History of Emergency Medical Services and Paramedics in Hawaii
Part 1

The year was 1908, the Board of Supervisors of Honolulu established the Department of Health for the City and County of Honolulu. Eight years later, in 1916, the Honolulu Police Department started the City’s first ambulance service. To overcome the strain on the Police Department manpower pool, the first two ambulance attendants were hired in 1917. Ambulance attendants in 1917 were basically just "ambulance drivers," (There it is, that dreaded label we all hate, "ambulance driver.") they did little if any actual "patient care." There were private ambulance service providers at that time, including the Queen’s Medical Center, which started their service in 1910.(There are photos of ambulances dated earlier, but I have been unable to find any info on who the provider was.)

In 1917, the Honolulu Police Department relinquished control of their ambulance service. At that time it came under the control of the Department of Health, but service was limited. A continuous 24-hour a day service was not established until 1931, and the level of care did not improve much between the 1930’s and the late 1960’s. Prior to 1971 the job requirements for a City and County Ambulance Attendant included a high school education or equivalency, a chauffeur’s license, the American Red Cross First Aid Course and no Felony record. The American Heart Association developed Basic Life Support and cardiopulmonary resuscitation (CPR) courses in the late 1960’s and these skills were incorporated into these limited requirements.

Between 1931 and 1970 the Honolulu City and County ambulance service did concentrate on improving access to care and providing better service, but this resulted in numerous complaints from private ambulance service providers that the public tax dollars were competing against them. In 1959 Honolulu Mayor Blaisdell set forth a decree stating that City and County ambulances would no longer transport patients between hospitals or to nursing homes. This was the first separation between "emergency" and "non-emergency" ambulance services. The City and County ambulance service in 1969 was deemed adequate for the locals, but was far below the then primitive services in other states

In 1969 a non-profit corporation was formed by four Californians, led by ambulance attendant Bryan Peterson. The objective of this corporation, named "American Paramedical Institute" was an evaluation of emergency care in Honolulu. Medical Requirements for Ambulance Design and Equipment, a document from the U.S.Department of Health, Education and Welfare was chosen to be a guideline for this evaluation.

In order to provide financing for this study, Peterson and friends decided to hold a rock concert. They obtained permission to use the crater of the Diamondhead Volcano as a site to hold this concert. Advertised as "Crater Festival to Benefit the American Paramedical Institute", they were able to draw 30,000 people to the crater on August 2, 1969. Despite their inexperience as promoters and poor planning, they managed to net $7000 to fund their study.

For the next nine months the evaluation of the Honolulu EMS took place. The evaluation consisted of 179 criteria items. Peterson and partners spent many hours each day looking at ambulance vehicles and equipment, riding as observers on emergency vehicles, and talking to anybody who had anything to say about ambulance services. The report was finally published and was highly critical of the system. The City and County system had failed to meet more than half of the criteria items.

The report also recommended several improvements, including paramedic training, a structured multi-tiered system, and improved ambulance vehicle designs.

This report caused a severe and rapid backlash. Mayor Frank Fasi is reported to have been so angry he threw the report across his office. Peterson reported a meeting with some of the senior ambulance personnel as threatening.

After the initial early negative reaction to the API report/evaluation, positive events began to take place. Within months lifeguards were being trained in emergency care. In 1971 a $220,000 Health, Education and Welfare grant was awarded to begin training basic life support and "first-responders," and by late 1971 Honolulu policemen were being trained to become the first tier of the rapidly developing multi-tiered system.

Of course, this was not the only factor in the development of Hawaii’s EMS system. The Hawaii Medical Association has been a major factor in the development of Hawaii’s excellent pre-hospital care. In November of 1971 HMA contracted with Honolulu City and County to develop the first Emergency Medical Technician program. This program consisted of 200 hours of didactic and 200 hours of clinical training. This far surpassed the Department of Transportation’s standard 81-hour certification training, bringing Hawaii’s EMTs to a level near the paramedic training level in other parts of the country. In the same year a countywide MEDICOM (Medical Communication) system was developed. This provided two-way communication between paramedics and EMTs in the field and the Hospitals. The MEDICOM system was soon a statewide system providing not only two-way communication between ambulance and hospital, but also communication between paramedics on the neighbor islands and hospitals statewide.

The HMA’s programs in Honolulu were used as a proving ground and as the programs became workable they were filtered down to the neighbor islands Kauai County, Maui County and Hawaii County.

In November of 1974, an agreement was reached between the City and County of Honolulu and the U.S. Army 68^th Medical Detachment to establish a helicopter MEDIVAC service that was named MAST (Military Assistance Safety and Traffic).