Lahaina Fire

Forward-Looking Report
Steve Kerber
Derek Alkonis
This publication is available free of charge from:
https://doi.org/10.60752/102376.28074944

Photo Credit: Dahlquist Photography

January 14, 2025

Columbia, MD

© 2025 Underwriters Laboratories Inc.

Acknowledgments
The authors express sincere gratitude to the people of Maui for their
willingness to share information and personal stories about this incident.
The authors also acknowledge the steadfast commitment of the Hawaiʻi
Attorney General Anne E. Lopez and the Hawaiʻi Department of the
Attorney General to complete this independent research and analysis.

The authors also thank the County of Maui and the following individuals
for their invaluable contributions: Clay Trauernicht from the University
of Hawaiʻi, John Bravender and Derek Wroe from the National Weather
Service, Elizabeth Pickett from the Hawaiʻi Wildfire Management Orga-
nization, Michael Walker from the State of Hawaiʻi Division of Forestry
and Wildlife, former Hawaiʻi County Mayor and Civil Defense Agency
Administrator Harry Kim, Karl Fippinger from the International Code
Council, and Darus Ane, Jim Barnes, Leonard Casson, Alysa Finlayson,
Tim Hagel, Todd Harms, Garrett Kim, T J Martin, Jessica Pickett, Kevin
Roche, and Adam Thiel from FACETS. Their insights and data have
been instrumental in the compilation of this report.

Special thanks also go to FSRI’s Gavin Horn and Daniel Gorham for
their contributions to the analysis, as well as Charley Fleischmann, Dan
Madrzykowski, and Dawn Ey for their supporting efforts.

Disclaimer
In no event shall UL Research Institutes (ULRI) be responsible to anyone for whatever use or non-use is made of
the information contained in this report and in no event shall ULRI, its employees, or its agents incur any obligation
or liability for damages, including, but not limited to, consequential damage arising out of or in connection with the
use or inability to use the information contained in this report.

2
TABLE OF CONTENTS

02 ACKNOWLEDGMENTS
02 DISCLAIMER
03 TABLE OF CONTENTS
05 LIST OF TABLES
06 1.0 Executive Summary

08 2.0 State of Hawai‘i Priorities and Recommendations

09 Priority 1. Action Planning and Accountability
09 Priority 2. State Fire Marshal
10 Priority 3. Wildfire Education Programming
11 Priority 4. Communication Systems
11 Priority 5. Utilities Risk Reduction and Planning
12 Priority 6. Fire Weather
12 Priority 7. Evacuation
13 Priority 8. Codes and Standards
13 Priority 9. Wildfire Response Preparedness
14 Priority 10. Vegetation and Land Management

15 3.0 County Priorities and Recommendations

16 Priority 1. Coordinated Action Planning and Accountability
18 Priority 2. Risk Assessment and Data Driven Investment
19 Priority 3. Wildfire Response Preparedness
22 Priority 4. Incident Management
22 Priority 5. Wildfire and Wildland Urban Interface (WUI) Education Programming
23 Priority 6. Communication Systems and Planning
24 Priority 7. Evacuation
24 Priority 8. Codes and Standards
25 Priority 9. Utilities Risk Reduction and Planning
25 Priority 10. Vegetation and Land Management

27 4.0 Fire Code and Building Code Review

28 4.1 Building and Fire Codes in the State of Hawaiʻi

28 4.1.1 Hawaiʻi State Building Code Council

3
TABLE OF CONTENTS

29 4.1.2 Hawaiʻi State Fire Council

29 4.1.3 Hawaiʻi State Fire Codes
29 4.1.4 Governor’s Affordable Housing Initiative and the State Building Codes

31 4.2 Building Codes in County of Maui

31 4.2.1 County of Maui Building Code Discussion
31 4.2.2 County of Maui Building Code - 2023 Updates
32 4.2.3 County of Maui Building Code Administration
35 4.3 Fire Codes in County of Maui
35 4.3.1 County of Maui Fire Code Administration
35 4.3.2 Organization of the County of Maui Department of Fire & Public Safety
35 4.3.3 Fire Prevention Bureau and Personnel
38 4.4 Maui Recovery Permitting Center

39 5.0 State Fire Marshal Review

40 6.0 Summary

41 7.0 Appendix

41 7.1 Lahaina Fire Incident Analysis Report (Phase Two) Findings and Recommendations

56 8.0 Acronyms and Meanings

4
LIST OF TABLES

8 Table 1 The 10 highest priorities for enhancing wildfire readiness at the state level.

16 Table 2 The 10 highest priorities for enhancing wildfire readiness at the county level.

33 Table 3 Developmental Services Administration Program Staffing.

34 Table 4 Developmental Services Administration Building Program Staffing.

36 Table 5 Maui Fire Department Fire Prevention Program Staffing.

37 Table 6 Maui Fire Department Plan Review, Processing, and Inspection Revolving Fund Program Staffing.

5
EXECUTIVE SUMMARY

On August 8, 2023, Hurricane Dora, spinning south The Lahaina Fire Incident Analysis Report3 (Phase
of the Hawaiian Islands added unprecedented Two) presents relevant background information;
winds to a landscape that was already susceptible discusses weather, fuel, and infrastructure
to fire. By the end of the day, multiple wildfires conditions; describes communication, incident
moved across the island of Maui. The Lahaina Fire, management, fire suppression, and evacuation
sparked by downed powerlines and whipped by efforts; and details the impact of the fire on
winds gusting over 80 miles per hour, quickly grew Lahaina’s built environment. It also considers these
into an urban conflagration that would eventually factors in the context of the National Cohesive
overtake and destroy most of Lahaina Town. Burning Wildland Fire Management Strategy4 (Cohesive
over 2,000 structures and resulting in the loss of Strategy). The analysis of the nearly two terabytes
102 lives, the Lahaina Fire became the most deadly of data collected for Phase One includes detailed
wildfire in the United States in the last 100 years. explanations of how the fire impacted zones where
The State of Hawaiʻi (the State), through Attorney there was a collection of destroyed, damaged, and
General Anne Lopez, determined to understand this undamaged structures. Analyzing each system
tragic event in all its complexities so that every effort component against organizational policies and
could be made to prevent similar catastrophes from procedures and evidence-based research resulted
happening again. The Fire Safety Research Institute in 84 Findings and 140 Recommendations (see
(FSRI) was contracted to complete three reports Appendix 7.1). The Findings and Recommendations
in an independent, comprehensive analysis of the highlight areas demanding attention to improve
Lahaina Fire and provide suggestions for a path fire safety. This report does not include an analysis
to a safer Hawai‘i. of recovery efforts or the fire’s cause and origin,
which was investigated by the County of Maui with
The Lahaina Fire Comprehensive Timeline Report1 assistance from the United States Bureau of Alcohol,
(Phase One) presents a chronology of the events Tobacco, Firearms, and Explosives (ATF). Phase
captured from an extensive data collection effort, Two was initially published September 13, 2024,
resulting in more than 12,000 timeline entries. with revision one published October 2, 2024.
This report focuses on the time period beginning
at 14:55 on August 8, 2023, and concludes at 08:30 A portion of this Lahaina Fire Forward-Looking
on August 9, 2023, and includes the relevant events Report (Phase Three) organizes these findings.
that occurred prior to, and during, this time, such A prioritized list of action items is provided to the
as preparedness efforts, weather and its impact to State and all counties so that changes can be made
infrastructure, and other fires occurring on Maui. that improve Hawaii’s response to wildfires. Phase
Phase One includes hundreds of data points used Three includes a Community Risk Assessment
to create a fire progression map showing the path (CRA), Community Risk Reduction (CRR) plan, a
the fire took as it impacted the built environment Standards of Cover (SOC) analysis, and a review
mauka (toward the mountain) to makai (toward the of the codes and standards adoption and use
ocean), and to the south and to the north. Phase processes for the County of Maui. Each of these
One was published April 17, 2024, with components are in progress.
the comprehensive timeline.2
FSRI has provided the State and counties with
their own guidance documents, identifying the 10
highest priorities for enhancing wildfire readiness.
In addition, FSRI has also engaged with the

6
EXECUTIVE SUMMARY

Department of the Attorney General (DOAG) and adoption process, and the versions of the codes that
Hawai‘i Wildfire Management Organization were in effect at the time of the August 8, 2023, fires.
(HWMO) to address the preparations needed for The adoption of contemporary codes and standards,
the Office of the State Fire Mashall (OSFM) to be and the use of advancements in building materials
effective as soon as possible. and construction techniques, are crucial components
of a community’s resilience in the face of wildfire.
Currently, the CRA, CRR, and SOC for the County
of Maui are underway. The Maui Fire Department The Phase Three building codes and standards
(MFD) has been provided with the resource demands section complements the Federal Emergency
for each analysis and the data needs for the SOC. Management Agency’s (FEMA), Maui Wildfire
FSRI has also identified data sources via public Mitigation Assessment Team’s (MAT) Recovery
websites that the MFD will validate and review for Advisories 1 through 4, and Codes, Standards, and
accuracy. Timeline for completion of these analyses Permitting Summary and Recommendations Report
for the County of Maui is expected to take several (90% Draft as of December 22, 2024).5
months due to anticipated challenges validating data,
and ultimately, completing the final report. Just prior to publishing this report, the County of
Maui released the Lahaina Long-term Recovery
Section 3.0 of Phase Three outlines the 10 highest Plan.6 The plan includes several “Priority Projects”
priorities for enhancing wildfire readiness in each within Section 7 that align with the Lahaina Fire
county within the State of Hawai‘i and recommends Incident Analysis Report7 (Phase Two) Findings and
that all counties complete a CRA, CRR, and SOC. Recommendations, which are also included within
To date, each county fire chief has received the the State and County Priorities of this report.
County Priorities and Recommendations and
personal briefings have been completed. The
briefings served to ensure the 10 priorities are
actionable and modified for each specific county’s
circumstance, where needed.

