Ruddy Hernandez started his shift on a recent Friday with a call from the family of a Honolulu man found hanging with a belt around his neck. 

Hernandez, a paramedic for 20 years, hurried to the scene with two of his colleagues. When they arrived, the man was unresponsive but alive, as anxious family members watched him being carried to the ambulance.

What paramedics and EMTs call the “golden hour” is how quickly they can save a life by transporting a trauma patient to the hospital. Hernandez and his coworkers made it to The Queen’s Medical Center in under eight minutes, putting the patient’s care in the hands of the hospital’s trauma team.

Though it was a stressful call, there wasn’t much time to reflect on how it went. Right now Honolulu’s Emergency Medical Services department is responding to calls every six to eight minutes.

Ambulance calls on Oahu have jumped 22% from this time last year — back to pre-pandemic levels. But pandemic protocols are still in place.

Now EMS responders are working to keep up with the flood of calls while dealing with new procedures. Constantly changing gloves, checking masks, keeping track of stacks of cleaning equipment.

“Every day, every call, I’m always anxious,” Paramedic Ashley Moriguchi said. “It makes you nervous. Did I clean everything? Did I touch something? Did I pick it up? There’s all these variants.”

Incoming Calls

On average, Honolulu EMS 911 receives about 260 calls a day – about 95,000 a year. On July 9, EMS responded to 305 medical calls.

Medical calls started increasing in April due to the influx of tourists. In June, there were 8,023 calls — 1,475 more than last June.

The calls included drug overdoses, COVID-19 patients, people with chest and abdominal pains, and even births and deaths. 

Now that tourism is back, EMS workers are noticing increases in hiking and ocean rescues and stabbings.

EMS currently has 21 ambulances on Oahu, up from 15 ambulances in 1976.

However, EMS Chief Jim Ireland said they’re trying to keep up with the high demand of calls because of Oahu’s growing population. The island’s population has grown from around 600,000 people in the 1970s to more than 900,000 today.

“There’s a lot of things we’re doing simultaneously, but we’re always playing catch up because the population is growing, people are getting older and tourism is back,” Ireland said.

Ireland hopes to expand the department to meet the high call volumes.

For the first time in 10 years, Ireland said EMS will conduct its own training academy next month in partnership with Kapiolani Community College, bringing 24 people into the department.  

Most of Oahu’s current 250 paramedics and EMTs are graduates of KCC, which is the only EMT program offered in the state.

High Stress, High Demand

A few hours after Hernandez and his colleagues, Jared Tanouye and Samantha Blanchard, started their shift with the attempted suicide, they watched another ambulance pull into Kaiser Permanente with a COVID-19 patient. Paramedics dressed from head to toe in personal protective equipment – masks, gloves, gowns and face shields – rushed the patient from the ambulance into the emergency room. 

When they came out of the emergency room, they had more work to do. Two paramedics and a student disinfected everything in the ambulance, using disinfectant wipes and even a spray gun with a cleaning solution. 

Ashley Moriguchi, a paramedic who transported the COVID-19 patient, wiped off the front seats of the ambulance. She said they have to do this within 15 to 20 minutes to prepare for the next call. 

The mother of two young children worries about her family despite being fully vaccinated. 

“It’s pretty nerve-racking,” she said.

Currently 80% of EMTs and paramedics are vaccinated and only one Emergency Services worker has tested positive for COVID-19 since the pandemic started, according to EMS spokeswoman Shayne Enright.

EMS has transported 600 COVID-19 patients since the beginning of the pandemic.

COVID-19 isn’t the first time EMS workers have had to deal with a pandemic and changing safety protocols. Ireland, who has worked for EMS on and off since the 1980s, said PPE procedures were much different before the AIDS and HIV epidemic. Some paramedics didn’t wear gloves at that time, according to Ireland.

“Now fast forward to present time, two years ago, most paramedics didn’t wear masks and they didn’t wear a gown unless there was vomit, blood, defecation, and the really messy calls,” Ireland said.  

“But with COVID-19, right away, masks, gowns, PPE protections,” he continued. “Then after the calls are over, there’s a huge disinfection protocol with sprayers, cleaners and disinfection. It’s much different than before.”

Hernandez, who was a paramedic in New York, double-gloves every time there’s a call. He said he does this because of an incident when his gloves ripped and the patient’s blood got on his hands. 

On average, Hernandez goes through 30 to 40 pairs of gloves a day. 

Hernandez said the most challenging part of the job is having coping mechanisms. Some days he’s ended a shift and gone home crying about the things he’s seen. 

“In all my years of working, I realize we have such a large capacity for dealing with stress, and we let things bury in deep,” Hernandez said. “Sometimes it’s the smallest things that can crack you and break you down.”

A Flood Of Visitors

Later that day, Hernandez, Tanouye and Blanchard received a call that a man had fainted behind the Hilton Hawaiian Village in Waikiki. Their ambulance, named Beaker 1, is one of the four busiest ambulances in Honolulu because of the area’s high number of residents, visitors and homeless people.

When they arrived at the scene, the sun was setting and many people had gathered in an open, grassy area between Lagoon Tower and Rainbow Tower to watch fire dancers.

That was interrupted by flashing ambulance lights, and curious bystanders watched the paramedics check on the man who fainted. Hernandez interviewed the family while Blanchard and Tanouye checked on the visitor.

Hernandez said the visitor was OK and didn’t want to go to the hospital, so they left.

Seeing Waikiki crowded with tourists again felt surreal to Hernandez as he drove down Kalakaua Avenue.

“There was absolutely no one,” Hernandez said, describing what the tourist hot spot looked like last year. “The only people you saw were the homeless people camped out who had nowhere to go. It’s so much more visual.”

Even though they are trying to keep up with the volume of calls and quickly disinfect their ambulances while protecting themselves from the virus, some EMTs are relieved to see the crowds in Waikiki because it’s a “sign of normalcy.” 

Even getting caught up in traffic on the H-1 made Hernandez and his colleagues happy. 

“Now that I see the traffic, it means people are providing and living a life,” he said. “I hope we appreciate what we have now a little more.”