History of Emergency Medical Services and Paramedics in Hawaii
Part 2

In 1975 the Mobile Intensive Care Technician (MICT) program was established by the Hawaii Medical Association. This program consists of over 400 hours of didactic training, 175 hours of clinical training, and a minimum of 640 hour of internship. This 1215-hour program has made Hawaii’s system one of the best in the nation.

Hawaii’s MICTs operate under extensive Standing Orders including intubation, IVs, defibrillation, and the administration of numerous medications. (Intraosseous cannulation, external pacing, pericardiocentesis, needle thoracentesis and cricothyrotomy are all done under physician’s orders.) Early last year PATI (Paralytic Assisted Tracheal Intubation) was added to our numerous Standing Orders as well as several new medications.  Cardiology plays a major part of the MICT program and from the beginning of the program, 12-lead ECG interpretation as well as rhythm strip diagnosis was included. Telemetry was rarely if ever used so competence and accuracy has always been a critical factor in MICT ECG skills. ACLS, PALS, and PHTLS are all required to maintain MICT Certification, although they were not initially included in the program. (I realize that most states now have advanced paramedic programs and operate at the same levels as we do here in Hawaii.)

Quoted from Reta Pozzi R.N. "Mother" from the Honolulu Advertiser dated January 12, 1981:

"Paramedics in Hawaii have more personal responsibility than their colleagues in other states in what they are allowed to do on their own before transporting a patient to the hospital.

They are allowed to use their own judgment when the patient’s life is on the line from five seconds to five minutes after the paramedics arrive on the scene.

The difference between Hawaii and some other states is that the enabling legislation - detailing what paramedics can and cannot do – was passed and in effect before such activities were started," Pozzi said. "And they don’t overstep the bounds."

In the late 1980s MICT training was added to the University of Hawaii/Kapiolani Community College curriculum and is no longer provided by the Hawaii Medical Association. The program continues to be at the forefront of EMS standards.

In March of 1975, the Oahu EMS Advisory Board was established in accordance with Federal guidelines and a 911 system was developed thanks to a $123,000 Federal Grant. Within a few short years the 911 system was extended to the neighbor islands and finally a Statewide "Enhanced 911" system became reality in 1996, when the Big Island of Hawaii completed the final link.

In April 1976 co-response with the Honolulu Fire Department was developed. This helped to bring aid to the sickest patients in the shortest period of time. A Standard Ambulance Report Form was developed in 1976 to aid in data collection.

Ambulance Service was provided at no cost to the taxpayers. "The State of Hawaii formed an Emergency Medical Services System (EMSS) branch under the authority of Section 27 21.6 Hawaii Revised Statutes (HRS) in 1976. This law provided that the State of Hawaii is charged with providing ambulance services directly or through contract ambulance service for counties with populations less than 200,000. This included the neighbor islands of Maui, Kauai, and Hawaii. Maui and Kauai are contracted out to a private ambulance service (presently American Medical Response) and the Big Island is administered by the Hawaii Fire Department." (From History of the City and County of Honolulu Emergency Medical Services – 1996.)

In 1977 the Mobile Intensive Care Technician Assistant (MICT-A) program was developed. This program no longer exists and has been replaced by the EMT-I certification (our EMTs can start IVs and defibrillate under supervision of the MICT.)

A federal block grant for $784,810 was received in July of 1977 for use in the Hawaii Medical Association EMS training programs. This was used to provide additional training for emergency room and critical care nurses, and to make available ACLS and ATLS courses for emergency physicians. A self-assessment exam was also developed for MICTs.

Friday June 2, 1978 Honolulu Advertiser, Hawaii’s EMS program was, "…. recognized as a program of excellence…and has been held as an example for the rest of the country."

First-Responder training courses for police, fire and lifeguards were established in July 1978. These provided training in basic first aid and basic life support in a 40-hour didactic course.

Hawaii continues to set standards of excellence in EMS.