds of medical services."

Hawai’i Air Ambulance is the only private player. "What prevents people from coming into this business is the size of the population," says Fukino. "This is a very expensive business."

Fukino hopes to improve the quality of emergency medical and trauma care on the Neighbor Islands, so that fewer flights will be necessary. An American College of Surgeons study last fall recommended that the state bring up trauma centers on all the Islands. "We’re working to make Maui Memorial a Level III trauma center, and eventually push it to Level II," says Fukino.

"We need to work hard as a state to get the level of services up on the Neighbor Islands, so that people can transferred on an as-needed basis, not an everyday basis. Ultimately, that will improve the quality of all healthcare."