Report Title:

Emergency Medical Services; Aeromedical Services


Requires DOH to integrate emergency aeromedical services into statewide emergency medical services; establishes emergency aeromedical system and quality improvement committee; appropriates funds for aeromedical services for Maui county.


S.B. NO.









relating to emergency medical services.




SECTION 1. Section 321-222, Hawaii Revised Statutes, is amended by adding a new definition to be appropriately inserted and to read as follows:

""Emergency aeromedical services" means a secondary response system which provides immediate critical care and transport by rotary-wing or fixed-wing aircraft of a patient to a facility that provides specialized medical care."

SECTION 2. Section 321-224, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(a) In addition to other functions and duties assigned under this part, the department shall:

(1) Regulate ambulances and ambulance services;

(2) Establish emergency medical services throughout the State, including both rotary-wing and fixed-wing emergency aeromedical services, which shall meet the requirements of this part, subject to section 321-228;

(3) Review and approve the curricula and syllabi of training courses offered to emergency medical services personnel who provide basic, intermediate, and advanced life support, consult and coordinate with the University of Hawaii, or any other accredited community college, college, or university, or any professional organization that provides emergency medical services training, regarding the training for basic, intermediate, and advanced life support personnel, as provided in section 321-229;

(4) Collect and evaluate data for the continued evaluation of the state system, subject to section 321-230;

(5) Coordinate emergency medical resources and the allocation of the state system's services and facilities in the event of mass casualties, natural disasters, national emergencies, and other emergencies, ensuring linkage to local, state, and national disaster plans, and participation in exercises to test these plans;

(6) Establish, administer, and maintain a communication system for the state system;

(7) Assist each county in the development of a "911" emergency telephone system;

(8) Secure technical assistance and other assistance and consultation necessary for the implementation of this part, subject to section 321-230;

(9) Implement public information and education programs to inform the public of the state system and its use, and disseminate other emergency medical information, including appropriate methods of medical self-help and first-aid, and the availability of first-aid training programs in the State;

(10) Establish standards and provide training for dispatchers in the state system, and maintain a program of quality assurance for dispatch equipment and operations;

(11) Establish a program that will enable emergency service personnel to provide early defibrillation;

(12) Establish within the department the emergency medical service system for children;

(13) Consult with the advisory committee on matters relating to the implementation of this part; and

(14) Establish and maintain standards for emergency medical services course instructor qualifications and requirements for emergency medical services training facilities."

SECTION 3. Section 321-228, Hawaii Revised Statutes, is amended to read as follows:

"321-228 Emergency medical services; counties. The department [of health] shall determine, in consultation with the advisory committee under section 321-225, the levels of emergency medical services, which shall be implemented in each county. The department [of health] may contract to provide emergency medical services including emergency aeromedical services or any necessary component of a county emergency services system in conformance with the state system. In the event any county shall apply to the department to operate emergency medical ambulance services within the respective county, the department [of health] may contract with the county for the provision of such services. The department shall operate emergency medical ambulance services or contract with a private agency in those counties which do not apply to it under this section. Any county or private agency contracting to provide emergency medical ambulance services under this section shall be required by the department to implement such services in a manner and at a level consistent with the levels determined under this section."

SECTION 4. Section 321-230, Hawaii Revised Statutes, is amended to read as follows:

"321-230 Technical assistance, data collection, evaluation. (a) The department [of health] may contract for technical assistance and consultation, including but not limited to categorization, data collection, and evaluation appropriate to the needs of the state system. The collection and analysis of statewide emergency medical services data, including pediatrics, trauma, cardiac, medical, and behavioral medical emergencies is for the purpose of improving the quality of services provided.

The department of health may implement and maintain a trauma registry for the collection of information concerning the treatment of critical trauma patients at state designated trauma centers and carry out a system for the management of that information. The system may provide for the recording of information concerning treatment received before and after a trauma patient's admission to a hospital or medical center. All state designated trauma centers shall submit to the department of health periodic reports of each patient treated for trauma in the state system in such manner as the department shall specify.

For the purposes of this [section,] subsection, "categorization" means systematic identification of the readiness and capabilities of hospitals and their staffs to adequately, expeditiously, and efficiently receive and treat emergency patients.

(b) The department shall establish, administer, and maintain an aeromedical emergency medical services system designed to collect and analyze data to measure the efficiency and effectiveness of each phase of an aeromedical program.

The aeromedical emergency medical services system shall serve the emergency health needs of the people of the State by identifying system strengths and weaknesses, the allocation of resources, and the development of aeromedical service standards. The department, in the implementation of this subsection, shall plan, coordinate, and provide assistance to all entities and agencies, public and private, involved in the system.

The aeromedical emergency medical services system shall measure, but is not limited to, the following factors:

(1) Communication and dispatch, including:

(A) Time at initial medical facility for stabilization;

(B) Availability and flight time of rotary-wing and fixed-wing emergency aeromedical services to the nearest airport or point of patient access;

(C) Availability and transport time by ground ambulance from hospital to airport or point of patient access;

(D) Flight time of rotary-wing and fixed-wing aircraft to Honolulu airport or receiving medical facility; and

(E) Availability and transportation by ground ambulance to the designated medical center;

(2) Medical oversight by physicians; and

(3) License and standards of emergency aeromedical services.

(c) The department shall establish an emergency aeromedical services quality improvement committee to analyze information collected from the aeromedical quality improvement performance measures as established by the American College of Surgeons, and to recommend system standards and resources to improve the Hawaii emergency aeromedical services system. The director of health shall appoint members to the committee, as follows:

(1) One member from each county representing hospital physicians;

(2) One member representing a major trauma center;

(3) One member specializing in tertiary pediatrics;

(4) One member representing burn center physicians;

(5) One member representing rotary-wing aeromedical services;

(6) One member representing fixed-wing aeromedical services; and

(7) One member representing ground ambulance services."


SECTION 5. The legislature finds that Hawaii, as an island state, is dependent upon the aeromedical transportation of patients from neighbor island medical facilities who require specialized care at tertiary hospitals in Honolulu. The rural nature of neighbor island communities also requires long ground transport times to medical facilities with the capability to stabilize and treat critical medical conditions. An aeromedical system must assure timely transport of seriously ill and injured persons to definitive medical care facilities.

In particular, Maui county is in need of a helicopter aeromedical unit. Residents of the islands of Maui, Molokai, and Lanai are without an adequate aeromedical system to meet the American College of Surgeons performance measure of four hours from the time a serious head injury patient arrives at the initial receiving facility until arrival at a facility capable of providing appropriate medical care.

The purpose of this part is to establish an intra-county helicopter critical care aeromedical service for the islands of Maui, Molokai, and Lanai, which operates twenty-four hours a day, and is adequately staffed by medical personnel to provide rapid transport to appropriate medical care and transportation facilities.

SECTION 6. There is appropriated out of the general revenues of the State of Hawaii the sum of $2,600,000, or so much thereof as may be necessary for fiscal year 2003-2004, for funding an intra-county helicopter aeromedical service for the county of Maui.

The sum appropriated shall be expended by the department of health through its emergency medical service system for the purposes of this Act.


SECTION 7. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 8. This Act shall take effect upon its approval, provided that section 6 shall take effect on July 1, 2003.