LIHUE — State and county officials expect the number of emergency medical response calls to rise as the elderly population on Kauai grows. But some say the dual response system of county fire department medics and private ambulatory transport is
LIHUE — State and county officials expect the number of emergency medical response calls to rise as the elderly population on Kauai grows.
But some say the dual response system of county fire department medics and private ambulatory transport is sufficient to handle the increase.
U.S. Census data from 2010 has Kauai’s 65-plus population at 16.1 percent, above the state’s average of 15.1 percent. The County Agency on Elderly Affairs anticipates Kauai’s elderly to comprise 25 percent of the island’s population by 2020, with more than half living alone.
About 68 percent of all calls to the Kauai Fire Department are for medical service, and the department averages around 3,500 annually, said Chief Robert Westerman.
That number may rise, but the demographics alone, combined with other factors, do not show a need to shift resources at this time.
“The aging of our citizens is not the only factor resulting in increased demand,” Westerman said. “We also have to take into account population growth as well as a growing visitor industry.”
KFD paramedics are also Emergency Medical Technicians and are the first-responders to provide basic life support to a victim at the scene along with a rescue truck and fire engine.
The state contracts American Medical Response to respond to calls and provide private transport service. They bring Medical Intensive Care Paramedics to perform advanced emergency medicine.
KFD absorbs the cost of each medical call into its budget. The department absorbs about $25,000 in annual, non-refunded expenses for medical responses and supplies, according to KFD.
The number is minuscule when compared to the department’s $23 million requested budget for fiscal year 2014. The 1.9 percent budget increase request, however, contrasts with a 7 percent total call load increase from 2012, and up 24 percent from 2002.
“We monitor trends closely to ensure we are on track for providing the best service possible,” Mayor Bernard Carvalho Jr. said. “The 2014 budget includes moneys for the Fire Department to work on a strategic plan update to address these issues and will help to improve services.”
KFD’s priority concerns are with increased housing density, improved GPS mapping and increased support for water safety and rescue teams. The department is exploring ways to recover costs.
AMR Operations Manager Tito Villanueva said the privately-owned national company operates under a term-based state contract for 911 response calls. It is not a fee for call reimbursement, he added, and the state renews the contract each year after comparing county ambulance response, quality and effectiveness data with national averages.
AMR has five 911 ambulance units based in Waimea, Koloa, Kapaa, Lihue and Kilauea, and one ambulance for inter-facility transport.
AMR offers advanced medical care, but there are still more fire stations than ambulance stations, Villanueva said. KFD is most often the first to arrive on the scene to offer rescue and extraction from vehicles or home, and basic life-saving support with oxygen and CPR.
“It is good for the patient to have an extra hand no matter how you look at it,” Villanueva said. “It makes sense to provide the community with better service.”
The neighbor islands run dual response systems and the Big Island is the only county fire department to provide paramedic and transport services. AMR provides inter-hospital transport and supports 911 call overflow.
The county fire department wants a dual response service that is efficient and within their budget, said Hawaii Fire Fighters Association President Bobby Lee.
The scale is different on Kauai when compared to the nearly $5 million that Honolulu County Fire Department spends on annual medical calls, he said, but it still presents a cost that could be recovered if structured differently.
“The state doesn’t reimburse bandages, equipment or anything to do with responses or training, and it is the same on Kauai,” Lee said.
“The best answer is to try and combine services and that is where one department provides both fire and EMS transport, like on the Big Island.”
The distance between stations on the Big Island make it necessary. It is also the only county with a volunteer firefighting force to respond in remote areas before full-time units arrive.
Kauai tried to become a sole response unit with transportation capability about five years ago, along with its own emergency communications center and medical supply room. The state canceled the program that would have funded it, Lee said, and since then, departments have not attempted to join the realm of public-private medical transport.
“There are a lot of good ideas out there,” Lee said. “At the end of the day, it is all about taking care of people.”
Westerman said the call load and demographic data helps KFD plan for an increased dedication of resources. KFD is not ready for fire-based EMS and transport, he said, but the department is exploring ways to improve service and increase capacity.
“The Fire Department does not operate in a silo,” Westerman said. “We are just one part of the first responder system, and so we must take into account how any change in our operations might affect partnering agencies.”
Dist. 16 State Rep. Dee Morikawa said the Hawaii Long-Term Care Commission’s 2011 report assists legislators in their work on addressing an increasing elderly population.
She said Kauai is fortunate to have enough hospitals, an ambulance service that covers the island, and KFD is providing excellent first responder service.
“We will address any immediate need for transport services, and if we did require the county to provide a service, I’m sure we would find a funding source,” Morikawa said. “The Legislature can provide funding out of the Emergency Medical Services Special fund for additional ambulance services where there is an extreme need.”
Dist. 14 State Rep. Derek Kawakami said the Legislature has appropriated funds for an Alzheimer’s and dementia services coordinator position within the State Executive Office on Aging.
This session saw funding for a task force on mobility management for elders and disabilities in each county, a Kupuna Care Program and a Healthy Aging Partnership Program.
On Kauai, Kawakami said it is important to maintain the operations and services of Kauai Veterans Memorial Hospital and Mahelona Hospital. The need to provide more services in the future is clear as our aging population increases, he added, which includes affordable assisted living facilities with response support.
“It is my belief that when it comes to health and safety, redundancy is often necessary especially when people’s lives are at risk,” Kawakami said.
