Requires the Department of Health to integrate emergency aeromedical services into statewide emergency medical services. Appropriates funds for aeromedical services for Maui county, ambulance services for the Waianae Coast, and advanced life support ambulance services for parts of Maui and Hawaii. (SB745 HD2)

A BILL FOR AN ACT

PART I

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 that provides immediate critical care and transport by rotary-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:

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] that 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] those 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] those 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] shall be 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 emergency aeromedical program.

The aeromedical emergency medical services system shall serve the emergency health needs of the people of the State by identifying:

(c) The department shall use an emergency aeromedical services quality improvement committee comprised of representatives of trauma, emergency, and tertiary care physicians and providers 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 maintain and improve the Hawaii emergency aeromedical services system."

PART II

SECTION 5. The legislature finds that trauma patients, and severely injured or ill patients in the county of Maui require timely and rapid emergency aeromedical transport services to ensure that they receive definitive medical care at tertiary hospitals in Honolulu, Oahu. Although there are fixed-wing aeromedical services in the State of Hawaii, there is no guarantee that these services are readily available in remote rural areas.

The legislature further finds that Hawaii's fixed-wing aeromedical system is highly developed and sophisticated; moreover, it is the primary mode of aeromedical transport in Hawaii. In most instances, fixed-wing operations provide a more cost-effective and efficient mode of transport of trauma patients and seriously or critically ill patients who have been stabilized and require emergency medical transportation to a tertiary care facility.

The primary value of emergency aeromedical helicopter services is to augment fixed-wing operations, where a severely ill or severely injured person can be transported to the most appropriate medical facility. This is particularly critical in cases where fixed-wing planes cannot readily land. Aeromedical helicopters are able to pick up patients alongside roads, in mountainous areas, and in isolated places. In many cases, the time required for persons to receive definitive medical care is the single most important factor in their survival.

For the past decade, emergency room physicians and others have expressed concerns over Hawaii's inadequate emergency aeromedical system. Consequently, the legislature passed Act 59, Session Laws of Hawaii 1998, to require the department of health to develop a plan for aeromedical services. In response, the department of health submitted a report to the legislature in 1999. According to the report, a panel was convened in 1998 to examine the need for both fixed-wing and rotor-wing aeromedical services in Hawaii. The panel agreed that "an aeromedical system must assure timely transport of seriously ill and severely injured persons to definitive medical care facilities."

The legislature agrees that such a system must be in place to transfer patients from the initial receiving facility to an appropriate facility safely and in a timely manner. In addition, residents of the county of Maui have a particular need for these services because of the region's geographic isolation and limited access to transportation.

Consequently, the purpose of this part is to appropriate funds to the department of health to:

SECTION 6. There is appropriated out of the general revenues of the State of Hawaii the sum of $         or so much thereof as may be necessary for fiscal year 2003-2004 to fund emergency aeromedical helicopter services for the county of Maui; provided that the services funded provide transportation only in geographic locations and emergency situations where Hawaii's current fixed-wing operations are unable to provide appropriate service; provided further that no funds shall be made available under this part unless the county of Maui provides $     for the purpose for which this sum is appropriated.

In establishing this service, the department of health is encouraged to partner with the county of Maui, health care providers, and the private sector, to ensure that this necessary service is provided in the most cost efficient manner, utilizing all available resources.

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

PART III

SECTION 7. There is appropriated out of the general revenues of the State of Hawaii the sum of $           or so much thereof as may be necessary for fiscal year 2003-2004 for ambulance services for the Waianae Coast.

The sum appropriated shall be expended by the department of health for the purposes of this Act.

PART IV

SECTION 8. The legislature finds that the Kihei/Wailea region of Maui is a growing community and tourist center that includes only one twenty-four-hour, locally based, advanced life support ambulance service for its visitors and residents. Thus, in emergency situations occurring when the single overburdened ambulance is already on call, the response time of ambulances from nearby communities increases by an additional twenty to thirty minutes, depending on the location of the ambulance. The legislature further finds that in many emergency medical situations, this prolonged response time can mean the difference between life and death for individuals visiting or living in this community.

The purpose of this part is to provide parity in emergency health care for residents and visitors of the Kihei/Wailea region of Maui by providing an additional twenty-four-hour advanced life support ambulance service.

SECTION 9. There is appropriated out of the general revenues of the State of Hawaii the sum of $         or so much thereof as may be necessary for fiscal year 2003-2004 to provide sufficient twenty-four-hour advanced life support ambulance services for the Kihei/Wailea region of Maui.

The sum appropriated shall be expended by the department of health for the purposes of this Act.

PART V

SECTION 10. The legislature finds that unacceptably long and potentially life-threatening delays in emergency ambulance service have occurred in the Hawaiian Ocean View Estates area of the island of Hawaii. These delays, which can last up to two hours, occur when the Ka'u ambulance--located in Naalehu--is already on call. Although emergency medical technicians with the fire department can provide basic life support until a backup advanced life support ambulance with mobile intensive care technicians arrives on scene, there is a world of difference between the level of care that each kind of technician is qualified to provide. Delays in the provision of appropriate emergency medical care because of geography are inhumane and unfair.

Consequently, the purpose of this part is to appropriate funds to the department of health to provide emergency advanced life support ambulance service to the residents of Hawaiian Ocean View Estates on the island of Hawaii.

SECTION 11. There is appropriated out of the general revenues of the State of Hawaii the sum of $           or so much thereof as may be necessary for fiscal year 2003-2004 to provide emergency advanced life support ambulance service to the residents of Hawaiian Ocean View Estates on the island of Hawaii.

The sum appropriated shall be expended by the department of health for the purposes of this Act; provided that any emergency advanced life support ambulance and its crews shall be based at the fire station constructed by the volunteer fire department in Hawaiian Ocean View Estates.

PART VI

SECTION 12. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 13. This Act shall take effect upon its approval; provided that sections 6, 7, 9, and 11 shall take effect on July 1, 2003.