Section 2.0 of Phase Three highlights the 10 highest

priorities for enhancing wildfire readiness in Hawai‘i
and was prepared at the request of Governor
Josh Green and delivered in October 2024. Like
Section 3.0, this distills Phase Two’s 84 Findings
and 140 Recommendations into 10 areas of focus
concentrated on the most urgent needs. A high-
priority item for the State is staffing the OSFM and
engaging state agencies in addressing Phase Two
Findings and Recommendations.

Building codes and standards play a critical role in

public safety by providing standardized requirements
for building construction. Phase Three reviews the

7
2.0 STATE OF HAWAI‘I
PRIORITIES AND
RECOMMENDATIONS

2.0 State of Hawai῾i the State to initiate progress and take the critical
first steps necessary to establish a solid foundation
Priorities and that supports future meaningful improvements.
While these 10 priorities are crucial for immediate
Recommendations action, the remaining recommendations are also
vital and should be urgently addressed to ensure
The Lahaina Fire Incident Analysis Report (Phase comprehensive wildfire system improvement
Two) was released on September 13, 2024. In a across the state. This document includes
briefing, Governor Green asked FSRI to identify recommendations for “how” to address each priority.
the 10 key priorities for the State of Hawaiʻi to These recommendations are limited by FSRI’s
address to enhance wildfire safety statewide. By understanding of the State of Hawaii’s organizational
distilling the report’s 140 Recommendations into structures but bolstered by FSRI’s experience within
these 10 areas of focus, the State (See Table 1) can each of the priority areas. We realize there may be
create an immediately actionable plan concentrated different approaches that better align with state,
on the most urgent and impactful areas. This county, and non-profit organizational processes.
streamlined approach provides a clear roadmap for

Table 1. The 10 highest priorities for enhancing wildfire readiness at the state level.

10 Highest Priorities for Enhancing Wildfire Readiness at the State Level

Priority 1
Ensures an organizational
structure that supports a

Action Planning & Accountability

coordinated process

Facilitation of process to plan and implement subsequent priorities

Priority 2
Office of the State Fire Marshal
Complete process to hire SFM and OSFM staff;
Identify and hire an interim leader to facilitate action planning toward
system components (below)
Lead agency assigned to

Priority 3 Priority 4 Priority 5

develop & implement

Wildfire Education Utilities Risk Priority 6

Communication
Programming Reduction & Planning Fire Weather
action plan

Systems

Priority 8 Priority 9 Priority 10

Priority 7 Wildfire Response Vegetation & Land
Codes & Standards
Evacuation Preparedness Management

8
2.0 STATE OF HAWAI‘I
PRIORITIES AND
RECOMMENDATIONS

Priority 1. Action Planning also work closely with all county, state, and federal
fire agencies, public utilities, community groups,
and Accountability the National Weather Service (NWS), and code
Require Department of Land and Natural and standards organizations such as the National
Resources, Division of Forestry and Wildlife Fire Protection Association (NFPA), International
(DLNR-DOFAW), Hawaiʻi Building Code Council Code Council (ICC), and Underwriter’s Laboratories
(HBCC), Hawaiʻi Public Utilities Commission Standards and Engagement (ULSE).
(HPUC), State Fire Council (SFC), Office of
Planning Sustainable Development (OPSD), The leader of this priority could be responsible
Hawaiʻi Emergency Management Agency for scheduling and facilitating meetings with the
(HI-EMA), Hawaiʻi Department of Law group of state organizations listed, sharing work
Enforcement (DLE), Hawaiʻi Department of product examples, preparing a timeline, using a
Transportation (DOT), and Commission on Water project planning tool to document progress toward
Resource Management (CWRM) to prepare a completion, and providing status reports to Priority
preliminary action plan for addressing Phase Two 1 owner, while ensuring all tasks are completed, as
Findings and Recommendations pertaining to their per the timeline.
areas of responsibility.
This priority sets the table for the subsequent
Findings and Recommendations Addressed*: priorities. Each state organization leading the
development of their action plan should avoid
• Finding 1 (page 303) - Recommendations 1 and 2 working in isolation or reinventing existing
processes, as this can lead to inefficiencies and
fragmentation. Collaboration with other agencies
Recommendations for how and stakeholders is encouraged and essential to
to address Priority 1 avoid duplication, competition, and potential harm.
Achieving more cohesive and effective outcomes
Select a Priority 1 task owner from a state
requires building on existing data, programs,
government organization.
and knowledge.
This priority could benefit from leadership from an
individual or organization having the most knowledge Priority 2. Office of the State Fire
of the wildfire system components addressed in
Phase Two. In many states, this would be the State Marshal
Fire Marshal (SFM). However, because there is State agency selected to oversee the OSFM to
no currently appointed fire marshal in Hawaiʻi, an recruit and hire the SFM and individuals required
alternative should be identified. Consider contracting to fill critical roles within the OSFM. The SFM
with the non-profit HWMO to share a leadership (or interim leader) to work closely with SFC
role with a leader from a state organization having and other state agencies to prepare an action
current wildfire responsibilities. The HWMO has plan for addressing Phase Two Findings and
knowledge and experience in wildfire prevention, Recommendations related to codes, standards,
preparedness, multi-partner coordination, and project zoning, vegetation management, wildfire data
management, and was also an excellent resource to collection, mutual aid response, and firefighter
FSRI throughout Phase One and Phase Two. They training and operations standards (including
private contractors).

*Page numbers referenced correspond to the Lahaina

Fire Incident Analysis Report (Phase Two). 9
2.0 STATE OF HAWAI‘I
PRIORITIES AND
RECOMMENDATIONS

Findings and Recommendations Addressed*: well-developed work plan that ensures efficiency
and accountability.
• Finding 3 (page 303) - Recommendations 1 and 2
The second part of this project includes identifying
• Finding 9 (page 304) - Recommendations 1, 2, 3,
an interim leader to address the system components
and 4
of Phase Two that will ultimately be the responsibility
• Note: Priority 2 is already in progress from of the SFM. This is another area where the HWMO
the last legislative session. FSRI provided may be able to assist as a contractor. As mentioned
input to the job description to support the in Priority 1, they have knowledge, experience,
effort; however, the status of the hiring and the professional network to develop a project
process is unknown. plan to address each of the items listed in Priority 2,
and several of the subsequent priorities where
Recommendations for how the SFM is listed.

to address Priority 2
Priority 3. Wildfire Education
This is a two-part project where both are
completed concurrently. One project is to hire Programming
individuals needed to establish an OSFM, and the Provide educational programming for the diversity
second is to identify an interim SFM who can work of audiences across the state regarding wildfire
on the tasks that will ultimately be managed by the preparedness. Programming should include
SFM once hired. mitigation best practices, defensible space and
vegetation management, fire weather, and fire
The first task is to select a Priority 2 owner. This behavior. Develop and implement a plan for
could be the leader of the organization most ongoing financial support for this programming.
responsible for managing the recruitment and hiring
of the SFM and staff, which may come from the Findings and Recommendations Addressed*:
state agency the OSFM will report to, Department
of Human Resources Development (DHRD), State • Finding 11 (page 305) - Recommendation 1
Personnel Office, and/or a member of the SFC.
• Finding 13 (page 305) - Recommendation 1
Each one of these organizations has been, or will
likely be, involved in the hiring process. • Finding 18 (page 306) - Recommendation 4
• Finding 37 (page 309) - Recommendation 1
The organizations listed above should finalize
• Finding 39 (page 309) - Recommendation 1
the class specification and associated job
duties to ensure it includes, but not be limited • Finding 75 (page 316) - Recommendations 2
to, wildfire (including wildland urban interface - and 3
WUI) prevention, preparedness, response, and
recovery, as well as multi-agency and multi-sector
coordination and strategy.

