Kea Smith, a 14-year paramedic station supervisor with the city and county of Honolulu, said his first responder colleagues recently completed a survey.
The overwhelming results of the study, according to Smith, support calls for the city government to create a task force to investigate whether the city’s paramedics, who now operate under the Emergency Department, should be transferred to the Hono lulu Fire Department transferred.
The requested action is based on allegations that the city’s ambulance service is unable to respond in a timely manner to everyday emergencies. Low morale, understaffing and continued redundancies in the paramedic corps are also worrying.
Smith indicated that these problems are real, both for himself and for regular paramedics.
“We have gone ahead and taken it upon ourselves to conduct an internal investigation of the staff,” Smith told the Council via remote testimony Wednesday before members voted to adopt Resolution 272.
He said 273 field personnel were given the opportunity to express their support or opposition to the resolution. Of the 190 who responded, Smith said 178 were in favor of the resolution and only 12 were against.
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The reported results are reminiscent of a similar informal poll conducted in May by city lifeguards — members of Hawaii Government Employees Association Bargaining Unit 15 — who overwhelmingly supported the creation of a stand-alone Department of Ocean Safety.
Through legislation signed that same month, Mayor Rick Blangiardi created the public safety sector that employs 294 lifeguards around Oahu’s 240 miles of coastline.
But unlike their lifeguard brothers and sisters, paramedics remain in the Emergency Medical Services department under the Emergency Department.
Persistent accusations of EMS’s faltering efforts were also acknowledged by City Council Member Val Oki Moto, who recently said that waiting too long for an ambulance during a family emergency had raised her concerns about EMS’ future operations and the introduction of Resolution 272 .
Challenges facing EMS include “staffing shortages that have resulted in ambulance facilities being taken out of service and units being closed; longer transfer times due to hospital emergency departments operating at or over capacity; and lost revenue resulting from the transfer of ambulance billing and management from the State of Hawaii to the City,” the resolution said.
“The integration of the EMS program into the HFD could enhance emergency services on Oahu by consolidating administrative, dispatching and communications functions, easing the burden of increased demand felt by both departments,” the resolution said .
Additionally, the resolution says that “the integration of the EMS program into the HFD could prove fiscally responsible over time, while also providing better care through shorter response times and an increase in the number of available units and personnel.” ”
Retention Issues The resolution also includes requests for the Mayor’s Office to investigate the possible relocation of the Health Services Branch and Crisis Outreach Response and Engagement (CORE) programs from ESD to other departments.
Furthermore, the resolution calls for a task force for a possible EMS response to include representatives from HFD, ESD and other city agencies, as well as the Hawaii Fire Fighters Association, United Public Workers Hawaii and the HGEA.
Smith noted that many EMS members “fear retaliation and retaliation and are afraid to publicly express their position for or against the resolution.”
However, Adam Ogden, a 25-year-old EMS paramedic, showed up in person Wednesday to support Resolution 272.
“Today I came in reluctantly to express my support for this (resolution),” he told the Council. “But I think it’s important.”
EMS “has had a lot of issues with retention due to call volume and other issues that caused our staff to leave,” he explained. “Some of my colleagues from the past, and some of them recently, have reached out to the UPW for their support in changing certain things, but they were kind of squashed. We even had some conversations with our administration and that actually yielded nothing.”
Ogden noted that EMS workers also contacted the mayor’s office, adding, “They were very helpful and super open to listening to what we had to say.”
At that, Okimoto asked Ogden to describe paramedic morale, as well as unit closures — essentially, when no ambulance is available to respond to 911 calls for help — “because I’m getting different answers, and I’ve been asking I’ve heard that from the department several times and I’ve heard different things.”
Ogden responded that he has “seen a sharp decline in morale in recent years. It’s getting to the point where people are leaving because of morale. We don’t feel like we’re getting a lot of the support from our administration that we need.”
He said the increase in service calls, pay issues, lack of promotion opportunities and other concerns are causing paramedics to leave, with many taking jobs with federal, provincial and mainland fire departments or private ambulance services.
As for unit closures, Ogden said there are 22 EMS units on Oahu.
“The island has about a million inhabitants,” he said. “And on any given day we can close an average of one to five units. And it has gone even higher.”
At one point, he noted, 13 paramedic units were closed.
“When you come to work and look at the schedule and see all these units closed, you know you’re going to have to work harder,” Ogden said. “And it trickles down to the community. The community has to wait longer.”
HFD and other first responders also have to wait longer, he added.
Should a task force be created, Ogden said, “it will focus on improving the working conditions of the men and women in EMS.”
“But that’s not the biggest reason,” he added. “It’s more about better serving the public, the visitors we serve.”
Pushing for Pay Increases Neither EMS nor HFD officials spoke at Wednesday’s Council meeting.
The mayor’s office then offered a response to the city’s overall shortage of paramedics. Ryan Wilson, the mayor’s spokesman, told the Honolulu Star-Advertiser that ESD is working with the Department of Human Resources to propose step moves for current paramedics and emergency medical technicians that would result in “immediate salary increases.”
“Additionally, the department is working with the state to fund a Nurse Navigator program that would help offload non-emergency calls, reducing call volume and easing the burden on ambulance personnel,” Wilson said.
“Our solutions focus is multi-faceted and includes hiring, retention, pay, workload stabilization and improved facilities and equipment.”
To reduce ambulance response times, Wilson said, “EMS must retain and hire additional ambulance personnel.”
“The city currently has 22 ambulances, but high call volume means that paramedics are responding to as many as 18 calls within a 12-hour shift,” he said. “The addition of the Nurse Navigator program will help divert thousands of non-emergency calls, freeing up paramedics to respond to life-threatening medical emergencies.
“Additionally, emergency department patient distribution helps alleviate patient surges in overloaded ERs, which has improved ambulance wait times in ERs. But it can still last longer than 30 minutes, but now less often longer than an hour,” Wilson added. “We use the Hospital Capacity System dashboard to continuously track emergency patient volumes, which are regularly 100% or more for many Oahu hospitals.”
As for setting up a task force, the city’s deputy director, Krishna Jayaram, previously told the Star-Advertiser that “the city is always open to exploring structural changes that will improve operations and delivery of critical city services.”
“Regarding this specific resolution, we recently made the (city) Ocean Safety Department independent from (ESD), and we are going to take the time to evaluate the impact on (ESD),” he said.
On Friday, EMS said it has begun a recruitment effort for paramedics and EMTs.
The starting salary for a city paramedic is $82,248 per year, while an EMT II makes $64,260 per year, according to a city news release.
