News Story

Critical Delays
Maui News

By ILIMA LOOMIS, Staff Writer

WAILUKU – When 11-year-old Kaliko Leialoha-Dutro was run over by a “monster truck” while riding his bike through Waiehu in March, ER doctors at Maui Memorial Medical Center decided he needed to be seen by trauma specialists in Honolulu. The boy had a dislocated hip, a fractured pelvis, a lacerated liver and internal bleeding. But because Hawaii Air Ambulance planes were busy with other patients, and it was too dark for Maui’s new helicopter ambulance to fly, he ended up spending almost 12 hours in the Maui emergency room waiting for transportation.

“That’s a parent’s worst nightmare come true,” said Kaliko’s father, David T.M. Leialoha, “to have a child hurt, and not have the medical system to get them where they need to be.” Kaliko was lucky. By the time he arrived at The Queen’s Medical Center’s trauma unit the next morning, his liver had stopped bleeding on its own, and he was out of danger. But Dr. Pedro Giron, who treated Kaliko on Maui, said it was one of many close calls.

Long delays in getting emergency transportation for patients to medical specialists in Honolulu are a regular concern for emergency room doctors, he said. “Fortunately, (this case) turned out well, but one of these days it won’t turn out well,” he said. Maui Memorial Chief ExecutiveOfficer Wesley Lo said the hospital has “had issues” with air ambulance delays for some time. Wait times can vary, but they average four or five hours, he estimated. Nonemergency patients, like psychiatric cases, can sometimes wait a day or more for transport. Hawaii Air Ambulance CEO Andrew Kluger said his company’s response times depend on how many patients need to be transported, and which ones are the most critical.

“There are many days when there’s not any delays, and there’s some days when there’s an inordinate amount of calls,” he said. The bottom line is that patients are triaged so the person in the most serious condition is transported first, he said, and that was the case with Kaliko Leialoha-Dutro.

“There were many more critical patients before that child,” Kluger said. Doctors in Maui’s emergency room who think their patients can’t wait for a Hawaii Air Ambulance flight are more and more often turning to Maui County’s medevac helicopter to fly patients to Honolulu. Long delays lead them to call the helicopter, even though Hawaii Air Ambulance’s fixed-wing planes are considered safer, are less expensive, and can provide a higher level of patient care during flight, Lo said.

“The helicopter has been well received by nurses and physicians as an alternative form of transportation,” he said. That contradicts the helicopter’s operating protocols, which say it is intended to be “primarily a 911 resource” and that it is “not intended to take the place of existing interfacility fixed-wing air ambulance transportation.”

In its first seven months of service, the helicopter was used more often to transfer a patient from one hospital to another than it was to respond to the scene of an emergency. Out of 53 flights, 72 percent were transfers and 28 percent were scene calls, according to a state Department of Health report.

While Hawaii Air Ambulance is a private company that receives no government funding, the Maui Emergency MedEvac Helicopter is a state-run program that costs taxpayers $1.2 million, made up of equal parts state and county funds.

Curt Morimoto of American Medical Response, the ground-ambulance company that received the state contract to run the helicopter program last year, said he was not surprised the helicopter was being used so heavily for interfacility patient transfers. “We anticipated that,” he said, noting that a past helicopter ambulance system run by Mercy Air also flew a high number of transfers. He also said it had been expected that the helicopter would not respond to many emergencies in central parts of Maui, including much of West Maui, because of the time it would take the helicopter to pick up medics in Kula or Wailea.

“For a lot of those calls, it’s just as fast to bring them in by (ground) ambulance,” Morimoto said. When the system of sharing the paramedics was first proposed, critics of the helicopter ambulance design said it would not provide faster service to West Maui and other regions. The helicopter ambulance does not have a dedicated medical crew and must fly from Kahului Airport to Kula to pick up medics before responding to an emergency.

Still, Morimoto said the helicopter is fulfilling its mission and is providing life-saving service, especially to the outlying regions of the county that are far away from medical services. For people injured on Molokai, Lanai or Kahoolawe, or in Hana or Kaupo, he said, “It’s still going to beat a ground ambulance, no matter what.” Of the 15 flights the helicopter has made to the scene of an emergency, five were to Hana, five to other remote areas of Maui, three to Molokai, and one each to Lanai and Kahoolawe.