The recruitment and hiring of the SFM should

include a project plan with tasks, task owners,
completion timelines, and other components of a

*Page numbers referenced correspond to the Lahaina

Fire Incident Analysis Report (Phase Two) 10
2.0 STATE OF HAWAI‘I
PRIORITIES AND
RECOMMENDATIONS

Recommendations for how Findings and Recommendations Addressed*:

to address Priority 3
• Finding 36 (page 309) - Recommendation 1
This is another two-part project where both tasks
• Finding 37 (page 309) - Recommendation 1
are completed concurrently. One task is to identify
a state government organization that will be • Finding 75 (page 316) - Recommendations 1
responsible for ensuring wildfire-related educational and 2
programming is prioritized and supported at the
state-level (accountability). The second is to fund
and support the ongoing work to be adequately Recommendations for how
carried out (implementation). to address Priority 4
Select a Priority 4 task owner from a state
The first task is to select a Priority 3 owner from
government organization.
a state government organization. Ensuring
ongoing state-level accountability and support for
Due to HI-EMA having responsibility for the OWSS
this priority may eventually fall under the SFM’s
they may be best positioned to own and lead this
purview, or potentially DLNR-DOFAW’s, should their
priority. Other organizations that can assist include
responsibilities expand beyond conservation areas.
county emergency management agencies,
In the meantime, the interim SFM, as identified in
DLNR-DOFAW (could provide wildfire input on
Priority 2, could take on this responsibility.
behalf of the SFM until one is selected, or have
the interim SFM from Priority 2 engage), NWS,
The second task is to ensure existing programming
telecommunications providers, and Hawaiian
is supported and implemented. Currently, the HWMO
Electric (may be able to help with addressing
serves as the lead coordinating entity for wildfire
resilient electrical power options).
outreach campaigns, educational resources, and
training programs, collaborating with the DLNR-
DOFAW, county fire departments, emergency Priority 5. Utilities Risk Reduction
management agencies, and communities to deliver and Planning
statewide, multi-sector wildfire preparedness and
mitigation programs. However, with minimal to no state HPUC and SFM to work with public utilities (electric
funding at present, securing financial support will be and water) to identify immediate improvements
crucial for the sustained implementation of this priority. to vegetation management programs to protect
infrastructure from wildfire and enhance resiliency,
and to provide guidelines for supporting incident
Priority 4. Communication management and operations.
Systems
Findings and Recommendations Addressed*:
HI-EMA and SFM to assess the resiliency and
functionality of communication systems and the
All-Hazard Outdoor Warning Siren System • Finding 29 (page 308) - Recommendation 1
(OWSS), and establish redundant public alerting • Finding 31 (page 308) - Recommendation 1
and warning processes, including best practice • Finding 56 (page 311) - Recommendation 1
messaging guidance.

*Page numbers referenced correspond to the Lahaina

Fire Incident Analysis Report (Phase Two) 11
2.0 STATE OF HAWAI‘I
PRIORITIES AND
RECOMMENDATIONS

Recommendations for how • Finding 6 (page 303) - Recommendation 1

• Note: This can be expanded to installing more
to address Priority 5 RAWS in West Maui and other wildfire prone
Select a Priority 5 owner from a state government areas since two (2) RAWS have been positioned
organization. in Lahaina.
• Finding 7 (page 303) - Recommendation 1
Since the HPUC falls under the Department of
Commerce and Consumer Affairs (DCCA), DCCA • Finding 8 (page 304) - Recommendation 1
may be best positioned to own and lead this priority
with assistance from the interim SFM identified in
Priority 2. DLNR-DOFAW, DLNR-Land Division, land Recommendations for how
owners, Hawaiian Electric, and CWRM can also to address Priority 6
contribute to this effort.
Select a Priority 6 task owner from a state
To address guidelines for incident management government organization.
and operations, the interim SFM mentioned in
Priority 2 can work closely with the SFC to develop The DLNR-DOFAW is the only state organization with
expectations/guidelines for cooperators supporting wildland firefighters possessing national qualifications
incident commanders. and having extensive knowledge of weather and
other factors influencing wildland fire behavior. The
It should be recognized that this priority is in- DLNR-DOFAW could work closely with the interim
progress. Hawaiian Electric has developed Interim SFM mentioned in Priority 2 and the SFC to complete
Wildfire Safety Measures8 to reduce the risk of this priority.
wildfires associated with utility infrastructure and
continues to work closely with government agencies Priority 7. Evacuation
to make improvements to their wildfire preparedness
HI-EMA, DLE, DOT, and OPSD to coordinate
and prevention efforts.
with county law enforcement, fire, emergency
management, and planning agencies in preparing a
Priority 6. Fire Weather standardized format for documenting and executing
DLNR-DOFAW, SFC, and SFM to support NWS evacuation plans for high wildfire risk areas.
in improving weather forecasting and historical
record keeping by ensuring Remote Automatic Findings and Recommendations Addressed*:
Weather Stations (RAWS) are positioned in high
wildfire danger areas statewide. Also, engage • Finding 16 (page 306) - Recommendation 1
other stakeholders, such as Hawaiian Electric and • Finding 17 (page 306) - Recommendation 1
University of Hawaiʻi, who are currently installing
• Finding 18 (page 306) - Recommendations 1 and 3
weather stations that may provide additional fire
weather information. • Finding 19 (page 306) - Recommendations 1 and 2
• Finding 71 (page 314) - Recommendations 1 and 2
Findings and Recommendations Addressed*:
• Finding 72 (page 315) - Recommendations 1, 2, 3,
4, 5, and 6
• Finding 5 (page 303) - Recommendation 2
• Finding 76 (page 316) - Recommendations 1, 2, and 3

*Page numbers referenced correspond to the Lahaina

Fire Incident Analysis Report (Phase Two) 12
2.0 STATE OF HAWAI‘I
PRIORITIES AND
RECOMMENDATIONS

Recommendations for how Recommendations for how

to address Priority 7 to address Priority 8
Select a Priority 7 task owner from a state Select a Priority 8 task owner from a state
government organization. government organization.

The DLE is the state law enforcement agency Until an SFM is appointed, and if the HBCC does
responsible for collaborating with federal, state, not have full-time administrative staff, a member
county, and private sector stakeholders. In addition of the Department of Accounting and General
to working closely with the organizations identified Services (DAGS) could be designated as the
in the priority, the DLE should also work with the owner. DAGS and the interim SFM identified
HWMO to learn where the wildfire risk areas are in Priority 2 could work closely with the HBCC,
located throughout the state, where these risks are SFC, ICC, NFPA and other code and standards
expanding to, and which communities currently have stakeholders to complete this priority.
neighborhood evacuation plans and safe refuge
locations already identified and/or developed.
Priority 9. Wildfire Response
Preparedness
Priority 8. Codes and Standards
SFM, SFC, HI-EMA, and DLNR-DOFAW to
SFM, HBCC, and SFC collaboratively evaluate
improve the coordination of wildfire preparedness
and enhance the review and adoption processes
and response of emergency responders across
for codes and standards, ensuring they effectively
all agencies and private contractors to ensure the
address wildfire risks, particularly in the WUI.
effective and efficient use of shared resources
Continued work is needed to align and coordinate
and to provide expectations for incident
codes to reduce fire risks to the built environment.
management organization.
Jointly ensuring organizational structures are
prioritized and appropriately staffed to efficiently
Findings and Recommendations Addressed*:
adopt and implement updated codes that reflect
the state’s wildfire threat will help provide a unified
• Finding 40 (page 309) - Recommendation 2
approach to wildfire resilience.
• Finding 41 (page 310) - Recommendation 1
Findings and Recommendations Addressed*: • Finding 42 (page 310) - Recommendation 1
• Finding 43 (page 310) - Recommendation 1
• Finding 14 (page 305) - Recommendation 3
• Finding 15 (page 306) - Recommendation 1
• Finding 77 (page 316) - Recommendation 2
• Finding 78 (page 316) - Recommendation 1
• Finding 80 (page 316) - Recommendation 2

*Page numbers referenced correspond to the Lahaina

Fire Incident Analysis Report (Phase Two) 13
2.0 STATE OF HAWAI‘I
PRIORITIES AND
RECOMMENDATIONS

Recommendations for how Recommendations for how

to address Priority 9 to address Priority 10
Select a Priority 9 task owner from a state Select a Priority 10 task owner from a state
government organization. government organization.

