A well-respected national organization, in which almost all emergency physicians are members of, gives Hawai'i a failing grade when it comes to access to emergency care and disaster preparedness.
According to the 2014 American College of Emergency Physicians' (ACEP) state-by-state report card on the nation's emergency care environment, Hawai'i earned an overall C- and ranks 24th in the U.S.
Despite an A in "Public Health and Injury Prevention" and a B- in "Quality and Patient Safety Environment", two state failed in both "Access to Emergency Care" and "Disaster Preparedness".
"The admirable commitment that Hawaii's state government shows to public health needs to be shown in other areas that affect emergency patients," wrote Dr. Jay Ishida, president of the Hawaii Chapter of ACEP in a statement regarding the state's report card. "Our ability to respond to both everyday emergencies and potential disasters or mass casualty events is seriously compromised by hospital shortages and lack of burn units and ICU beds."
Other local health officials admit there are elements of the report that ring true – most notably the lack of hospital beds, which in busy urban areas can lead to average ER wait times of around five hours.
Under-staffing is another concern.
"If a plane went down, if a bus crash occurred – people would be shocked at how difficult it is for us to get the adequate care to all of those individuals at once," described Senator Josh Green, an emergency-room physician, who chairs the Senate's Health committee.
He believes a major contributing factor to the failing grades is the closure of two O'ahu hospitals in 2011, but says the biggest challenge here in Hawai'i is geographic.
"We'll never have enough patient volume on the neighbor islands to have to have full staffs there but on the other hand we can't turn our backs on our people. So either we put in extra resources for trauma teams on the neighbor islands or we continuously beef up our air ambulance air med services to get people over here," explained Dr. Green.
Healthcare Association of Hawai'i's Emergency Services Director says the report isn't inaccurate, but it doesn't look at the right things – like the state's contingency plan.
"We can stand up to 250 beds in the field if we had to. One of them is just a single module 150 beds complete with air-conditioning, lights, showers, sinks, toilets, infusion pumps, biomedical equipment, pharmaceuticals and team members to staff it," described Toby Clairmont, HAH's Emergency Services Director.
He says the ACEP assessment is incomplete because it simply examined what's currently is in place, not what could be, adding that's where Hawai'i excels.
"I think it's true in the fact that we don't have enough beds – that has a lot to do with day to day demand why that isn't there and the economy that it supports it, but on the other hand, in time of disaster there's a lot of things hiding in the corners that could be deployed to fill that gap and that's what we've been working on for the last ten years," Clairmont explained.
Clairmont says measured against federal criteria, Hawaii's emergency procedures are ranked one of the top 5 in the country.
"There's a lot out there that's pre-positioned throughout the state ready to help in our neighborhoods and communities," Clairmont said.
While the report does credit the state's emergency medical services as top-notch, ultimately it finds gaps in hospital and treatment facility capacity are leading to poor overall access to emergency care.
Senator Green says the state's trauma health system, which was created in 2006 by tobacco tax dollars, has made great strides since its inception, but there are still areas that need improvement.
"All of our hospitals are becoming more competent with trauma services. They're getting better staffing. We actually have investment, so we're improving every year but that doesn't solve the problem of the backed up access to beds and that's going to be a long solution that's going to take many years to do," Green said.
Clairmont says the biggest obstacle now facing Hawai'i and every other state is funding. After the September 11th attacks, the federal government began allocating funds to build systems to address emergency disaster, but Thursday Congress voted to cut that budget by 30%. It goes into effect July 1, 2014 and Clairmont says here in Hawai'i that means about a $500,000 loss to emergency services.
"It just basically takes a good chunk out of what we're capable of doing and I think Hawaii deserves the very best, so I'm advocating for taking care of each and every person here and we might not be able to do that," Clairmont said.