By Ian Bauer
The Honolulu Star-Advertiser
HONOLULU 鈥� Val Okimoto Val Okimoto The apparent inability of the city鈥檚 ambulance service to respond to daily emergencies on a timely basis is of concern to many current and former first responders.
The allegations of Honolulu Emergency Medical Services鈥� faltering efforts are also recognized by City Council member Val Okimoto, who recently said an overlong wait for an ambulance during a family emergency had, in part, prompted her concerns over the future operations of EMS.
To that end, Okimoto introduced Resolution 272, which asks the city administration to establish a task force to explore whether the paramedic program鈥攏ow operating under the city Emergency Services Department鈥攕hould be integrated into the Honolulu Fire Department.
Challenges facing EMS include 鈥渟taffing shortages that resulted in ambulance rigs being taken out of service and unit closures; increased transfer times due to hospital emergency departments running at or over capacity; and lost revenues due to the transfer of ambulance billing and management from the State of Hawaii to the city, 鈥� the resolution states.
鈥淭he integration of the EMS program into the HFD could improve emergency services on Oahu by consolidating administrative, dispatch, and communication functions, thereby alleviating the burden of increasing demand felt by both departments, 鈥� the resolution states.
Moreover, the resolution says that 鈥渢he integration of the EMS program into the HFD could prove over time to be fiscally responsible, while also providing better care through decreased response times and an increase in the number of available units and personnel.鈥�
The legislation also requests that the Mayor鈥檚 Office 鈥渟tudy the migration of the Health Services and Crisis Outreach Response and Engagement programs within HESD to other departments.鈥�
The legislation urges the city include representatives from HESD and HFD on the task force as well as the following entities:鈥擧onolulu Department of Human Resources鈥擧onolulu Department of Budget and Fiscal Services鈥擧awaii Fire Fighters Association鈥擴nited Public Workers Hawaii鈥擧awaii Government Employees Association During the Council鈥檚 recent Public Safety Committee meeting, EMS Assistant Chief Korey Chock鈥攁ppearing on behalf of HESD Director Jim Ireland鈥攕aid, 鈥淲e would like to stand in support of anything that鈥檚 going to improve the services of EMS on Oahu.鈥�
Okimoto later questioned Chock on EMS staffing issues that resulted in ambulance unit closures鈥攅ssentially, no paramedics made available to 911 calls for service.
鈥淥n average, what鈥檚 the highest number of units that will be closed at any time ?鈥� she queried.
鈥淚 think the highest number, and don鈥檛 quote me, was maybe seven units in a 24-hour period, 鈥� he replied.
Chock said the prospect of removing ambulance units from service was evaluated daily by the city. 鈥淲e try to look at different units around the island as (those ) not going to have a big impact on the service that鈥檚 provided, 鈥� he added. 鈥淪o that鈥檚 how our operations will look into the closures.鈥�
鈥淗ow do you determine which units will not be the most impacted ?鈥� Okimoto asked.
He said the city looks at 鈥渢he distance between multiple units.鈥�
鈥淚f there are five units in the town area, and we can afford to close one of those units versus an outlying unit, like in the country, we鈥檒l look at closing those units where there are more resources to cover that area, 鈥� Chock said, adding that rural-area ambulance units 鈥渁re less likely to be closed.鈥�
HFD Fire Chief Sheldon Hao also spoke at the meeting, saying his department would be 鈥渁 willing contributor to the task force.鈥�
However, the fire chief stated 鈥渃oncerns 鈥� about how a consolidation might affect HFD鈥檚 operations. That included addressing budgetary issues, staffing and labor issues.
The firefighters union supported the merger.
鈥淲e believe that this consolidation will create a stronger, more resilient and efficient service delivering immediate emergency care that will save lives, 鈥� HFFA Secretary-Treasurer Aaron Lenchanko told the committee.
An active-duty fire captain with 30 years of service, Lenchanko said EMS鈥� understaffing has been around for years. The dire situation, he added, was personal.
鈥淢y wife is a paramedic; she鈥檚 a unit supervisor, and she has 25 years in EMS, 鈥� he said. 鈥淭his has been a struggling problem ever since I鈥檝e been with (HFD) and before me, and it continues.鈥�
Edward Fujioka, a 45-year EMS district chief who鈥檚 now retired, agreed.
鈥淪ince the day I started, we could never fill all the vacancies in EMS, 鈥� he told the panel. 鈥淪o that鈥檚 45 years of an agency not being able to fill their staffing issues, and it鈥檚 gotten worse recently.鈥�
Fujioka also supported Chock鈥檚 prior statement that seven paramedic units were closed in one day.
鈥淎nd the current delivery of service for EMS is unsustainable, 鈥� he added, noting his full support of Resolution 272 鈥渢o form the task force to look for a solution.鈥�
The meeting drew over 100 written testimonials鈥攎ost coming from first responders鈥攊n support of forming a task force.
Among them, Christopher Sloman, a former acting chief at EMS, said ongoing issues at the agency included 鈥渁dministrative overreach.鈥�
鈥淐urrently, EMS operations are heavily influenced by bureaucratic decisions that often prioritize political agendas over public welfare and professional development, 鈥� he said. 鈥淭his has led to a systemic inefficiency where decisions do not always reflect the best interests of service delivery or personnel development.鈥�
A 鈥渓ack of merit-based promotion 鈥� also exists, he said.
鈥淚nstead, there is a noticeable inclination to favor personal connections or political affiliations, which undermines morale and potentially compromises service quality, 鈥� Sloman said.
Resource allocation was of concern, too, he added.
鈥淔unds intended to enhance EMS capabilities are sometimes redirected or allocated in ways that benefit external business interests rather than directly improving emergency services, 鈥� he said. 鈥淭his misallocation not only affects service delivery, but also hampers the professional growth opportunities for EMS personnel.鈥�
鈥淭he integration of EMS with HFD presents an opportunity to transform emergency services in Honolulu into a model of efficiency, professionalism and community-focused service, 鈥� Sloman said.
But not everyone backed a consolidation of services.
鈥淎s a firefighter and former EMS (mobile intensive care technician ) 鈥� I must strongly express opposition to a potential merger at this time, 鈥� C. Lee said. 鈥淭he efficiency and quality of service HFD provides is not mirrored by EMS.鈥�
Lee noted that HFD, via the Commission on Fire Accreditation International, remained an 鈥渁ccredited agency 鈥� that 鈥渋s held accountable to standards 鈥� for such things as adequate fire service staffing and response times.
鈥淓MS has no such metric and lacks the (quality assurance and quality improvement ) methodology to uphold the standard of excellence in community service, 鈥� Lee said.
Ultimately, the committee voted to recommend Resolution 272 for full Council adoption.
After the meeting, city Deputy Managing Director Krishna Jayaram told the Honolulu Star-Advertiser that 鈥渢he city is always open to exploring structural changes that will improve the operations and delivery of critical city services.鈥�
鈥淲ith respect to this particular resolution, we just recently made the Honolulu Ocean Safety Department independent from Honolulu Emergency Services Department, and we are going to take the time to evaluate the impact on HESD, 鈥� he said. 鈥淭hen, when appropriate and as needed, we would conduct a thorough and thoughtful examination of whether an integration of HESD into the Honolulu Fire Department makes sense.鈥�
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