Wednesday, February 22, 2012


Oahu at risk—little ER capacity if disaster strikes

by Larry Geller

This is going to be a lame article, I admit it. I have not yet found anyone willing to say on the record that Oahu could face a crisis if disaster struck due to inadequate emergency room capacity. Yet the evidence points to that, in the absence of any expert assurance.

This question has been bugging me since the two former St. Francis hospitals closed: What happens if we have a hurricane, an unpredictable tsunami, or other disaster, natural or unnatural? Suppose a plane goes down someplace on the island? Suppose a dangerous virus hits a hotel?

We just lost a chunk of our emergency room capacity when Hawaii Medical Center closed its doors. As a result, there are already diversions (when an ambulance is sent to another hospital because a nearby ER is full). What happens in a crunch situation?

How will ambulances get through a traffic jam on the H-1 to the east side hopsitals in a weather emergency?

Immediately after the HMC closing there was some coverage of diversions. According to information given at a town hall meeting hosted by Representative Kymberly Pine on February 9, 2012, these diversions are still occurring. Relief is in the indefinite future and subject to some unknowns.

When the hospitals closed I fired off some emails, and left some phone messages. I asked if our emergency preparedness was in jeopardy, and asked about the hurricane or tsunami scenario. No answer on the record.

The video of Rep. Pine’s town hall meeting does provide some strong hints. Referring to the closure of ERs, Dr. Scott McCaffery of the Hawaii Medical Association said “We’re in a rough patch right now.”

Dr. Don Olden of Wahiawa General Hospital stated that the closed hospitals handled 70-90 patients per day. With the loss of that capacity, Oahu’s ability to handle a typical day-to-day demand has been compromised. What happens in an emergency situation?

This would not be the first time that Oahu has had an emergency room overload situation. Former Star-Bulletin reporter Helen Altonn wrote in 2006, quoting Dr. Bill Lee, emergency physician in charge of the ER at Straub Clinic:

"…The underlying problem is we have more patients every year. They're older, sicker and requiring longer hospitalization. There are no nursing home beds. It's a capacity problem."

Straub's 12-bed ER has had a 10 to 15 percent increase in patients per year, Lee said.

"There is no capacity to handle a crisis," he said.

"We can't get patients out of the hospital, and we can't get them in the hospital and we have backup in the emergency room. ... There are multiple reasons why there is overcrowding, and you just couldn't build a big enough emergency room to accommodate everybody."

A domino effect occurs as ambulances are rerouted from one ER to another because they are full, a CAT scanner or something is not working or a specialist is not available, the ER doctors said.

"Suddenly you're getting another hospital's patients, and suddenly your capacity is overrun…"

[Star-Bulletin, Hospital ERs fall victim to success,7/10/2006]

Where is Helen Altonn when we need her?  (The Star-Advertiser “retired” her.)

Maybe some paid reporter could pick up on this. I don’t want to see the question die. I think someone from the established media could get answers. Find out what will happen if a couple hundred people need emergency treatment at the same time on Oahu right now. And what the state is doing about it, if anything.

In the meantime, here’s the YouTube video of Rep. Pine’s town hall meeting. Form your own conclusion. The meeting did not directly address the question of emergency preparedness.

As we learned so many times last year—the Fukushima earthquake/tsunami, flooding in Pakistan, Thailand etc.—stuff happens.

Is Oahu prepared?


Larry, what are you worried about. According to CONservatives the free market will take care of us. If there is a need and profit to be made some private entity will step in and fill that need. Of course a few thousand of us may die waiting before this reactive response can be implemented.

I have good guess what would happen: triage.

Incoming patients would be evaluated during transport or immediately upon arrival (i.e before treatment). ER space would be prioritized and allocated to the patients most likely to survive. Mistakes in allocation of space would be inevitably be made, but by and large the system has a good track record.

Frankly, you can't guarantee a "win" in the "what happens in an emergency of XL size" game unless you're willing to drastically over-build ER capacity. Even non-profit health care providers realize that is a waste of resources.

Agree. But where is the middle ground? Without a disaster the ambulances are already being diverted.

It's not only the disaster victims who would be triaged. Anyone needing ER services, even from the general population, would be competing for those services.

You were ahead of the curve on this story.

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