Play Live Radio
Next Up:
Available On Air Stations

Blangiardi Administration And State Lawmakers Come To Agreement On EMS Transfer


A proposal to transfer the responsibility of O?ahu's emergency services system from the state to the city is moving forward at the legislature. Although city offiicals were surprised at first, the Blangiardi administration believes it will improve ambulance services on the island.

Hawai?i is the only state in the country that regulates and funds the EMS systems of its counties. Paramedic services are generally the responsibility of local municipalities, and can be part of a county's fire department.

However, the state legislature is aiming to transfer the responsibility under House Bill 1281. It proposes a four-year transfer of O?ahu's EMS system starting as soon as July.

Under the measure, the state would give the City and County of Honolulu $46 million in operational expenses for the first year, and reduce that amount over the next three -- until the city is solely responsible for the system.

It costs roughly $50 million to operate O?ahu's ambulance service.

Earlier this year, the City Council urged state lawmakers, and the Blangiardi Administration, to oppose the bill. The Council cited concerns with taking on the financial responsibility tied to the EMS system, during a time when it was trying to make ends meet.

Mayor Rick Blangiardi says the administration wasn't opposed to the idea, but didn't have time to do its due diligence before the bill was introduced.

"We were being asked to take over a business that was running at a deficit. [It's] been, historically, losting $20 million a year," Blangiardi said. "And all were were doing is asking the prudent due diligence questions, so we could best understand and ensure, for ourselves, that we have the proper party to make the decisions we need to run that business."

Since then, the administration has worked with state lawmakers to come to an agreement. Specifically, the revenues attached to the EMS system.

"Initially, we weren't able to keep the billing at the City and County level -- the state was going to keep the billing," said Dr. James Ireland, director-designate for the city's emergency services department.

"Accepting a $50 million responsibility, and running the service, and having zero funding -- not even the billing that we collect through ambulance bills -- was really not an acceptable situation."

Ireland says the ambulance billing accounts for $30 million of the system's revenues. He believes city councilmembers were very concerned with the added responsibility, with little funding support.

"Our biggest concerns all along were to make sure we had adequate funding to keep the service at its current level, or perhaps expand," Ireland said.

"We know the population is growing. We know the population is getting older. As COVID leaves us, the tourists are going to start coming back, and they have. Call volume is going to go up, and we need to be there to meet those challenges."

But with funding now resolved, Ireland says there are great benefits to having the city be in charge of the ambulance services.

Currently, if the city wants to make any changes to the system, it would have to amend its contract with the state, and get approved from the state legislature. Ireland says they have done contract amendments with the state in the past.

"It's not impossible, but there is a little time and bureaucracy involved in that," he said.

"But I think moving forward, a local-county system operated, and controlled, at the county level is going to be a lot easier. I think adding ambulances or ambulance service in the future, deployment -- how we move the ambulances around -- is going to be a lot easier,"

Ireland says if the department wants to add another ambulance unit, all it would have to do is get approval from the mayor and City Council, rather than get approval from the state legislature during the legislative session.

Going forward, Ireland believes there will be more collaboration with the City Council to improve ambulance service and expand other EMS resources to better serve individual communities.

"It's going to be a better system, a more efficient system, it's going to have more flexibility," he said.

A House and Senate conference committee approved HB 1281 last week.

It now heads to a floor vote in both chambers this week.

Casey Harlow is an HPR reporter and occasionally fills in as local host of Morning Edition and All Things Considered. Contact him at or on Twitter (@CaseyHarlow).
Related Stories