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Djou faults mayor for end of 911 overuse outreach

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Mayoral candidate Charles Djou has chastised Mayor Kirk Caldwell for eliminating a program designed to reduce the overuse of ambulances by chronic 911 callers.

The decision demonstrates how Caldwell and Emergency Services Director Mark Rigg have mismanaged the short-handed Department of Emergency Services, Djou said at a forum Thursday hosted by the Native Hawaiian Chamber of Commerce.

Administration officials, after some initial confusion, told the Honolulu Star-Advertiser that staffing shortages led them to discontinue the community paramedic program, and that other moves they’ve made have cut down on staffing and overtime problems.

The community paramedic program was initiated in November 2012 by then-Mayor Peter Carlisle and Dr. James Ireland, Carlisle’s emergency services director, after research found that the top 10 callers to 911 had taken an average of 52 ambulance rides annually.

Hoping to reduce the number of calls for people with nonemergency needs such as medicines or substance abuse treatment, the program tasked two community paramedics with visiting the top 50 callers to look into the root causes of their problems and point them toward more appropriate care.

Speaking after Caldwell at Thursday’s forum, Djou said that a small percentage of ambulance users regularly use EMS, and those people “have adopted 911 almost as taxi service. And this tiny minority overburdens our system.”

Djou called for re-establishing the community paramedic program, which dedicates a small group of paramedics to addressing chronic, nonemergency 911 callers.

“It’s a good, smart, valuable program” that he would work to reinstate, he said.

The program was terminated shortly after Caldwell took office in January 2013, with Rigg citing the need to focus resources on the struggle to fill shifts caused by a large number of vacancies at the time, which also triggered wide absenteeism.

On Thursday, shortly after the mayoral candidates’ forum at the Willows, Caldwell and spokesman Jesse Broder Van Dyke told the Star-Advertiser that the program had ended under Ireland and Carlisle.

When the Star-Advertiser showed administration officials evidence that the program was canceled during Caldwell’s tenure, Rigg on Friday said he had lost track of when the program ended and had given wrong information to the mayor and Broder Van Dyke the previous day. Rigg, who was Ireland’s deputy, said the program had made a few trial runs in November 2012 but was never fully operational, primarily because of the funding considerations.

Broder Van Dyke, on Saturday, said the program was suspended during the 2012 holidays, and then never reinstituted by Rigg “as he determined that staffing our ambulances would be the priority.”

Ireland, when reached for a response, said the program had proved effective.

“It was fully operational.” he said. “They had engaged patients from that top 10 of frequent callers. It was successful in reducing some of those calls from that top 10 list. … because they redirected those callers to the more appropriate resources in the community.”

For instance, one woman the paramedics reached did not have a primary care doctor.

“They connected her with the Waikiki Health Center,” Ireland said. “If the mayor canceled the program, and it was a good program, he should just admit his mistake.”

In a June 2013 Star-Advertiser article about the program ending, Rigg said he recognized the merits of a community paramedic program but said that the state Department of Health, from which the city receives compensation for emergency services, was in a better position to manage such an endeavor.

Dr. Linda Rosen, then chief of the Emergency Medical Services and Injury Prevention Branch of the Health Department, told the Star-Advertiser that her agency was eager to look into it.

Health Department spokeswoman Janice Okubo said Friday that Rosen likely had been looking into it but then was appointed health director in early 2014, and then moved to become chief executive officer of the Hawaii Health Systems Corp. later that year.

The 2016 state Legislature adopted a resolution asking the DOH to look into development of a community paramedic program, and the agency will submit a report in the coming session, Okubo said.

Djou, at Thursday’s forum, also criticized the Caldwell administration for failing to address an ongoing shortage of paramedics and emergency medical technicians, a situation that has forced the city to either shut down shifts or pay overtime for EMS workers to avoid the cancellations.

“The problem here is we’re spending too much money (on overtime),” Djou said. “And the reason we’re spending too much money is we’re not sufficiently recruiting enough paramedics.”

The issue last became news in July when multiple shifts were forced to close one weekend due to staffing shortages after personnel called in sick. Under the 12-hour pilot project, EMTs and paramedics are not required to work beyond their scheduled shifts, and private company American Medical Response filled in.

Djou, a major in the Army Reserve, proposed that the city relax its requirements for EMS personnel to allow military veterans to gain required hours while on the job as full-time paramedics and EMTs instead of going to classes to gain those hours.

