HCR172 SD1

WHEREAS, patients on Oahu and the neighbor islands are currently experiencing significant delays while waiting for transfer to a facility that can provide a higher level of care; and

WHEREAS, according to the Hawaii Chapter of the American College of Emergency Physicians (HACEP), these delays have led to serious, sometimes even fatal repercussions for affected patients; and

WHEREAS, HACEP has conducted a preliminary review of these cases which affirms the critical need to address this issue and has identified three primary issues with the current patient transfer and ambulance system; and

WHEREAS, first, unless there is a preexisting agreement between two hospitals, if a physician caring for a patient needs specific services not available at the physician's health care facility, the physician must research what is available at other facilities and contact them one by one to determine whether the other facility has the services and bed space to care for the patient, which can lead to significant delays of up to five days in some reported cases; and

WHEREAS, second, patient transportation capacity can be a major obstacle; even if a bed or service is available in another facility, a suitable transportation service must also be available, one which can accommodate the specific medical needs of the patient; and

WHEREAS, currently, only one company, Hawaii Life Flight, offers air ambulance services for neighbor islands, and on Oahu, American Medical Response is the sole private ground ambulance and primary provider of inter-facility transport, with Honolulu Emergency Medical Services primarily focused on emergency 911 responses; and

WHEREAS, third, limited bed availability and the ability to provide appropriate care by a receiving hospital must also be addressed; even if a bed is available at a certain facility to receive a patient, the facility must also have the necessary personnel and infrastructure to care for that patient which could include specialized services such as hemodialysis, cardiac catheterization, and provision of an intensive care unit level of care, among others; and

WHEREAS, to develop and evaluate potential solutions to these complex issues will likely require the input, expertise, and collaborative efforts of the many stakeholders involved in providing care to patients throughout the State; now, therefore,

BE IT RESOLVED by the House of Representatives of the Thirty-second Legislature of the State of Hawaii, Regular Session of 2024, the Senate concurring, that the Director of Health is requested to convene a working group to address issues relating to the existing system of patient transfer and ambulance services and evaluate potential solutions including:

(1) Formation of a statewide coordinated transfer system to identify available beds, specialized medical services, medical specialist availability, and level of care;

(2) Increasing transportation capacity for both ground and air transport of patients, including interisland air transport of patients; and

(3) Increasing bed and specialized medical service availability at accepting hospitals, with a focus on high-need areas such as hemodialysis capacity; and

BE IT FURTHER RESOLVED that the Director of Health invite representatives of the following stakeholders to serve on the working group:

(1) The emergency services or fire department of each county in the State;

(2) The State Emergency Medical Services Advisory Committee;

(3) Healthcare Association of Hawaii;

(4) Hawaii Chapter of the American College of Emergency Physicians;

(5) Hospitals and federally qualified health centers serving both rural and urban populations, including representatives from each county in the State; and

(6) Transportation service providers including current and future air and ground transportation service providers;

provided that the Director of Health may invite other stakeholders as necessary; and

BE IT FURTHER RESOLVED that the working group is requested to submit a final report to the Legislature, including recommendations and proposed legislation, no later than twenty days prior to the convening of the Regular Session of 2025; and

BE IT FURTHER RESOLVED that certified copies of this Concurrent Resolution be transmitted to the Director of Health who is in turn requested to transmit a copy to each stakeholder invited to the working group.

Report Title:

Working Group; Patient Transfer; Ambulance Services

HOUSE OF REPRESENTATIVES	H.C.R. NO.	172
THIRTY-SECOND LEGISLATURE, 2024		S.D. 1
STATE OF HAWAII