The state's most populous island has limped along without an on-call helicopter medical transport service for almost six months, a situation that can't be tolerated for much longer.

The Emergency Medical Services division for the City and County of Honolulu reports that the lack of a medevac provider hasn't caused any harm because in the overwhelming percentage of medical calls, ground transport turns out to be just as quick.

Emergency care patients on the Neighbor Islands are transported through private contractors, an essential service because the only trauma treatment center is The Queen's Medical Center.

But on O'ahu, during freeway rush hours, it can be a judgment call for EMS professionals whether or not to summon air transport. They must have that option open to them when necessary.

That's why the move by the state Department of Defense to re-establish medevac service for O'ahu through a private, pay-as-you go contract deserves support.

The service had been provided for free by Schofield Barracks helicopters, and then in succession by the Hawai'i National Guard and an Alaska Army unit when our troops deployed to the Middle East. These stopgap solutions cost the state millions.

Now, the state Department of Defense's request for proposals specifies payment would be made for medevac service only when the helicopter is used, not for standby time.

This seems to be a practical approach: The Army already needs helicopter medevac to be available in during their training exercises. The state could use the same provider under a separate contract.

The charge for each transport is partly recouped through billing patients or their insurance carriers — roughly $3,300 by air, compared to $600 or more by ambulance. EMS officials need to reinforce through training that paramedics base their choice between ground and air-transport on emergency-care protocols, not cost. Just because medevac is a pay-per-use service doesn't change the mandate to save lives.