The DLNR-DOFAW may be best positioned to Currently, there is no state organization tasked with
be the owner and leader of this priority due to developing or enforcing vegetation management
their specialized wildland firefighting training and guidelines, directives, or laws, and there is no
operational expertise. The other organizations framework governing responsible land management
identified in the priority, including the interim SFM or related codes and policies that ensure public
identified in Priority 2, can assist by expanding safety is prioritized in such land management
response to the WUI and other types of emergencies. practices. In other states, this is often the
responsibility of the SFM, state forestry, and/or land
management agency.
Priority 10. Vegetation and
Land Management For this priority, the DLNR-DOFAW may have the
Identify the state agency responsible for vegetation most state agency experience in the design and
management of non-conservation areas and implementation of vegetative fuels management
establish a framework for land owners to follow for for fire risk reduction, even though its efforts are
responsible land management. Appropriate agencies restricted to conservation areas.
to lead this effort include those with experience in
natural resource and land management, zoning, The HWMO currently provides training, best practice
education, and enforcement. information, and mitigation planning support for
vegetation management. They have also developed
statewide vegetation management maps and
Findings and Recommendations Addressed*:
reports, and collaborated with communities, land
stewards, and agencies on small defensible space
• Finding 9 (page 304) - Recommendations 1, 2, 3, 4, and fuel break projects.
and 5
• Finding 10 (page 305) - Recommendations 1, 2, Perhaps the owner of this priority is the DLNR-
and 3 DOFAW with assistance from the interim SFM
• Finding 11 (page 305) - Recommendation 1 identified within Priority 2. Other relevant partners,
such as the HWMO (described above) and UH
• Finding 12 (page 305) - Recommendations 1 and 2 Economic Research Organization (UHERO), who
• Finding 13 (page 305) - Recommendations 1, 2, have initiated a study about the economics related
and 3 to this issue, could also be engaged for an informed
• Finding 78 (page 316) - Recommendation 1 and collaborative approach to developing the action
plan and framework.

*Page numbers referenced correspond to the Lahaina

Fire Incident Analysis Report (Phase Two) 14
3.0 COUNTY
PRIORITIES AND
RECOMMENDATIONS

3.0 County Priorities the Lahaina Fire Findings and Recommendations.9

Some of the priorities are consistent with the 10
And Recommendations priorities FSRI identified for the State.

This streamlined approach provides a clear

The Lahaina Fire Incident Analysis Report (Phase
roadmap for the counties to initiate progress
Two) was released September 13, 2024. The report
and take the critical first steps necessary to
includes 84 Findings and 140 Recommendations.
establish a solid foundation that supports future
At the request of Governor Green, FSRI identified
meaningful improvements. While these 10 priorities
10 key priorities for the State of Hawaiʻi to address
are crucial for immediate action, the remaining
to enhance wildfire safety statewide. The document
recommendations are also vital and should be
was released September 30, 2024.
urgently addressed to ensure comprehensive
wildfire system improvements across each county.
The follow-up to the state priority list is the county
list. This list includes what the counties should focus
The priorities were reviewed with each county
on immediately to address the increasing threat of
fire chief. The chiefs provided valuable input that
wildfire and urban conflagration (See Table 2). The
was incorporated within the document to make
10 priorities draw on the recommendations from
the “how” to implement more actionable and
Phase Two that pertain to all Hawaiʻi counties and
achievable for all counties.
other published reports that include references to

15
3.0 COUNTY
PRIORITIES AND
RECOMMENDATIONS

Table 2. The 10 highest priorities for enhancing wildfire readiness at the county level.

10 Highest Priorities for Enhancing Wildfire Readiness at the County Level

Priority 1
Ensures an organizational
structure that supports a

Coordinated Action Planning & Accountability

coordinated process

Facilitation of process to plan and implement subsequent priorities

Priority 2
Risk Assessment and Data Driven Investment
All county fire department complete a community risk assessment, community
risk reduction plan, and standards of cover
Lead agency assigned to

Priority 3 Priority 4 Priority 5 Priority 6

develop & implement

Wildfire Response Incident Wildfire & WUI Communication

Preparedness Management Education Systems
action plan

Programming

Priority 7 Priority 8 Priority 9 Priority 10

Evacuation Codes & Standards Utilities Risk Vegetation & Land
Reduction & Planning Management

Priority 1. Coordinated Action and non-governmental organizations (NGOs)

involved in wildfire/WUI prevention, preparedness,
Planning and Accountability and response should also engage in this exercise.
Assign county-based organizations — including Together, these entities can conduct the learning
fire, law enforcement, emergency management, and research necessary to begin planning and
the mayor’s office, county corporation counsel, taking action, and coordinate their work plans to
water department, planning department, and best address the recommendations applicable to
public works — to prepare a preliminary action their organization.
plan for addressing Phase Two Findings and
Recommendations pertaining to their areas of Findings and Recommendations Addressed*:
responsibility. County-based representatives
from the electrical utility provider, emergency • Finding 1 (page 303) - Recommendations 1 and 2
medical services contractors, and state and
federal agencies, such as DLNR-DOFAW,
National Park Service, and Airport Rescue Fire
Fighters (ARFF) and other relevant government

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Fire Incident Analysis Report (Phase Two) 16
3.0 COUNTY
PRIORITIES AND
RECOMMENDATIONS

Recommendations for how Each organization’s Priority 1 Task Owner could be

responsible within their organization for:
to address Priority 1
Assemble a Leadership Team to facilitate and • Selecting wildfire/WUI agenda topics relevant to
oversee this coordinated multi-partner effort. The their organization
team should include experts in pre-suppression, • Developing work plans to address these priority
suppression, and collaborative multi-system wildfire topics effectively
mitigation to guide effective wildfire planning across • Facilitating internal and external meetings to
county agencies. This team will ensure stakeholder coordinate efforts and address organizational
collaboration and alignment, while safeguarding the priorities
accuracy and adherence of technical components
to best practices. This priority sets the table for the subsequent
priorities.The Leadership Team can encourage
The Leadership Team could be responsible for the or ensure that as each county organization leads
following: the development of their specific action plan, they
should avoid working in isolation or reinventing
• Scheduling and facilitating meetings with federal, existing processes, as this can lead to inefficiencies
state, inter-county, and NGO partners to foster and fragmentation. Collaboration with other
a collaborative and unified approach to wildfire/ agencies and stakeholders is encouraged and
WUI prevention, preparedness, and response essential to avoid duplication, competition, and
potential harm. Achieving more cohesive and
Each organization listed above should designate effective outcomes requires building on existing
an internal lead and point of contact to serve as data, programs, and knowledge.
the Priority 1 Task Owner. This individual will be
responsible for ensuring that the work remains
on track and is effectively prioritized within their
organization.

As the plans are being developed, a strategy for

ensuring wildfire/WUI topics are appropriately
prioritized is to include them within upper-, mid-,
and lower-management meeting agendas. This
can ensure the county’s wildfire threat is given the
consistent organizational attention required.

17
3.0 COUNTY
PRIORITIES AND
RECOMMENDATIONS

Priority 2. Risk Assessment and emergency incident, planning, and building

information. Data should be de-identified (if
Data Driven Investment needed), aggregated, and combined with data
Each county fire department should complete a from other public and private sources, such as
CRA and CRR plan according to NFPA 1300. All fire Census data, to characterize risk from all hazards
departments should also complete an SOC analysis. across each county.
These analyses provide the data needed to identify
Community Risk Reduction Plan
the investment in fire department resources to
comprehensively address fire risk, as well as all the Based on the CRA, and in concert with community
other hazards that exist throughout each county. groups/partners, the comprehensive CRR is
designed to provide realistic strategies to increase
Phase Two Findings and Recommendations the resiliency of the county’s residents, infrastructure,
Addressed*: and environment. The plan describes actions that can
be taken by individuals, community organizations,
• Mentioned on page 302 of Summary government agencies, and others to mitigate risks,
Other sources of information that also address the prepare to actively address risks, and make long-term
need for the MFD to complete a risk assessment progress on addressing risk in the community.
and SOC. These recommendations extend to all
counties within the state.10 11 12 The CRR planning process should recognize
the vital cultural and historical attributes of each
county community by including residents and local
Recommendations for how businesses at every stage.
to address Priority 2
Currently, the State contract with FSRI includes a Data for this work will include information from
CRA, CRR, and SOC for the MFD. Because wildfire county fire department staff on past risk-reduction
and urban conflagration hazards exist within all four efforts and the viability of proposed risk-reduction
counties, it is highly recommended all four county strategies; ideally, fire department and emergency
fire departments conduct these critically important management staff should be directly involved with
analyses if they have not been completed in the past all facets of the CRR planning effort.
five years. The analyses includes the following: Standards of Cover Analysis
Community Risk Analysis An independent, comprehensive SOC analysis of
The CRA evaluates and enumerates natural, the deployment and performance of a county fire
technological, and societal contributors to the department is required to objectively identify areas
health and safety of county residents, businesses, where additional resources are needed to help
and visitors. This assessment benefits from the protect the community from all hazards.
active involvement of county residents and local
businesses in community-centered discussions of This analysis will quantify the fire department’s ability
risk perception, societal and cultural contributors to deliver the capabilities described in NFPA 1710—
to risk, and the impact of multiple factors in the Standard for the Organization and Deployment of
county’s risk profile.13 Fire Suppression Operations, Emergency Medical
Operations, and Special Operations to the Public by
Data needed for this work primarily consists of Career Fire Departments.

