Hawaiʻi Fire Department secures $2.4 million in federal funds to expand paramedicine program

The Hawaiʻi Fire Department will receive nearly $2.4 million in federal funds for its paramedicine program, which seeks to keep people who frequently call 911 for non emergencies at home, and provide them with resources to address their physical and mental health issues.

This program tries to accomplish this by connecting the frequent 911 callers to services and resources such as County’s Office of Aging, Big Island Substance Abuse Council’s detox facility or HOPE Services Hawaiʻi.

These type of callers often include individuals experiencing chronic medical conditions, older adults experiencing falls or isolation, people facing mental health crises, or those dealing with substance use disorders.

An example could be a senior who is experiencing memory loss and mistakenly calling 911 multiple times. Paramedics on these calls would then connect the individual to a program through the Aging and Disability Resource Center, so there isn’t a wasted ambulance ride or unnecessary trip to the emergency room.

The department started the paramedicine program informally in 2016 to address challenges posed by the county’s rural landscape.

Currently sustained by Emergency Medical Services (EMS) captains in their free time, the program allows paramedics to respond to crises outside of an ambulance or hospital for frequent 911 callers. After crises pass, they connect individuals with services and resources, such as the

On Tuesday, the Hawaiʻi County Council Finance Committee heard a resolution to receive the federal funds, which will support personnel, telehealth equipment, software, and program implementation materials for the paramedicine program.

“Since we’ve seen success through this program, this is the next natural evolution of what we are already doing,” said temporary Fire Chief Daniel Volpe. “We want to connect our community members with more specified, holistic care that can fit the specific needs of frequent 911 users while also helping to limit emergency transport when it is not needed.”

Volpe noted challenges in Hawaiʻi County include the overuse of 911 among frequent callers and underuse among isolated residents; behavioral health crises resulting in costly emergency transport and delayed care; limited primary care, specialty care, and behavioral health resources in remote areas; and strained EMS resources causing increased response times for emergencies.

“Our 911 capacity is strained, and we want to use this funding to implement a plan for mobile integrated health care so we can meet people where they are,” said Kili Kanaʻe, Battalion Chief of EMS. “Not every 911 call needs an ambulance. What we need is interaction with social workers, case management, and more specialists who can impact the need for emergency services.”

The department will use the funding to expand the program by:

• Deploying telehealth kits and integrating with the department’s data dashboard for case tracking and reporting
• Beginning dispatch-driven case selection for high utilizers and vulnerable populations
• Procuring and deploying two alternate response vehicles to divert low-acuity and behavioral health calls from EMS islandwide
• Expanding proactive care provider home visits and case management
• Hiring a licensed clinical social worker to address behavioral health needs
• Formalizing referral agreements with federally qualified health centers, hospitals, and behavioral health agencies

Kanaʻe stated that the telehealth kits are already available on a limited basis and are used to help mitigate deterrents to accessing health care, such as housing and transportation.

“If a person living in a rural area can’t get to a provider or doesn’t have access to communication, they can rent out these kits long term,” Kanaʻe said. “If there’s a way to get regular health care or consultations through telehealth, that will help alleviate the need for emergency response or hospital beds.”

Kanaʻe also sees the program freeing up space at hospitals and positively impacting burnout felt by health care professionals across the county.

“This is an alternative to ambulance response, and as we start doing this, it will be an exercise in the data,” Volpe said. “It will illuminate the service gaps we have, encouraging partners to build that infrastructure, which may include a crisis or detox facility.”

The federal grant will fund at least one licensed clinical social worker position and provide workforce development. The department would then seek a county grant as more positions are created over time.

The grant period runs from October 2026 to September 2027, with funding expected to continue for five years. This year’s grant will specifically fund telehealth equipment and software and provide training, travel, and program materials to EMS personnel.

“We have seen the success from this program informally and believe that bringing health care to our communities will transform the entire Big Island’s health care ecosystem,” Volpe said.

According to County Council Member Ashley Kierkiewicz, she would like to see funding from the County’s Homelessness and Housing Fund support this program.

“As we look toward our philosophical debate about the Homelessness and Housing Fund, this is a program I could support,” Kierkiewicz said. “Our first responders are the ones who know what the community needs, and meeting people where they are is essential, especially with many residents’ mental and physical health following Hurricane Lala.”

Reflecting on the program’s informal success, Volpe and Kanaʻe are hopeful that investing time, money, and effort will benefit everyone on the Big Island and address healthcare issues in rural areas.

“We see patterns during our emergency responses and understand what is going on with individuals in our communities,” Volpe said. “We spend a lot of time away from our families and want to use that time wisely and in a way that benefits everyone.”

The Hawaiʻi County Council Finance Committee passed Resolution 651-26 with a unanimous favorable recommendation. The legislation will be heard by the Hawaiʻi County Council on Wednesday, Sept. 15.