Rigg, in response, said a pilot program converting paramedic and EMT shifts to 12 hours from eight hours that was implemented in August 2014 led to increased employee retention, a decrease in overall leave, a drop in shift closures and a reduction in non-holiday overtime.

Closures like the ones in July are rarer occurrences since the 12-hour shifts were put in place, city officials said.

EMS employs 247 paramedics and EMTs, and there are currently 13 vacancies, the department reported.

There were 68 EMS unit closures from Aug. 31, 2014, to July 9, 2015, and only 21 closures from Jan. 1 this year, the department reported. Non-holiday overtime has dropped to $3.7 million in fiscal 2016 from a high of $5.6 million in fiscal 2014.

On Djou’s idea of relaxing restrictions for military paramedics, Rigg said: “It is a great idea to potentially hire people and train them. However, there is no set program as each individual situation is unique. Not all programs for national certification, even the military, follow the same amount of set hours.” Additionally, such a program would need additional funding from the state, he said.

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  • certainly the community paramedic program is a good program designed to identify the needs of frequent callers abusing the 911 emergency ambulance services. even more certainly, this is a program that would benefit the entire state.

    however, tasking already depleted working county emergency ambulance paramedic staff with performing what is essentially non-emergency social services is not be the best use of highly trained critically needed emergency medical services personnel.

    the state department of health should be the boots on the ground for this program, directing its state-wide non-emergency social services personnel to perform this task. leave working county emergency paramedics where they are needed: in ambulances to respond to 911 emergencies.

    djou would better serve the people of honolulu and the state if he instead chastised governor ige and the state department of health for not recognizing the value of implementing this program state wide using non-emergency state health department social workers instead of already short staffed emergency ambulance paramedics.

    • Djou is not running for governor, yet… His points are well made. cladwell and his minions, it must be noted, blamed the Carlisle administration for discontinuation of the program, which actually occurred on cladwell’s watch. The naked emperor just lost his loin cloth.

      Shows you that a deeply-entrenched Dem, who admits collecting $200,000 a year from a bank directorship for 2 hours of work per month, who got almost $1 mill from toy choo-choo contractors and developers for his campaign warchest, married into money, and paid only $300 property tax for years for his trail of historic homes while claiming to understand the plight of the average family, has now attained a level of arrogance and hubris that give lie to his claim of being a grassroots Dem.

      For shame, cladwell, the naked emperor!

  • There’s a simple solution: the 52 chronic non-emergency users of EMS should be warned that further abuse of the system will be prosecuted and that they will lose access to the 911 system. If they continue to abuse the system, use caller ID or block their address from the system. It’s tough love, but them abusing the system risks the safety of all Oahu residents.

  • “The top 10 callers to 911 had taken an average of 52 ambulance rides annually.” – There’s a simple solution: 1) warn them that if they call 911 in a non-emergency manner, they will lose access to 911 and EMS services. 2) if they continue to abuse the 911 system, block their phone number and address and fine/jail them. Their abuse of the emergency system puts all citizens of Oahu at risk by tying up resources that could be used for real emergencies.

  • Kirk Caldwell caught lying once again. The “on time and on budget” Mayor seems to have problems telling the truth, yet no problem taking a second job from Territorial Savings for $200,000 a year. How did we get stuck with this guy?

    • How did we get stuck with Krook?

      The previous two mayors were worthless, lying hacks that got booted after one term and CLodwell was just the next in line aided by lying, dirty union money slandering opponents!

    • Anyone who’s been around legislation for a while knows that a bill is like a pot of stew. All kinds of unrelated stuff mixed in. A legislator needs to look at the overall pros and cons of a bill and decide which way to vote. It’s disingenuous to pick one aspect of a bill and use it to slant a story about how a lawmaker voted.

  • Sad to say Emergency Services Director Mark Rigg fails to understand how he and the state are directly accountable for the EMT/Paramedic shortage. As the 2001 article at the link below proves, state will only hire people trained locally, meet Jurassic state standards. In the article, a qualified and experienced EMT tried to move back to Hawaii. Thanks to layers of utter turf protecting bureaucracy, he could not get a job here.

    Example from the article, “When he asked whether his nearly two years of actual service as a licensed paramedic in Wisconsin might somehow be treated as the functional equivalent of the 400 training ride-along hours, he was told unequivocally, “Work experience means nothing to us.” Only training hours could be counted.” Really? Truly the Nei is so backwards.

