HONOLULU (KHON2) — The Emergency Medical Services director said they’ll need to add to their existing fleet of ambulances in order to keep up with increasing demand. But ongoing staffing issues and budget constraints could hinder that.

Hawaii’s aging population, the return of tourism and COVID are all contributing to the increasing demand for emergency services.

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They receive roughly 273, 911 calls each day.

KHON met with the EMS director Dr. James Ireland who said the department needs to grow.

“Going forward, every year we’re going to have to add another ambulance and the personnel to go with it,” said Ireland.

There are currently 21 ambulance stations on Oahu. In the next two years Ireland said they plan to add more ambulances in high volume areas like Kakaako and Kaimuki.

He said they need to add one 24-hour ambulance every year for five years.

“Maybe even more,” he explained. “Going from 21 up to 26 or even approaching 30 ambulances over the next five to 10 years.”

While they’re necessary, it’s not that simple.

An ambulance can cost anywhere from $100,000 to $350,000. It takes more than a year to arrive once it’s ordered. A new ambulance lasts for two to five years.

Ten new ambulances, partially paid for with CARES funds, are set to arrive this year. EMS received eight last year. But they are not adding to the fleet, they are replacing older vehicles.

Adding to the fleet of 21 ambulances, will require an increase in budget.

The city took over operations last year to help streamline budget issues EMS faced under the state.

Ireland said they are functioning more efficiently under the city.

Initial concerns about possible budget shortfalls, spurred lawmakers to create a law allowing EMS to charge patients treated by ambulance paramedics who refuse to be taken to the hospital.

“We are not going to be doing that initially, and I think that just needs more discussion.” said Ireland.

The last piece of the puzzle is staffing. EMS has around 260 Paramedics and EMTs. They could use at least 10 more according to a spokesperson.

Ireland said they also reinstated their EMS Academy for the first time in 10 years to hire and train personnel.

“We’ve actually partnered with KCC to do the instruction so the product is still the same,” Ireland explained. “We’re getting KCC instructors but the differences instead of going through the program as a student we’re actually going through as a city employee, as an EMS employee.”

The EMS academy graduated 37 EMT’s in the last year. 6 have already left.

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“It’s a hard job,” Ireland said. “EMS is not for everybody.”