Detailed
History of the City & County of Honolulu
Emergency Medical Services

The Department of Emergency Services of the City and County of Honolulu (CCH) was established in 1908 through ordinance number nine by the Board of Supervisors. On February 22, 1916, the Honolulu Police Department ran the City's first ambulance service. In order to have police officers concentrating on police matters, the first two ambulance attendants were hired in 1917. Other ambulance providers of that era were private ambulance companies, and hospitals like The Queen's Medical Center who started their ambulance service in 1910.

The Honolulu Police Department transferred control of their ambulance unit and personnel in 1917 to the Health Department, but it wasn't until 1931 that a continual 24 hour a day ambulance service was established. The major requirements to be designated a City and County ambulance attendant prior to 1971 was to possess a chauffeur's license, high school education or equivalency, American Red Cross First Aid Course, and no felony record. In the late 1960's, the American Heart Association developed basic life support and cardiopulmonary resuscitation (CPR) courses; it became another requirement for employment.

Thus, from 1931 to 1970 the City and County ambulance system concentrated on providing service and improving access to care while waiting for developments in medical science to transform it into an Emergency Medical System (EMS). In 1959, Mayor Blaisdell acknowledged complaints from the private ambulance companies who successfully argued that public tax dollars were competing against them. The mayor decreed that City and County ambulances would no longer transfer patients between hospitals or to nursing homes. In 1971, a $220,000 Health, Education, and Welfare grant was awarded to the City and County to conduct and establish basic life support classes.

The City and County of Honolulu contracted with the Hawaii Medical Association (HMA) to provide the medical expertise using a medical model to establish the first Emergency Medical Technician (EMT) course in November, 1971 consisting of 200 hours of didactic and 200 hours of clinical experience. A county wide MEDICOM (Medical Communication) system was initiated the same year, which allowed two way communication between the ambulance and the hospital.

In November 1974, an agreement was crafted between the City and County of Honolulu and the United States Army 68th Medical Detachment to establish a helicopter MEDIVAC service known as MAST (Military Assistance Safety and Traffic).

In 1975, the Mobile Intensive Care Technician (MICT) program was established consisting of 400 didactic hours, 175 clinical hours, and 640 hours of internship. In March 1975, the Oahu EMS Advisory Board was established by then Mayor Fasi in accordance with Federal regulations. Oahu also developed a 911 system with the help of $123,000 Federal grant.

In April 1976, co response was initiated with the Honolulu Fire Department in an attempt to extend first response care in the shortest period of time to Honolulu's sickest citizens. In July 1976, a standard ambulance report form was established to facilitate data collection. The City had 15 ambulance vehicles in its fleet which met or exceed federal and state requirements. Sea rescues were coordinated between the Coast Guard, Honolulu Fire Department and the ambulance service. Disaster Planning was established with Civil Defense at both the City and County and State level. Ten Critical Care Units (CCU) were identified on Oahu and mutual aid agreements were made with neighbor islands to give them access by radio to Oahu's ALS system and The Queen's Hospital.

The City and County of Honolulu was able to provide the ambulance service at no cost to the taxpayers and in fact was a resource to the neighbor islands to provide expertise and training for EMTs and MICTs (paramedics). The State of Hawaii had established 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 services 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 and the Big Island is administered by the Hawaii Fire Department.

In 1977, the Mobile Intensive Care Technician Assistant (MICT A) was established as an intermediate level of training utilizing EMTs who recieved training in IV techniques and defibrillation. On April 19, 1977 Health Education and Welfare gave a lump sum grant of $2,524,315 directly to the City and County of Honolulu to further develop the Emergency Medical System. From 1971 1978, HEW grants to the city approached $3 million ($2,994,718). In July 1977, a federal block grant for $784,810 was received to enhance Hawaii Medical Association Emergency Medical Services (HMA EMS) training. These funds provided additional training to emergency nurses and critical care nurses. Also, in July of 1977, emergency physicians were offered courses in advanced cardiac life support (ACLS), and advanced trauma life support classes (ATLS) and a MICT self assessment examination was established with the assistance of the HMA.

By July 1977, The City and County of Honolulu had an operational emergency medical services (EMS) system as defined by federal standards, including 1) the provision of manpower, 2) training of personnel, 3) communications, 4) transportation, 5) facilities, 6) critical care units, 7) use of public safety agencies, 8) consumer participation, 9) accessibility to care, 10) transfer of patients, 11) standard medical record keeping, 12) consumer information and education, 13) independent review and evaluation, 14) disaster linkage and 15) mutual aid agreements.

The Honolulu Star Bulletin's Friday June 2, 1978 edition noted that, according to HEW officials, Oahu's EMS program established by the City and County of Honolulu was, "...recognized as a program of excellence...and has been held as an example for the rest of the country." In July 1978 First responder courses for police, fire and lifeguards were established to teach basic first aid and basic life support in 40 didactic hours.

A state wide 911 system became operational in 1996 when the Big Island completed a 911 emergency system.