    Problem could be fixed in a heartbeat if our USA Dept of Labor set national standards to qualify as an EMT, applying to all 50 states. Just as you can with an Air frame and Power plant (A&P) license to work on aircraft. Then a person could easily move state to state, no bureaucratic hoops to follow.

    It would also help if our state EMT program was managed by forward thinking, competent professionals. Sad to say the clueless baboozes in charge are their own worst enemy. Legends in their own mind.

    Just another day in the little 10th world of Hawaii Nei.

    • So true and well said localguy. Racism, nepotism, cronyism all rolled into one, continues to plague this state like cancer infiltrating the bile ducts of society. Until they cut these “legends in their own minds” out like the cancers they are, we will continue to see the results of “clueless baboozes” gone wild.

    • Sadly, the ambulance service lost a potential EMT. From your reference link, the applicant decided to leave Hawaii after being offered a job with the City, and the State had granted him a license based on his on the work experience. Initially, the City waited for him to get a license, and the State initially denied the license because his formal training laoked an additional 400 hours of ride-along training, and lacked formal training for about 94 of 100 skills required. But the State relented and granted the license, and the City asked him to take a physical. That usually means the City has selected him for the job. But he made plans to leave anyway. He received the formal job offer the next month.

    • No, they are a hardworking, highly effective, well skilled group. What they lack is the backing to give them more jelp and better housing conditions. Oahu ambulance personnel are one of the best in the Nation. They are highly qualified and work their backsides off!

    • Naaahhh. Not even close. Mufster, Carlisle, Kirky Boy have set the bar so high it will never be equaled. I had no idea how high these baboozes could take bureaucratic incompetence.

  • Typica Caldwell response to getting caught: IT’S NOT MY FAULT!

    Rail is f***ed? Blame HART.

    HPD royally screwed up? Blame the police commission.

    Ethics Commission falling apart? Blame Totto, then force him out.

    EMS heading off the cliff? Blame the former director you fired years ago.

    I’ve had enough of this incompetent, dishonest crook. Time for Kirk to go.

  • Caldwell has failed as the leader of this City. “On time, on budget” is a black hole taxing us with unknown debts. Our roads are in disrepair. Our sewers overflow every time we have a heavy rainstorm. Our water mains are breaking. Our traffic is horrendous. Homeless are everywhere. No area is free of homelessness. Ambulance service is hit or miss. Overall he has done a terrible job. It is time for new management.

  • This is a non-issue that has been raised by Dijou. The real issue here is why isn’t either candidate talking about moving the paramedics to the Fire Department, like almost all of the other major metropolitan cities in the United States. Are all those other cities wrong? Is Honolulu’s 1960’s model of a county run ambulance service a better way to do things? No; a fully integrated emergency medical service within the fire department, which includes EMT certification for all firefighters and firefighter/paramedics staffing the paramedic vans is what a modern emergency medical system looks like. This model will save Honolulu money by reducing overhead and duplication of management. It will reduce staffing needs by putting the paramedics on 24 hour shifts. It will increase paramedic retention by creating a career path with promotional opportunities and a salary commensurate with their responsibilities. And the residents of Honolulu will see a greatly increased level of service because there will be trained and certified EMT’s in every firehouse on this island. No more waiting for the paramedics to arrive, firefighters will be able to initiate lifesaving actions the moment the nearest fire engine or ladder truck arrives at your home or business. This is the kind of customer service these mayoral candidates should be concerning themselves with; not some non-sense about a couple of paramedics spending time talking to frequent fliers, we’ve got professional social workers that can do a much better job of that.

  • Have a friend whose son, local boy, living in California who is fully accredited to be ems but was told forget it, there were no jobs available, the powers that be are gaming the overtime system. Most importantly, went to symposium on homeless issues with business leaders & social workers from IHS & the like & these consistent callers, who refuse to go to shelters are costing tax payers close to $1MILLION EACH. Today walking Waikiki, I saw a fire truck & an ambulance with a mentally ill substance abuser in front of Hyatt. Then walked further down to Queens Beach & commercial,surfing schools were selling lessons,,taking up parking. Parks Dept guy standing there smoking cigarette said there’s nothing they can do. Bums sleeping everywhere once again. Very discouraging Mr Mayor. I called & have photos for proof

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