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Fire Incident Analysis Report (Phase Two) 18
3.0 COUNTY
PRIORITIES AND
RECOMMENDATIONS

The SOC analysis is best conducted utilizing water companies to improve the coordination of
dynamic deployment modeling that considers wildfire preparedness and response of emergency
the activity level of MFD response units and the responders across all agencies and private
interaction of these units with the County’s EMS contractors to ensure the effective and efficient use
provider and mutual-aid resources (e.g., AMR, of shared resources and to provide expectations for
ARFF, DOFAW, etc.). incident management organization.

Data needed will primarily include computer Findings and Recommendations Addressed*:
aided dispatch (CAD) and fire department records
management system (RMS) emergency incident • Finding 5 (page 303) - Recommendations 1 and 2
information that is de-identified (if needed), • Finding 6 (page 303) - Recommendation 1
aggregated, and analyzed without any personally • Finding 7 (page 303) - Recommendation 1
identifiable information.
• Finding 8 (page 304) - Recommendation 1
Funding and Getting Started
• Finding 27 (page 308) - Recommendation 1
Completion of the same analyses for Kauaʻi,
• Finding 28 (page 308) - Recommendation 1
Hawaiʻi, and Honolulu county fire departments
requires additional funding. Contracting for the • Finding 34 (page 309) - Recommendation 1
same services for the three counties can be • Finding 35 (page 309) - Recommendation 1
efficiently executed using the same request for
• Finding 40 (page 309) - Recommendation 2
proposal and statement of work that is agreed upon
by the three counties. • Finding 46 (page 310) - Recommendation 1
• Finding 55 (page 311) - Recommendations 1 and 2
Prior to securing funding, fire departments can
• Finding 59 (page 312) - Recommendations 1, 2, 3, 4,
begin gathering the data necessary for the three
and 5
different analyses. The data elements are identified
in NFPA 1300 and the FSRI SOC list (provided to • Finding 60 (page 312) - Recommendations 1, 2, 3,
each county fire department Priority 1 Task Owner and 4
upon request). • Finding 61 (page 313) - Recommendation 1
• Finding 62 (page 313) - Recommendations 1 and 2
The HWMO can also be contracted to assist with
assembling and analyzing the data needed for the • Finding 64 (page 313) - Recommendation 1
CRA and CRR. The previous and current work • Finding 65 (page 313) - Recommendation 1
performed by the HWMO, fire departments, and • Finding 67 (page 313) - Recommendations 1 and 2
others will help inform the new CRA and CRR.
• Finding 68 (page 314) - Recommendations 1, 2, 3, 4,
5, and 6
Priority 3. Wildfire Response • Finding 69 (page 314) - Recommendation 1

Preparedness • Finding 70 (page 314) - Recommendation 1

County fire departments, police departments, • Finding 83 (page 317) - Recommendation 1

emergency management agencies, county-based
DLNR-DOFAW, electrical utility providers, and

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Fire Incident Analysis Report (Phase Two) 19
3.0 COUNTY
PRIORITIES AND
RECOMMENDATIONS

incident command posts, incident base, helispots,

Recommendations for how
public temporary refuge areas, public safe refuge
to address Priority 3 areas, safety zones, staging areas, pools, reservoirs,
This priority requires the following steps to ensure gates, evacuation routes, structure defense groups,
assisting and cooperating agencies are prepared for and hydrant locations with connection sizes and
wildfire/WUI response. municipal vs private identification. The maps should
be accessible during incidents to all responders
Pre-incident Planning, Training, and Readiness and updated annually or when changes occur. The
Task 1 - Above listed organizations become process of creating and maintaining the maps can be
familiar with existing Community Wildfire Protection codified in policy and procedure to ensure they are
Plans (CWPP). The objective of the review is for available and kept current.
organizational leaders through local responders
to become aware of wildfire hazards, built Task 4 - Initiate automatic / mutual aid agreement
environment vulnerabilities, and where evacuation between county fire department and county-based
challenges exist. The CWPP serves as an DLNR-DOFAW for joint response to all vegetation
introduction to learning about the level of wildfire fires. This allows for more wildland capable
risk in communities and where urban conflagration resources on scene for initial attack, and for
is a threat to life safety and property conservation. incidents requiring significant mop-up.
It also identifies community- and agency-identified
priorities for wildfire protection and action. Task 5 - Fire departments and the DLNR-DOFAW
establish a system to track fleet readiness to
Task 2 - Fire departments enhance training to ensure preparedness of reserve/relief emergency
strengthen operational readiness during forecasted apparatus prior to forecasted weather events.
extreme conditions. Focus areas include initial The report should be available via a web based
attack strategies, structure defense tactics, utilizing platform so officers know the real time status of
alternative water sources, safely navigating vehicles as listed by apparatus identification, type,
electrical hazards, and effectively managing and location. This can be codified in policy and
mop-up operations for wind-driven wildland and procedure to ensure it is adhered to.
WUI fires.
Task 6 - Fire departments and county-based
Task 3 - Fire departments and the DLNR-DOFAW DLNR-DOFAW work with private heavy equipment
use the CWPPs to develop electronic wildland pre- companies (and operators) to establish wildland
attack plans / structure defense maps. The maps firefighting expectations/standards addressing
serve as a reference tool for responders before and training, equipment, personal protective equipment,
during an incident. Maps can include locations for and operational performance.

20
3.0 COUNTY
PRIORITIES AND
RECOMMENDATIONS

Weather Tracking and Response Task 10 - Fire departments, county-based DLNR-

DOFAW, and electrical utility providers should
Task 7 - Fire and emergency departments should
consider establishing an augmented staffing
assign a dedicated individual or team responsible
plan triggered when fire weather and/or other
for tracking and consistently monitoring NWS fire
severe weather conditions are forecasted. The
weather forecasts, fire weather products, drought
parameters for augmented staffing should be
monitors, real-time conditions, and fuel conditions.
related to fire history, weather, and fuel. Analyzing
This critical information should be regularly
when, where, and how big fires burn in relation to
communicated to leadership and operational staff on
weather and fuels data can land decision makers
a daily basis or as updates occur to support informed
on a probability of large growth where augmented
decision making and operational readiness.
staffing could make a difference in controlling the
fire when it is small. Augmented staffing can also
Task 8 - During wildfire season (as per county
be implemented at different levels.
incident data), fire departments and county based
DLNR-DOFAW should consider having operational
A basic augmented staffing plan may consist
conference calls with officers to share weather
of staffing the water tenders/tankers with an
and fuels information, reserve/relief unit status,
additional firefighter. A more robust plan could
augmented staffing plan, and other operational
include wildland apparatus staffed with two to four
preparedness issues. This can be codified in policy
personnel, a select number of relief apparatus
and procedure to ensure it is adhered to.
being positioned and staffed in high risk areas,
a chief officer assigned to dispatch, and a Type
Task 9 - When fire weather, or other significant
3 incident management team on call status. The
weather events, are forecasted it is recommended
augmented staffing process should be codified in
the NWS brief fire departments, police
policy and procedure so it is clear what weather
departments, county-based DLNR-DOFAW,
and fuel parameters are being evaluated to trigger
county-based National Park Service, electrical
staffing, and to identify the individual (role/rank)
utility provider, public works, water department,
responsible for making the decision.
and other cooperating agencies on expected
severity of conditions and provide preparedness
recommendations.

21
3.0 COUNTY
PRIORITIES AND
RECOMMENDATIONS

Priority 4. Incident Management Wildfire Coordinating Group (NWCG) training and

qualification standards provide structure that can
County emergency management agency, fire
be adapted and scaled to organizational size and
department, and law enforcement work with
response demands. Additionally, standardized
HI-EMA and SFM to develop and implement
training and a unified incident management
a statewide incident management training,
framework enable reliable personnel sharing and
qualification, and response framework consistent
seamless support across agencies.
with the National Incident Management System
(NIMS14) and in alignment with Homeland Security
This commitment to a standard should be codified
Presidential Directive 5.16
in state and county regulations.
Findings and Recommendations Addressed*:
Priority 5. Wildfire and Wildland
• Finding 40 (page 309) - Recommendations 2 and 3
Urban Interface (WUI)
• Finding 41 (page 310) - Recommendation 1
Education Programming
• Finding 44 (page 310) - Recommendations 1 and 2
Provide educational programming and risk
• Finding 46 (page 310) - Recommendation 1
reduction support for the diversity of audiences
• Finding 47 (page 310) - Recommendation 1 across the county regarding wildfire preparedness.
• Finding 50 (page 311) - Recommendation 1 Programming to include mitigation best practices,
defensible space and vegetation management,
• Finding 51 (page 311) - Recommendation 1
fire weather, and fire behavior. Develop and
• Finding 52 (page 311) - Recommendations 1 and 2 implement a plan for ongoing financial support for
• Finding 55 (page 311) - Recommendations 1 and 2 this programming.
• Finding 56 (page 311) - Recommendation 1
Findings and Recommendations Addressed*:
• Finding 57 (page 312) - Recommendations 1 and 2
• Finding 59 (page 312) - Recommendation 3 • Finding 11 (page 305) - Recommendation 1
• Finding 13 (page 305) - Recommendation 1
• Finding 18 (page 306) - Recommendation 4
Recommendations for how
• Finding 37 (page 309) - Recommendation 1
to address Priority 4
• Finding 39 (page 309) - Recommendation 1
Although individuals from state and county
emergency management and response agencies • Finding 75 (page 316) - Recommendations 2
complete some NIMS courses, currently there is and 3
no standardized incident management framework
for the State of Hawaiʻi. Establishing a NIMS
framework for all county emergency management
agencies, fire departments, police departments, and
cooperating support agencies ensures consistent
incident management preparation and operations.
The NIMS framework and associated National

