O'ahu, the state's most populated island with more than 900,000 people, hasn't had on-call helicopter medevac for serious traffic accidents and other emergencies for almost six months.

Schofield Barracks helicopters provided the service for free for 32 years, followed by stopgap service by the Hawai'i National Guard and then an active-duty Army unit out of Alaska.

Surprisingly, the recent absence hasn't been that detrimental, according to the City and County of Honolulu's Emergency Medical Services division.

Still, the state is working on a plan to restore limited helicopter medevac without the need to spend the millions it did in recent years for the series of temporary measures.

The state has issued a "request for proposal" that seeks to pay for helicopter medevac only when it is used, and not for standby time.

"We'll pay for how much time they are on the helicopter," said Maj. Gen. Robert G.F. Lee, the state adjutant general. "Kind of like renting an airplane. I use it for two hours, I'll pay you for two hours. I'm not going to pay for all the standby."

Such an arrangement might work because the Army needs to have helicopter medevac for training, and has been using a private contractor to provide that service.

The state could piggyback off that requirement to provide civilian medevac on O'ahu under a separate contract, but using the same helicopter provider, officials said.

"There may be other vendors that want to apply for this," Lee said. "If we can make it work this way, it's going to be very cost-effective for the state."

Since 1974, Schofield Barracks' Military Assistance to Safety and Traffic program, or MAST, transported more than 7,100 patients on more than 6,000 missions, saving the state nearly $90 million.

The Black Hawk helicopter missions provided training for the Army medical units, and saved lives on O'ahu.

But stepped-up war duty meant a greater need for combat training and lengthy deployments away from the state. The 25th Combat Aviation Brigade at Schofield and its helicopters returned in October from 15 months in Iraq, and the unit is expected to deploy again within a year.

The Army suspended the MAST service on March 31, 2006. A series of measures followed, with Charlie Company, 1st Battalion, 207th Aviation Regiment of the Hawai'i National Guard stepping in with its Black Hawk helicopters before getting its own orders for Iraq.

The unit now is at Logistics Support Area Anaconda north of Baghdad and is expected back home around August.

BROUGHT FOR TRAINING

In late 2006, the Army brought in Black Hawks from an active-duty Alaska unit to O'ahu and the Big Island to support military training and civilian emergencies. Eventually, six of the Alaska choppers were operating in Hawai'i.

Through August 2007, the Alaska crews flew 12 civilian medevac flights.

After the Schofield MAST program ended, alarm was raised that O'ahu residents would be at extra risk, especially along the Wai'anae Coast and North Shore, where traffic gridlock might delay an ambulance in getting to a victim and then to a hospital.

But Patty Dukes, chief of city Emergency Medical Services, said that has not been the case.

"We've discovered throughout the years that the time to drive from the Wai'anae area (by ambulance to The Queen's Medical Center) very often is the same whether you fly or you drive," Dukes said.

Dukes said it takes a helicopter crew 15 minutes to get in the air and then fly to a pick-up spot. The victim of a serious car crash has to be taken by ambulance to the helicopter's landing zone, offloaded from the ambulance, and secured in the helicopter for what then becomes a quick trip to the hospital.

The time needed before a victim gets on a helicopter means an ambulance making the direct trip from accident scene to hospital often arrives in the same amount of time, Dukes said.

"One or two patients are very manageable in the back of an ambulance," Dukes said. "As a matter of fact, they are far more manageable in the back of an ambulance than they are in a helicopter."

Where helicopter medevac really is of value is with the ability to transport six or more patients at once in a disaster, she said.

The last major event of that magnitude was in 1999 at Sacred Falls park. A Mother's Day landslide killed eight people and injured 50 others.

Even though there hasn't been an event on O'ahu like that since, Dukes said the state needs to be prepared, and that's where helicopter medevac is important. The military would step up and provide helicopter assistance, if possible, she added.

"We've managed well," Dukes said. "We've taken care of our patients. I'm not certain of any detrimental outcomes because we didn't have a helicopter."

Some estimates have placed the cost as high as $8 million for Charlie Company of the Hawai'i National Guard — a Hilo-based unit — to be on call on O'ahu for civilian medevac before it had to start training for the Iraq mission.

DEFINITE NEED

State Rep. Kymberly Pine, R-43rd ('Ewa Beach, Iroquois Point, Pu'uloa), said there is a definite need for helicopter medevac on O'ahu. She cited the September 2006 crash of a military truck and excavator into an 'Aiea overpass, which led to one of the worst traffic tie-ups in state history, as a case when helicopter medevac would have a huge advantage over ambulance transport.

"Having this (helicopter medevac) as a backup is so important," she said.

Lee, the state adjutant general, said there would be significant cost-savings in paying only for actual medevac service as proposed. He also wants to expand the number of landing zones from the current 10 or 11 — particularly on the North Shore at remote locations that have a history of bad automobile accidents.

Doing so would speed up transport of critically injured people, he said.

"The key there is to get the clearance and let the helicopters land there, and if we can reach that stage, I think EMS would like that," Lee said. "It will help them in their work and we can be more responsive."

The state could piggyback on the Army's existing private contractor for civilian medevac needs, but the current contract is subject to a number of protests by a competitor.

Evergreen Helicopters Inc. in November began providing services and support under a $3.5 million contract with U.S. Army Garrison Hawai'i.

That contract, which is in effect through this month, is for medevac services for military personnel, and fire suppression support on O'ahu and the Big Island.

The contract was extended for a month, and will be maintained on a month-to-month basis, as the U.S. Government Accountability Office works out a dispute with Carson Helicopters Inc., Army officials said. Both companies are out of Oregon.

The Evergreen contract includes two new Bell 412EPs for operations on O'ahu and at the Pohakuloa Training Area on the Big Island.

Howard Sugai, a spokesman for the Army's Installation Management Command at Fort Shafter, said Carson filed five protests over the Evergreen contract.

Three were dismissed, Sugai said, and the remaining two involve Defense Department requirements for safety and performance standards in aircraft.

The Army contract required that bidders meet the requirements, and Carson has claimed they are too restrictive and limit competition, Sugai said.

The GAO was expected to resolve the disputes within about three months.

Reach William Cole at wcole@honoluluadvertiser.com.