An Oahu man who was attacked by a shark off Molokai in September considered himself living proof that the helicopter was providing a life-saving service. “It was all the difference in the world,” said Davy Sanada, reached at home Saturday. The helicopter took him from remote Pukoo in East Molokai to Maui Memorial in 56 minutes – hours less than it would have taken to move him by ground ambulance and fixed-wing air ambulance.

“I think it was a big part of my survival that day,” he said. But even though the helicopter’s protocols say it is “intended to be available 24 hours daily, seven days per week,” there are restrictions on when it can fly. Bad weather can keep it grounded, and the same protocol says the helicopter should not fly at night unless the moon is more than half full and above the horizon. Morimoto said the guidelines were borrowed from a similar system in place on the Big Island.

“There are X number of days in the month that, because of the (protocol), they will not fly at night,” he said. That was the case on the night of March 6, when Giron called for the helicopter to transport Kaliko Leialoha-Dutro. “They said it was too dark to fly,” he said. Giron said he was “happily surprised” by the degree to which the medevac helicopter has transported patients to Honolulu, but he and other ER doctors were still concerned about ongoing delays in the system as a whole. “We’re stunned that this is an island state . . and we have this air transport that regularly leaves us hanging,” he said. “It’s inadequate.”

Hawaii Air Ambulance CEO Andrew Kluger said emergency room doctors don’t always see the big picture when it comes to transporting patients. “Every doctor feels their patient is most important,” he said. “What they don’t realize is we’re serving 10 airfields and countless patients.” Kluger said that in the case of Leialoha-Dutro, there were patients with more serious injuries who had to be transported first.

There may also have been a problem of miscommunications. Although Maui doctors say the boy suffered internal bleeding, Kluger said his medical staff was told the injury was a broken leg. He also said that the air ambulance medics reported the boy was sitting up, asking questions about the plane and showing “no distress” during the flight. HAA Dispatch records showed that Maui Memorial staff called for an air ambulance around 11:30 p.m., and a plane picked up the boy at Kahului Airport at 6:36 a.m., Kluger said.

The child’s mother, Piikea Dutro, said he arrived at the hospital around 7 p.m. Kluger said he didn’t know why Maui’s medevac helicopter was being used for so many interfacility transfers, but he thought that “there are a number of doctors at Maui Memorial that feel the helicopter is there to serve the hospital.”

Protocol requires doctors to call Hawaii Air Ambulance dispatchers to request the helicopter for a hospital-to-hospital transfer, and it says the helicopter should be used only if a Hawaii Air Ambulance plane would take more than two hours to respond. But Kluger said some doctors “bypass” Hawaii Air Ambulance dispatchers and call the helicopter directly. “Sometimes protocols are followed, and sometimes they’re not,” he said. While the new system has occasionally been “difficult,” Kluger said that overall, he was satisfied with it.

“I don’t consider the helicopter to be anything but excellent,” he said. “We work together very well.” State Sen. Roz Baker, who was a driving force behind the creation of the helicopter ambulance at the Legislature, said she thought the medevac helicopter was doing its job. “I’m very satisfied,” she said. “I think it’s done exactly what it was envisioned to do. I know we’ve had a number of lives saved because the helicopter was available.”

Initially there was concern that the helicopter should focus on scene calls as its primary mission, not interfacility transfers. But Baker said that medics and other health professionals say it has been useful in getting patients to Oahu when other means of transportation weren’t available. “They seem to think it’s working very well,” she said.

The high number of helicopter transfers aren’t a reflection on Hawaii Air Ambulance’s abilities, she said, because there could be many reasons why the helicopter was used instead of a plane. She said she was aware of past “issues” with Hawaii Air Ambulance wait times. But she reiterated that there were many factors behind the delays, and felt that Hawaii Air Ambulance was “pretty much back on track.”

Maui Sen. Shan Tsutsui, who previously questioned the awarding of the helicopter contract to AMR without a competitive bid process, said he still is not sure how well the system was working. He planned to study the issue over the summer months. “In terms of, am I satisfied, I don’t think I can be confident and say, yes, I’m fully satisfied, but I want to look into ways that we can improve the service,” he said. To Piikea Dutro, the only thing that matters is that neither the plane nor the helicopter was there when her son needed them. “God forbid something like this happens to a family, they need the service and the service can’t provide,” she said. “It sucks.” Ilima Loomis can be reached at iloomis@mauinews.com. Moving

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