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Fire Incident Analysis Report (Phase Two) 22
3.0 COUNTY
PRIORITIES AND
RECOMMENDATIONS

Recommendations for how Recommendations for how

to address Priority 5 to address Priority 6
The recommendations outlined in the State’s list can County emergency management, fire department,
also be applied at the county level. and law enforcement should work closely with
telecommunications providers and the Hawaiʻi
Contract with the HWMO to prepare and implement Association of Broadcasters (HAB) to assess the
wildfire education programming. This would help functionality and resilience of communications
maintain consistent messaging statewide. These systems in each high-hazard area of the counties,
programs and resources, co-developed with and to develop plans for how each public
county and state fire agencies, are already being emergency communications form will be used.
collaboratively implemented. Ensuring financial These organizations can inform emergency
investment in these programs is essential to their managers and responders of the strength
success, enabling them to function effectively, meet and vulnerabilities of the telecommunications
community needs, and drive the critical shift from infrastructure, and determine how radio can be
community and land manager wildfire awareness to used more effectively to communicate alerts and
proactive mitigation action. updates when electrical and telecommunications
infrastructure is compromised.

Priority 6. Communication County emergency management should also work

closely with HI-EMA to understand the functionality
Systems and Planning and resilience of the OWSS in each high-hazard area.
County emergency management agency to Other organizations that can assist include county-
coordinate with HI-EMA to assess the resiliency and based DLNR-DOFAW (could provide wildfire input),
functionality of public emergency communication NWS, and Hawaiian Electric (may be able to help with
systems and the OWSS, and establish redundant addressing resilient electrical power options).
public alerting and warning processes, including
best practice messaging guidance. This priority County agencies follow best practices to ensure
also extends to: preparing plans for how different alerts include language that is clear, concise,
forms of public emergency communications will be and standardized. Achieving interoperability of
executed and ensuring interoperability of emergency emergency responder communications requires
responder communications. planning and investment. This should start with fire,
law enforcement, and emergency management
Findings and Recommendations Addressed*:
working together to ensure investment in
infrastructure and radio equipment achieves
• Finding 36 (page 309) - Recommendation 1
reliable interoperability.
• Finding 37 (page 309) - Recommendation 1
• Finding 39 (page 309) - Recommendation 1
• Finding 75 (page 316) - Recommendations 1 and 2

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Fire Incident Analysis Report (Phase Two) 23
3.0 COUNTY
PRIORITIES AND
RECOMMENDATIONS

Priority 7. Evacuation Priority 8. Codes and Standards

County law enforcement, fire, emergency County fire departments (prevention chiefs) and
management, and planning agencies should county planning departments should evaluate and
collaborate to prepare a standardized methodology enhance the review and adoption processes for
and format for documenting and executing codes and standards, ensuring they are driven
evacuation plans for high wildfire risk areas. by public safety and effectively address wildfire
risks, particularly in the WUI. Focus on aligning
Findings and Recommendations Addressed*: and coordinating codes to reduce fire risks to the
built environment, while simultaneously building
• Finding 16 (page 306) - Recommendation 1 the capacity needed for plans review, permitting,
• Finding 17 (page 306) - Recommendation 1 inspection, and enforcement. Organizational
• Finding 18 (page 306) - Recommendations 1 and 3 structures should be prioritized and appropriately
staffed to adopt and implement updated codes
• Finding 19 (page 306) - Recommendations 1 and 2
efficiently, reflecting the county’s wildfire threat and
• Finding 71 (page 314) - Recommendations 1 and 2 fostering a unified approach to wildfire resilience.
• Finding 72 (page 315) - Recommendations 1, 2, 3,
Findings and Recommendations Addressed*:
4, 5, and 6
• Finding 76 (page 316) - Recommendations 1, 2, • Finding 14 (page 305) - Recommendation 3
and 3
• Finding 15 (page 306) - Recommendation 1
• Finding 77 (page 316) - Recommendation 2
Recommendations for how • Finding 78 (page 316) - Recommendation 1
to address Priority 7 • Finding 80 (page 316) - Recommendation 2
County emergency management, police
departments, and fire departments should develop
evacuation plans based on known and anticipated
Recommendations for how
evacuation needs. County emergency management to address Priority 8
and law enforcement agencies should coordinate County fire department prevention chief tracks SFM,
with the state DLE to ensure consistency with the SFC and HBCC code amendment and adoption
state evacuation planning format. Coordination progress. The chief can also review code adoptions
with the HWMO is also helpful to learn where and amendments of other states and counties with
the wildfire risk areas are located throughout the similar wildfire and built environment risk. The work
state, where these risks are expanding to, and other states are doing in this area can inform next
which communities currently have neighborhood steps for county codes adoption and amendment
evacuation plans and safe refuge locations already process. The county prevention chief should also
identified and/or developed. Coordinate local work closely with the ICC, the NFPA, and other code
community efforts to develop neighborhood-specific and standards stakeholders to complete this priority.
evacuation plans that align seamlessly with broader
agency evacuation strategies.

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Fire Incident Analysis Report (Phase Two) 24
3.0 COUNTY
PRIORITIES AND
RECOMMENDATIONS

Priority 9. Utilities Risk Priority 10. Vegetation and

Reduction and Planning Land Management
County fire departments and public utilities (electric Identify a county agency to work with the state
and water) should identify immediate improvements agency responsible for vegetation management of
to vegetation management programs to harden non-conservation areas and establish a framework
and protect infrastructure from wildfire, prevent for land owners to follow for responsible land
utility-ignited fires, and enhance overall resiliency. management. Appropriate agencies to lead this
Additionally, they should develop guidelines to effort include those with experiences in natural
support incident management, operations, and resource and land management, zoning, education,
responder safety. and enforcement.

Findings and Recommendations Addressed*: Findings and Recommendations Addressed*:

• Finding 29 (page 308) - Recommendation 1 • Finding 9 (page 304) - Recommendations 1, 2, 3,

• Finding 31 (page 308) - Recommendation 1 4, and 5

• Finding 56 (page 311) - Recommendation 1 • Finding 10 (page 305) - Recommendations 1, 2

and 3
• Finding 11 (page 305) - Recommendation 1
Recommendations for how
• Finding 12 (page 305) - Recommendations 1 and 2
to address Priority 9
• Finding 13 (page 305) - Recommendations 1, 2,
While the State is working with the HPUC to and 3
develop vegetation management guidelines/
regulations for electrical installations, the county fire • Finding 78 (page 316) - Recommendation 1
department should work with local electrical utilities
in the same effort, while also developing incident
management operations and a responder safety
training program.

Responder safety training programs related to

compromised electrical infrastructure should
include evidence-based practices for firefighters
and police officers. Programs should be codified
in agency policies.

This priority should complement Hawaiian Electric’s

ongoing efforts toward wildfire prevention
and preparedness.16

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Fire Incident Analysis Report (Phase Two) 25
3.0 COUNTY
PRIORITIES AND
RECOMMENDATIONS

Recommendations for how evidence-based research, and following ecological

and environmental preservation standards. Other
to address Priority 10 relevant partners, such as the HWMO (described
Currently, there is no state or county organization above) and UHERO, which has initiated a study
tasked with developing or enforcing vegetation about the economics related to this issue, could
management guidelines, directives, or laws, and also be engaged for an informed and collaborative
there is no framework governing responsible land approach to developing the action plan
management or related codes and policies that and framework.
ensure public safety is prioritized in such land
management practices. In other states, this is Owners and managers of large vegetated land
often the responsibility of the SFM, or state/county parcels in wildland or unmaintained agricultural
forestry agency. areas should be actively engaged to promote
education and encourage voluntary compliance.
For this priority, the DLNR-DOFAW may have the Additionally, they should provide critical information
most experience in the design and implementation to aid response efforts, including gate accessibility,
of vegetative fuels management for fire risk points of contact, staging areas, access routes, and
reduction, even though its efforts are restricted to available water resources.
conservation areas.

The HWMO currently provides training, best

practice information, and mitigation planning
support for vegetation management. They have
also developed statewide vegetation management
maps and reports, and collaborated with
communities, land stewards, and agencies on small
defensible space and fuel break projects.

Perhaps the owner of this priority is the county-

based DLNR-DOFAW unit, with assistance from
individuals from the fire department and planning
department.

