By Ian Bauer
The Honolulu Star-Advertiser
HONOLULU — 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 survey’s overwhelming results, Smith said, are in support of a calling on the city administration to create a task force to explore whether the city’s paramedics, who now operate under the Emergency Services Department, should be moved to the Honolulu Fire Department.
The requested move is based on allegations that the city’s ambulance service is unable to respond to daily emergencies on a timely basis. Low morale, understaffing and ongoing resignations among the paramedic corps are also of concern.
Smith indicated those problems are real for himself as well as rank-and-file paramedics.
“We went ahead and took it upon ourselves to do an internal survey amongst the personnel, ” Smith told the Council via remote testimony Wednesday before members voted to adopt Resolution 272.
He said that 273 field personnel were given the opportunity to voice their support or opposition to the resolution. Of the 190 who responded, 178 were in favor of the resolution and only 12 were opposed, according to Smith.
The reported results are reminiscent of a similar informal poll taken in May by city lifeguards—members of Hawaii Government Employees Association Bargaining Unit 15—who overwhelmingly supported creation of a stand-alone Department of Ocean Safety.
Via legislation signed into law that same month, Mayor Rick Blangiardi created the public safety sector that employs 294 lifeguards around Oahu’s 227 miles of coastline.
But unlike their lifeguard brothers and sisters, paramedics remain in the Emergency Medical Services Division under the Emergency Services Department.
Ongoing allegations of EMS’s faltering efforts were also recognized by City Council member Val Oki Moto, 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 and the introduction of Resolution 272.
Challenges facing EMS include “staffing 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, ” the resolution states.
“The 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, ” the resolution states.
Moreover, the resolution says “the 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.”
Retention issues
Also contained in the resolution are requests that the Mayor’s Office study possibly moving ESD’s Health Services Branch and Crisis Outreach Response and Engagement programs, or CORE, to other departments.
Further, the resolution urges that a task force on a potential EMS move include representatives from HFD, ESD and other city agencies, as well as from the Hawaii Fire Fighters Association, United Public Workers Hawaii and the HGEA.
Smith noted many of the EMS rank-and-file are “fearful of retaliation and retribution and are afraid to publicly express their stance on the resolution for or against.”
However, Adam Ogden, a 25-year EMS paramedic, showed up in person Wednesday to back Resolution 272.
“I reluctantly came in today to voice my support for this (resolution), ” he told the Council. “But I think it’s important.”
EMS “has had a lot of issues with retention because of the call volume and other problems causing our staff to leave, ” he explained. “A bunch of my colleagues in the past, and some of them recently, have reached out to the UPW for their support in changing certain things and they got kind of squashed. We’ve even had some discussions with our administration and that really hasn’t gone anywhere.”
Ogden noted EMS employees also reached out to the Mayor’s Office, adding “They were very supportive and super open to listen to what we had to say.”
To that, Okimoto asked Ogden to describe the morale of the EMS employees as well as unit closures—essentially, when an ambulance is not available to respond to 911 calls for service—“because I get different answers, and I’ve asked that several times from the department and I’ve heard different things.”
Ogden replied that he’s seen “a sharp decline in morale over the past few years. It’s getting to the point where people are leaving because of morale. We don’t feel like we have a lot of the support that we need from our administration.”
He said the increase in service calls, wage issues, lack of promotion opportunities and other concerns are causing paramedics to leave, with many getting jobs with federal, county and mainland fire departments or private ambulance services.
As far as unit closures, Ogden said there are 22 EMS units on Oahu.
“The island has a population of about a million or so, ” he said. “And on any given day, on average, we can close between one and five units. And it’s gone higher.”
At one point, he noted, 13 paramedic units closed.
“When you come to work and you look on the roster and you see all of 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-responder agencies have to wait longer too, he added.
Should a task force be established, Ogden said, “it will look at improving the working conditions of the men and women in EMS.”
“But that’s not the biggest reason, ” he added. “It’s more to better serve the public, the visitors that we serve.”
Push for pay increases
Neither EMS nor HFD officials spoke at Wednesday’s Council meeting.
Afterward, the Mayor’s Office offered a response to the city’s overall shortage of paramedics. Ryan Wilson , the mayor’s spokesperson, told the Honolulu Star-Advertiser that ESD is working with the Department of Human Resources to propose step movements for current paramedics and emergency medical technicians that would result in “immediate salary increases.”
“Additionally, the department is collaborating with the state to fund a Nurse Navigator program that would help to off-load non-emergency calls, thereby reducing call volume and alleviating strain on EMS crews, ” Wilson said.
“Our focus on solutions are multifaceted and involve hiring, retention, pay, workload stabilization and better facilities and equipment.”
To reduce ambulance response times, Wilson said “EMS needs to retain and hire additional EMS personnel.”
“Currently the city operates 22 ambulances, but high call volumes result in EMS crews responding to up to 18 calls within a 12-hour shift, ” he said. “The addition of the Nurse Navigator program will help to redirect thousands of nonemergency calls, freeing up EMS crews for life-threatening medical emergencies.
“Also, EMS emergency room patient distribution helps to alleviate the surges in patients at overwhelmed ERs, which has improved ER wait times for ambulances. But it can still exceed 30 minutes but now less commonly exceeds an hour, ” Wilson added. “We use the Hospital Capacity System dashboard to continuously track ER patient volumes, which regularly is 100 % or greater for many Oahu hospitals.”
As far as creating a task force, city Deputy Managing Director Krishna Jayaram previously told the Star-Advertiser that “the city is always open to exploring structural changes that will improve the operations and delivery of critical city services.”
“With respect to this particular resolution, we just 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 stated it’s begun a recruitment effort for paramedics and EMTs.
Starting pay for a city paramedic is $82, 248 a year, while an EMT II earns $64, 260 a year, according to a city news release.
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