Honolulu’s paramedics and emergency medical technicians face exhaustion due to extensive overtime work within a chronically understaffed agency. This situation sometimes results in ambulances remaining unused due to a lack of drivers.
A long-discussed solution involves merging the city’s Department of Emergency Services with the Fire Department. Such a merger could help consolidate resources, streamline dispatch operations, and deliver improved, cost-efficient medical services.
City officials have revisited this potential merger on multiple occasions, specifically during the 1990s, early 2000s, and again around 2011. In 2011, the city invested $175,000 in a consultancy that recommended merging the departments, then including lifeguards. However, this consolidation did not occur.
Fast forward over a decade, and the merger is up for discussion once more. By December, the City Council had passed a resolution to form a task force dedicated to considering this merger. Council member Val Okimoto put forward this resolution in light of grievances from both past and current EMS workers about ongoing understaffing issues and diminished team morale.
“If changes aren’t initiated now, this problem will persist,” Okimoto stated. “We might find ourselves in the same predicament decades down the line without a solution.”
Addressing these systemic issues is anticipated to be neither quick nor straightforward.
‘Ambulance Service Close to Breaking Point’
The dilemma concerning Honolulu’s ambulance services is not newfound. Discussions have circulated for more than 30 years about addressing the overburdened system.
In 1992, an auditor described a workforce of committed and proud employees working under gross inefficiency, with operations in certain areas reaching critical thresholds.
Recommendations from the auditor involved better preventative maintenance for ambulances, increased user fees to bolster EMS, and modifications in worker schedules and placements.
Attilio Leonardi, who served as the fire chief from 1998 to 2006, recalled the notion of merging departments surfacing repeatedly during his career.
A 1994 independent consultancy recommended examining a merger, prompting council member John Henry Felix to instigate a task force for study purposes. After two years, he attempted a charter amendment vote, but the council declined it.
Leonardi proposed the merger again in 2005, but it did not advance further. While open to the idea, he noted the challenges of integrating EMS and firefighter training requirements into a single unit.
Consultants Advocated for Efficiency and Savings
In subsequent years, the conversation reignited. The city tasked Emergency Services Consulting International with evaluating the situation. Their comprehensive report identified challenges mirroring current issues and suggested a merger as a potential remedy.
High urban ambulance usage has culminated in staff burnout. The dependency on overtime to fulfill demand, a lack of career progression opportunities, and workforce competition against federal fire departments were documented.
The city implemented a convoluted dispatch system for these services, transferring 911 calls to the Department of Emergency Services instead of directly dispatching ambulances. This often resulted in callers being placed on hold when ambulance availability was lacking.
Separate dispatch for ambulances and fire trucks prevented a cohesive performance assessment of emergency responses. Fire department response times were measured differently from EMS, highlighting the absence of consistent metrics for evaluating overall response efficacy.
Consultants argued that merging the departments might evenly distribute workload among responders, vehicles, stations, and dispatchers, thus minimizing delays. Some personnel would undergo cross-training, and applicants willing to be cross-trained could be prioritized for hiring. Firefighters with advanced medical training could independently manage calls, easing paramedic demand.
The consultants asserted that merging could address fundamental EMS challenges while preparing the unified department to respond to future demands, such as the needs of an aging population. They projected that consolidation could reduce staff numbers and save the city roughly $10 million over five years. However, Honolulu Emergency Services Department Director Jim Ireland refuted this estimate, arguing additional training costs would elevate employee salaries.
The merger became a pivotal topic during the 2012 mayoral race, notably featuring in Kirk Caldwell’s campaign. However, divergences existed regarding EMS workers’ representation by United Public Workers and the firefighters’ representation by the Hawai‘i Firefighters Association.
The consultancy report became contentious, partially due to perceptions of bias favoring the fire department, given its connections with the International Association of Fire Chiefs. The city’s Ethics Commission examined whether the consultancy contract was improperly awarded following amendments by a city officer. Additionally, the state health department, which financed the city’s ambulance system at the time, requested a say in the outcome.
While Caldwell triumphed in the election, the merger endeavor collapsed due to resistance from the EMS union, departmental leadership changes initiated by Caldwell, and potential impacts on state funding for ambulance services.
Moving Forward with Considerations
The city may be stepping into familiar territory again. City managing director Mike Formby flagged the merger issue early in Mayor Rick Blangiardi’s administration in 2021. Priority was initially given to redefining the EMS department and segregating lifeguards into a distinct unit.
In December, several current and past EMS personnel advocated for initiating a task force to delve into the merger.
Caldwell suggested that a merger might be smoother today since the state no longer manages Honolulu’s EMS system. Yet he indicated that union concerns remain pivotal.
UPW state director Kalani Werner echoed cautious optimism regarding the task force, voicing apprehension about potential job losses from the merger. He emphasized the longstanding union apprehension tied to previous integration discussions. “While the UPW advocates for enhanced emergency services and improving EMS members’ working conditions, we’re wary of role reductions post-merger,” he mentioned.
Deciding on a merger isn’t an immediate fix for current ambulance service challenges. Despite the council’s task force call, no meetings have occurred. Formby, having a list of task force volunteers, anticipates initiating discussions by mid-year.
The task force is set to comprise representatives from the departments, unions, human resources, and budget sectors. Formby expresses confidence in maintaining a process-driven timeline over rigid deadlines.
A projected $250,000 allocation for consultancy is set within the budget year starting July.
Should a merger move forward, the process could span three to five years, as projected back in 2011 by consulting firms familiar with the city’s emergency services operations.