Engagement of the departments with the capacity

to inspect and enforce is necessary due to
land owners receiving notification to maintain
properties, in accordance with local codes and
ordinances. Counties not having a local vegetation
management policy should adopt one, following
national best practices for clearance around
structures and management of large parcels. How
land owners comply with vegetation management
mandates must adhere to best practices,

26
4.0 FIRE CODE AND
BUILDING CODE REVIEW

4.0 Fire Code and Building Code Review

A component of the Phase Three report is a comprehensive independent review of the efficacy of current
building and fire codes in Maui, including the present status of code implementation, education, and
enforcement in place at the time of the August 8, 2023, Maui wildfires.

Although the information available from public facing websites (see footnotes) captures the code and standards
adoption elements and processes in place on and before August 8, 2023, evaluating the efficacy of the current
system requires additional data. The Phase Three components of CRA and the CRR planning process will
provide data needed to determine how the prevention resources and investment effectively address the risks
in Maui Nui. Furthermore, understanding the efficacy of fire prevention efforts statewide requires CRAs and
CRRs to be completed by the counties of Kauaʻi, Hawaiʻi, and Honolulu, as recommended within Section 3.

FEMA’s Mitigation Assessment Team’s (MAT) Recovery Advisories and Report on Codes, Standards and
Permitting17 also includes a review of the code adoption process while also providing recommendations for
addressing deficiencies.

27
4.1 BUILDING AND FIRE
CODES IN THE STATE
OF HAWAI‘I

4.1 Building and Fire Codes in four-year terms between the two organizations and
the first four-year term to be served by the Building
the State of Hawai‘i Industry Association of Hawaiʻi
This section presents an overview of the State • One member representing the Subcontractors’
of Hawaiʻi and County of Maui building and fire Association of Hawaiʻi who has significant
codes that were in place prior to the August 2023 experience with building codes
Maui wildfires. Applicable codes and regulations
are included along with a profile of the established
code administration programs in place for building HRS §107-2321 directs the SBCC to appoint an
safety and fire prevention programs as they were executive director with administrative abilities and
prior to the Maui wildfires. experience with the building industry. Separately,
HRS §107-23 directs the SBCC to appoint an
executive assistant with experience in statutory and
4.1.1 Hawai‘i State Building Code administrative rulemaking processes to assist in
Council carrying out the duties of the council. The salaries of
The State Building Code Council (SBCC), the executive director, executive assistant, and other
authorized by Hawaiʻi Revised Statutes (HRS) §107- staff are to be included annually in the budget of
22,18 establishes state building codes through the DAGS. These positions have not been appointed or
adoption and amendment of nationally recognized funded since their creation in 2007.
model building codes on a three year cycle.19 20 The
SBCC is comprised of 11 voting members and one 4.1.1.1 Hawai‘i State Building Codes
non-voting member as described below: The approved building codes adopted by the SBCC,
referred to comprehensively as the Hawaiʻi State
• Four county building officials, one from each of the Building Code Rules, in effect at the time of the Maui
four counties, appointed by the mayor wildfires were:
• One member representing the SFC
• One member representing the Department of • The latest fire code adopted by the Hawaiʻi SFC
Labor and Industrial Relations who has significant (detailed in Section 4.1.2)
experience in elevator safety • The 2018 edition of the International Building Code
• One member representing the State Energy (IBC)©22 with state amendments23
Office of the Department of Business, Economic • The 2018 edition of the International Existing
Development, and Tourism Building Code©24 with state amendments25
• One member representing the Structural • The 2020 edition of the National Electrical Code
Engineers Association of Hawaiʻi (NEC)©26 with state amendments27
• One member representing the American Institute • The Hawaiʻi State Elevator Code28
of Architects, Hawaiʻi State Council • The 2018 edition of the International Energy
• One member representing the Building Industry Conservation Code (IECC)©29 with state
Association of Hawaiʻi or the General Contractors amendments30
Association of Hawaiʻi, who has significant • The 2018 edition of the Uniform Plumbing Code©31
experience with building codes, with alternating with state amendments32

28
4.1 BUILDING AND FIRE
CODES IN THE STATE
OF HAWAI‘I

• The 2018 edition of the International Residential FSRI anticipates there will be legislation
Code (IRC)©33 with state amendments34 introduced in the Hawaiʻi Legislature’s upcoming
• Hawaiʻi design standards to implement Act 5, 2025 session that will create an attached agency
Special Session Laws, 200535 as applicable to for the SFM, which will alter some of the duties and
emergency shelters and essential government responsibilities of the SFC, if passed.
facilities
4.1.3 Hawaiʻi State Fire Codes
4.1.2 Hawai‘i State Fire Council The Hawaiʻi SFC adopted the NFPA 1, Fire Code©,
2018 Edition, as amended as the state fire code
The Hawaiʻi SFC,36 authorized under HRS §132- on September 10, 2020. The HBCC moved to
16,37 is organized under the Department of Labor adopt the NFPA 1, Fire Code© 2018 Edition,41
and Industrial Relations. Hawaiʻi does not currently as amended on January 19, 2021 as part of its
have an appointed SFM or have a SFM’s Office. comprehensive building code package (detailed
above in Section 4.1.1.1).
The SFC is comprised of the fire chiefs from
Hawaii’s four major counties - Hawaiʻi County,
Honolulu County, Kauaʻi County, and County 4.1.4 Governor’s Affordable Housing
of Maui. With a population under 100 people,38 Initiative and the State Building Codes
Kalawao County and the Village of Kalawao on
On July 17, 2023, prior to the Maui wildfires,
Moloka‘i are not represented on the SFC. The
the Governor of Hawaiʻi issued an Emergency
State Fire Council is supported by four staff39 — two
Proclamation42 relating to housing that suspended
administrative specialists, a program specialist, and
the ability of the SBCC to amend or update state
a secretary.
building codes. By statute, this also precludes both
the SFC and the SBCC from amending or updating
Under HRS §132-3,40 the SFC is charged with
the state fire code. This action was taken as part
adopting a state fire code that sets minimum
of a broader effort by the Governor to control home
requirements for the protection of persons and
prices and encourage construction of additional
property from fire loss. This charge includes setting
residential dwellings throughout the state.
minimum requirements for the storage, handling,
and use of hazardous materials and in controlling
On September 15, 2023, the Governor’s
conditions considered hazardous to life or
Emergency Proclamation43 was amended and
property in the design, use, or occupancy of
renewed following the Maui wildfires. This version
buildings or premises.
of the Emergency Proclamation continued the
suspension of the SBCC’s authorities to amend or
While the Hawaiʻi SFC adopts the state fire code,
update the Hawaiʻi State Building Codes. However,
the SBCC is the authorized body to develop and
this version also included amended language
adopt a comprehensive building code package for
allowing Hawaii’s counties to update their county
the state. The SFC Representative to the SBCC
building codes as authorized by law.
carries the State Fire Code Council’s position
and any concerns to the SBCC. Ultimately, the
SBCC develops, adopts, and promulgates a
comprehensive building code package which
includes the state fire code.

29
4.1 BUILDING AND FIRE
CODES IN THE STATE
OF HAWAI‘I

Subsequent amendments to the Governor’s Suspending the automatic adoption of the latest
Emergency Proclamation continue to uphold the codes will allow the State and counties to leapfrog
suspension of the SBCC’s authorities to amend or over amending the 2021 statewide and model
update the Hawaiʻi State Building Codes. Amended codes and focus their review efforts on the 2024
proclamations were published: codes. This will provide more consistency and
stability in the construction of affordable housing.52
• October 24, 2023 - Second Proclamation.44 Does
not apply to the area affected by the Lahaina
wildfire. Statement and map included within all As per the SBCC website,53 and as required
subsequent Proclamations. by HRS§107-24(c),54 the following building
codes without amendments from HBCC, have
• December 22, 2023 - Third Proclamation45 automatically become part of the Hawaiʻi State
• January 18, 2024 - Fourth Proclamation46 Building Code package:
• February 20, 2024 - Fifth Proclamation47
• State Building Code – 2021 IBC (Unamended)55
• April 19, 2024 - Sixth Proclamation8
• State Residential Code – 2021 IRC
• June 18, 2024 - Seventh Proclamation49 (Unamended)56
• August 15, 2024 - Eighth Proclamation50 • State Energy Code – 2021 IECC (Unamended)57
• October 10, 2024 - Ninth Proclamation Places
51
• State Fire Code – 2021 NFPA 1 (As amended by
a pause on the automatic adoption of county the SFC)58
building codes, giving the counties additional
time to review, amend and adopt the latest • State Plumbing Code – 2021 UPC (Unamended)59
state and national building codes to suit their • State Electrical Code – 2023 NFPA 70
particular safety and design standards and needs. (Unamended)60

