Dr. Libby Char has lived and breathed the health-care profession for most of her 50-plus years.
Her husband is on the faculty at the John A. Burns School of Medicine. She works now as a consultant on community projects aimed at improving the emergency medical response, including her post chairing the state Emergency Medical Services Advisory Board, currently lobbying hard to expand the state network of ambulance units.
Char volunteered in hospitals before she worked in them, doing transport and other nonmedical functions before becoming a physician herself.
It didn’t take her long in medical school — at the University of Hawaii — for her to decide that emergency medicine would be her calling. There was something about the immediacy of the work that appealed to her, she said, and she felt drawn to the people in the emergency and “pre-hospital” practice, including the paramedics and others.
“Emergency medicine is a team sport,” she added. “You form some lifelong bonds with those on the team, and you get a lot of satisfaction from being a part of that team, knowing that you are all there pulling together to arrive at the best outcome.”
A Hawaii-born “proud public school graduate” of Kalani High, Char did her residency at UCLA, which she saw as an optimal emergency medicine training environment. She worked at The Queen’s Medical Center ER from 1997, followed by 5-1/2 years heading the city’s Emergency Services Department, supervising ambulance and ocean-safety crews.
Char said she chose living and working in her home state because she loves the relaxed lifestyle here, the hiking and other outdoor pursuits. She underscores the importance of balance between work and leisure whenever she’s advising medical students or young doctors.
That said, advocating for better resources and facilities that they need remains her focus. As she walked past the ambulances en route to the interview, she struck up an easy conversation with the crew gathered outside the ER. Working with these people, and the patients they serve, is deeply fulfilling.
“We just had a meeting with somebody who had gone into cardiac arrest, and through the efforts of the pre-hospital providers, they saved this person,” she said. “We recently had a get-together with this person, and the fire crew and EMS crew. And that kind of thing is just heart-warming.”
QUESTION: How hopeful are you that the additional funding request for ambulance service will be approved this year?
ANSWER: I try and maintain some degree of optimism every year about funding and the Legislature. Without it, the motivation to send in testimony, rouse the stakeholders and even just to show up at the Legislature becomes very difficult. …
The legislative committees we interact with have been very supportive of our quest for additional EMS resources, and we are very grateful for that. …
Where we have an issue is with the fiscal side of the Legislature. … Last year they stated that these are new projects, and there is no funding for new projects. The fiscal process seems very murky and nebulous to me.
An additional EMS unit is not a “new project.” It is simply trying to designate appropriate resources to keep up with growing population demands and shifting demographics. The need won’t dissipate, just because they ignored it for another year.
In fact, it will compound and we will have a greater strain on the existing ambulances, medics, equipment and the entire system of emergency care, including all of our first responders.
Q: Is this a recent crisis due to the aging population or the homeless, or was Hawaii always under-equipped?
A:Hawaii EMS has always faced challenges in securing funding. We are the only state with a statewide EMS system.
It’s neither all good nor all bad, but it presents a unique set of challenges because there seems to be a constant tension between the state providing funding and the county providing a degree of funding.
There remains a lingering question of whom EMS agencies should answer to, and what services and functions each EMS agency should provide in the communities, beyond responding to a 911 call …
The growing elderly population and homeless population are just an added strain to an already taxed system.
Q:Doesn’t the Honolulu Fire Department take some of the paramedic calls?
A: So, the fire department here, they’re not paramedics. They work collaboratively with EMS, and EMS will ask for a Fire Department co-response, for certain types of calls. …
If you think about it this way: There are 20 EMS units across the island, and at any given time, there are 43 fire stations. So the chances that one of the fire stations is available to respond at any given time is probably better than EMS. … If fire can get there sooner and start CPR, that will benefit the patient.
Q: As an alternative to emergency care, how helpful are mobile clinics or other solutions?
A: I think we need to look at the health care system as a whole and revamp the traditional model. We know that prevention is cheaper and more effective than emergency response alone. We also know that as the emergency system becomes more burdened, we will need to respond with more creative solutions. …
If we can create a network with various levels of care and communication, we can probably do a better job of getting patients to a more appropriate place for care than just calling 911 and having an ambulance treat them and transport them to an ER. Sounds great, but it’s obviously not an easy undertaking or else we would have done it by now.
Q: How has technology helped emergency doctors handle increases in demand?
A: Technology is a double-edged sword. If you can get timely information about previous care and recent visits, it can be very helpful.
It’s also great for EMS to be able to transmit certain types of data such as an EKG of a person having a heart attack, directly to the receiving ER even before the ambulance arrives. ERs now have bedside ultrasound and rapid access to digital radiographs.
Technology can also be very frustrating when it doesn’t work, and it can even be a burden, when people spend increasing amounts of time dealing with technology tasks.
Q: The Affordable Care Act, it was hoped, would draw people away from ER dependence and toward lower-cost clinical and preventive care. Do you think it helped?
A: The idea is terrific and it certainly makes sense to focus on prevention and catch things early, and hopefully before they become problematic …
But in order to increase access, we need to have a robust pool of primary-care practitioners, and even specialists, available. If you have insurance but don’t have a primary-care provider, you will likely still end up in the ER for something that might have been treated in the primary-care setting.
Q: What did you learn in your administrative position with the city, as opposed to your medical practice?
A:I think you get a better appreciation for the system overall, and the different components of it. And it leads to a better recognition that each component of the system has its own unique challenges.
I think very often when we’re at home on the couch watching TV, you say, “Gosh, that’s so simple, why don’t they just do this?” — not knowing the constraints that each component is under. … Not having worked in government before, I didn’t really have an appreciation for that.
Q: What is the most satisfying to you about emergency medicine, and what is the hardest part to deal with?
A: One of the most difficult aspects of working in EMS or the ER is making decisions when all we have is incomplete information.
The best part can also be the hardest part: We see people at their worst or in a very stressful situation. Sometimes we meet people who are having the worst day of their lives.
It can be very draining to have those interactions day in and day out, and it can be very frustrating when we are stymied by rules or regulations we don’t understand or feel powerless to change.
But it is also very gratifying to be able to help, in whatever form that takes. We may actually save a life or, equally important, we may be able to provide some comfort.
