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Free-standing emergency department in West Maui would be a good start

Viewpoint

I am writing in support of the idea of constructing a free-standing emergency department in West Maui.

In the interest of full disclosure, I am employed by Pacific Permanente Group, a subsidiary of Kaiser Permanente, and work at Kula Hospital. I have no firsthand knowledge of Kaiser’s opinion about the feasibility of a West Maui FSED and I am fully committed to my work Upcountry.

I am a career emergency physician who moved to Maui in June 2018 to work in the Kula Hospital Emergency Department. My wife and I rent an apartment in West Maui, so I have firsthand knowledge about travel to and from West Maui from elsewhere on the island.

Ambulances weaving through heavy traffic on the pali, a daily occurrence, put patients, first responders and other drivers at risk. Critically ill ambulance patients are subject to delays in care relating to the heavy traffic, accidents and disasters that may make the highway impassable, as was the case during the recent fire.

I understand a West Maui hospital has long been sought, land for its construction has been acquired and various options explored and yet, no health care entity has thus far taken on the task of converting the dream of a hospital into reality. On any given day there are 30,000 or so tourists in West Maui alone and an equal number of residents, making for a large potential patient population.

A FSED is typically staffed by a doctor, several nurses, a respiratory therapist, ED tech, lab and radiology techs and registration clerks. In the FSEDs where I’ve worked, X-ray, extensive lab testing, ultrasound and CT scanning are readily available. These capabilities allow the doctor to treat a wide variety of patients with everything from minor illnesses and injuries to life-threatening emergencies. The vast majority of patients are treated and released. Patients found to require inpatient care are first stabilized and then transported by ambulance to an inpatient facility. Recognizing the limitations of a FSED (no operating room for example) requires working out triage protocols with first responders such that some patients would be taken directly to Maui Memorial Medical Center.

Once established, a FSED could form the nucleus of a future full service hospital and in the interim help to decompress the ED services at Maui Memorial, provide more timely patient care, mitigate some of the hazards of transporting patients to Wailuku from West Maui and augment Maui’s disaster preparedness and mass casualty capabilities.

I imagine the idea of a FSED has been discussed. Obviously, the issues involved in health care delivery are complex and require in-depth analysis and the concerted efforts of multiple stakeholders who share the common goal of promoting the health and safety of Maui’s citizens and visitors.

* Peter Angleton, M.D., practiced emergency medicine in Idaho for 27 years before moving to Maui in 2018. He currently works full time at the Kula Hospital Emergency Department.