Sarah Perez was in tears Monday when she tried to go to Hawaii Medical Center in Ewa for severe shoulder pain and saw a sign that read, "Emergency Room Closed."

"My jaw just dropped, my eyes opened wide, I was just in shock that the ER was closed," said the 26-year-old Waipahu resident, who had her three young children in tow. "You just never know, anything can happen and you just would hope there’d be a close emergency facility. It is scary for the community."

HMC closed its emergency room facilities at both hospitals in Liliha and Ewa early Monday morning.

The company, which has been in bankruptcy since June, announced Friday that it would not be selling its hospitals, and instead immediately began winding down operations. The hospitals stopped admitting patients and notified the city’s Emergency Medical Services Division to divert all ambulances to nearby hospitals.

There were just a handful of workers left Monday in West Oahu’s only full-service emergency hospital, which handled 6,400 ambulance patients last year — the state’s second busiest ER for ambulance arrivals. ER employees were asked not to return today.

"What we’re anticipating is with this ER now closed, more people will utilize 911," said James Ireland, director of the Emergency Services Department. "Our other concern is that not everybody knows that there’s no one here. A lot of people drive to the ER quite ill, and they’re going to pull up here and there’s no one to take care of them."

There was a paramedic stationed at HMC-West’s emergency department from 7 a.m. to 11 p.m. Monday to treat or redirect patients. EMS will reassess the situation every 12 hours, he said.

Four of Oahu’s largest hospitals were overwhelmed with patients at least part of the day in the aftermath of HMC’s two emergency room closures.

The Queen’s Medical Center said it has seen an increase in ER admissions over the past few days, and Hawaii Pacific Health boosted its staffing and physician coverage at Pali Momi Medical Center to accommodate emergency cases that would have otherwise gone to HMC-West.

But by Monday afternoon Pali Momi, Kaiser Permanente Moanalua Medical Center and Clinic, Straub Clinic & Hospital and Queen’s were rerouting ambulances because their emergency rooms were completely full.

With the exception of critical cases, EMS instead directed ambulances to Kuakini Medical Center, Tripler Army Medical Center, Wahiawa General Hospital and Castle Medical Center in Windward Oahu.

Meanwhile, Pearl City Urgent Care, which opened Nov. 28, said it has doubled its patient count since HMC announced its closure.

"We were seeing maybe five or six patients every six hours. Today we saw 12 before noon," said Melanie Kelly, medical director.

However, the urgent care facility, which is looking to double its staff, doesn’t have the same equipment as an acute-care hospital and can’t take critical cases.

"I am very much concerned for the safety of the community because this is our high season where a lot of people get asthma attacks, colds, pneumonia and the flu," she said. "Usually ERs are very busy at this time. There’s not a lot of providers available. All area hospitals are very busy. They’re overloaded and stressed by this closure."

HMC-East and West combined saw more than 100 patients per day in their emergency rooms, including 25 ambulances, according to the city’s Emergency Services Department.

The city beefed up its emergency services over the weekend, adding two additional ambulance units in Leeward Oahu and expanding an existing unit at Nanakuli to 24-hour coverage.

Hawaii’s Department of Health is tracking ambulance data to determine the effects on Oahu’s other emergency rooms and ensure appropriate diversion plans.

"The DOH has received HMC’s closure plan and is working with them to ensure patients will be safely and appropriately transferred," said DOH spokeswoman Janice Okubo.

Donalyn Dela Cruz, spokeswoman for Gov. Neil Abercrombie’s office, said, "Our reaction was being proactive and making sure the hospitals that are still operating can manage the additional patients, and we’ve been assured of that."

Hawaii News Now video: Hawaii Medical Center closes emergency rooms