30
4.2 BUILDING CODES IN
THE COUNTY OF MAUI

4.2 Building Codes in County of 4.2.2 County of Maui Building Code -

Maui 2023 Updates
The general ordinances of the County of Maui, In April 2023, prior to the wildfires, the County
Hawaiʻi, are codified and published as The Code of of Maui adopted revised ordinances63 to update
the County of Maui, Hawaiʻi.61 The County of Maui’s and amend the county’s building codes. While
building codes are published in Title 16 - Buildings not published in The Code of the County of Maui,
and Construction62 of The Code of Maui County, Hawaiʻi in its May 31, 2023, version, the April 2023
Hawaiʻi. The approved building codes adopted and ordinance included updates to and adoption of:
enforced by the County of Maui’s at the time of the
Maui wildfires were: • Chapter 16.08B - Residential Code based on the
International Residential Code©, 2018 edition
• Chapter 16.08A - Residential Code based on the with state amendments (county amendments to
International Residential Code©, 2006 edition as be determined)
amended • Chapter 16.10 *New Code/New Chapter* -
• Chapter 16.16C - Energy Code based on the Existing Building Code based on the International
International Energy Conservation Code©, 2018 Existing Building Code©, 2018 edition with
edition as amended, as adopted by the State state amendment (county amendments to be
Building Code Council on December 15, 2020 determined)
• Chapter 16.18B - Electrical Code based on the • Chapter 16.16C - Energy Code based on the
NFPA 70, National Electrical Code©, 2008 Edition International Energy Conservation Code©, 2018
as amended edition as amended
• Chapter 16.20C - Plumbing Code based on the • Chapter 16.25 *New Chapter* - Building Code
Uniform Plumbing Code©, 2018 Edition as amended Administrative and Supplemental Provisions
• Chapter 16.26B - Building Code based on the • Chapter 16.26C - Building Code based on the
International Building Code©, 2006 Edition as International Building Code©, 2018 edition as
amended amended
• Chapter 16.18B - Electrical Code was not
changed and remained on the NFPA 70, National
4.2.1 County of Maui Building Code Electrical Code©, 2008 Edition as amended
Discussion • Chapter 16.20C - Plumbing Code was not
The County of Maui’s promulgation and on-going changed and remained on the Uniform Plumbing
use of both the International Residential Code© and Code©, 2018 Edition as amended
the International Building Code©, 2006 editions, as
amended, were, for several years, inconsistent with The enabling ordinances took effect on approval.
HRS §107-28. Hawaiʻi statute prescribes that, “Each However, as specified within the ordinances,
county shall amend and adopt the Hawaiʻi State the County of Maui only began enforcing the
Building Codes and standards listed in section 107- updated editions of the codes on October 28, 2023,
25, as the referenced Hawaiʻi State Building Codes 180 days following their approval and after the
and standards for its respective county building code August 2023 wildfires.
ordinance, no later than two years after the adoption
of the Hawaiʻi State Building Codes.”

31
4.2 BUILDING CODES IN
THE COUNTY OF MAUI

4.2.3 The County of Maui Building

Code Administration
The County of Maui Development Services
Administration (DSA) administers the County’s
subdivision, building, electrical, plumbing, grading,
and other construction related ordinances.

4.2.3.1 Organization of the County of Maui DSA

At the time of the Maui wildfires, the County
of Maui DSA was one of three organizational
elements under the direction and oversight of the
County of Maui Department of Public Works.64
These included the DSA, the Engineering Division,
and the Highways Division.

The County of Maui DSA was organized into

seven sections:

• Building Plans Review Section

• Building Permit Section
• Building Inspection Section
• Civil Construction and Inspection Section
• Electrical Permit and Inspection Section
• Plumbing Permit and Inspection Section
• Subdivision Section

4.2.3.2 The County of Maui DSA Budget

and Personnel
The County of Maui DSA operates under the Maui
County Council Adopted Budget. The Fiscal Year
2024 adopted budget, which was in effect during
the Maui wildfires, began July 1, 2023, and ended
on June 30, 2024. The DSA is funded under two
separate lines of effort:

32
4.2 BUILDING CODES IN
THE COUNTY OF MAUI

Table 3. Developmental Services Administration Program Staffing.

The Development Services Administration

Position Title 2024 Adopted
Program,65 funded by the Maui County
General fund.
Development Services
1
FY 2024 Adopted: $2,822,519 Operation Clerk

Personnel: 21 Electrical Engineer III 1

Description: The DSA Program is primarily

responsible for the administration of Electrical Engineer IV 1
subdivision, building, electrical, plumbing,
grading, driveway, roadway, and other Electrical Engineer V 1
construction codes. It also provides staff
support for the Public Works Commission and
the Board of Variances and Appeals. Electrical Inspector II 4

See Table 3 Engineering Support

1
Technician I

Land Use & Building Plans

1
Examiner

Land Use & Codes Building

3
Permit Clerk

Plumbing Inspector II 4

Secretary II 1

Specialty Plan Examiner I 1

Specialty Plan Examiner II 1

Supervisor Land Use/Build

1
Plans Examiner

Program Total 21

33
4.2 BUILDING CODES IN
THE COUNTY OF MAUI

Table 4. Developmental Services Administration Building Program Staffing.

The DSA - Building Permit

Position Title 2024 Adopted
Program,66 funded by the Maui
County DSA Revolving Fund.
Chief Building Plans Examiner 1
FY 2024 Adopted: $1,921,800
Civil Engineer IV 1
Personnel: 19

The DSA - Building Permit Clerk III 1

Program collects a plan
review fee from each building
Computer Applications Support Technician III 1
permit applicant. The fees are
deposited into a revolving fund
for the purpose of facilitating Computer Applications Support 0
the building permit process.
The program performs plan Electrical Inspector II 1
check and inspection services,
as well as permit clerk services,
which include distribution, Engineering Construction Clerk 1
monitoring of permit status,
and maintaining the permit Engineering Support Technician II 2
tracking system.

See Table 4
Land Use & Building Plans Examiner 3

Land Use & Building Plans Technician 1

Land Use & Codes Building Permit Technician 3

Land Use & Building Plans Technician 1

Specialty Plans Examiner III 1

Supervising Building Inspector 1

Supervising Plumbing Inspector 1

Program Total 19

34
4.3 FIRE CODES IN
COUNTY OF MAUI

4.3 Fire Codes in County of Maui 4.3.1 County of Maui Fire Code
The Code of the County of Maui, Hawaiʻi, Chapter Administration
16.04D67 incorporates the NFPA 1, Fire Code©, The County of Maui Department of Fire & Public
2018 Edition as amended. Safety’s (MFD) Fire Prevention Bureau administers
the County of Maui Fire Code. The Fire Prevention
The County of Maui passed Ordinance 5451 on Bureau provides services including plan review,
November 23, 2022, which included amendments permitting, code enforcement, fire education, and
to NFPA 1, Fire Code, 2018 edition, specifically fire investigation.69
addressing vegetation management.68 The
amendment within Subsection 10.13.10 within
4.3.2 Organization of the County of
Ordinance 5451 extends authority to the fire
department to require property owners to mitigate Maui Department of Fire & Public
the vegetation around structures and to establish Safety
and maintain fuel breaks when deemed necessary. At the time of the wildfires, the MFD70 was
organized across five verticals:

• Fire Administration
• Training/Health & Safety
• Fire/Rescue Operations
• Fire Prevention
• Ocean Safety

The Fire Prevention Bureau was led by two

Captains who reported to the Assistant Fire Chief
of Support Services. The Assistant Chief of Support
Services reported to the Deputy Fire Chief, who in
turn reported to the Fire Chief.

4.3.3 Fire Prevention Bureau and

Personnel
The Fire Prevention Bureau operates under the
Maui County Council Adopted Budget. The Fiscal
Year 2024 adopted budget, which was in effect
during the Maui wildfires, began July 1, 2023, and
ended on June 30, 2024. The Fire Prevention
Bureau is funded under three lines of effort:

35
4.3.3 FIRE PREVENTION
BUREAU AND PERSONNEL

Table 5. Maui Fire Department Fire Prevention Program Staffing.

The Fire Prevention Program, funded by

Position Title 2024 Adopted
the Maui County General fund.

FY 2024 Adopted: $1,493,093 Account Clerk III 1

Personnel: 12
Fire Captain 2

Description: The Fire Prevention Program71

is comprised of two Captains, two Firefighter Firefighter III 6
IVs, six Firefighter IIIs, an Account Clerk III,
and an Office Operations Assistant II. Its
Firefighter IV 2
primary function is to reduce the likelihood
of fires and minimize their various impacts
to life, property, and the environment. Office Operations Assistant II 1
It accomplishes this primarily through
plans review, inspections, permitting, fire Program Total 12
investigation, and public education.

See Table 5

36
4.3.3 FIRE PREVENTION
BUREAU AND PERSONNEL

The Plan Review, Processing, and

Inspection Revolving Fund; and The Fire
Hazard Removal Revolving Fund72

FY 2024 Adopted: $474,289

Personnel: 2

Description: The Plan Review, Processing, and

Inspection Revolving Fund was established for
the collection of fees for the review of plans
and specifications submitted under section
132-9, HRS. Funds are to be expended for the
salaries of two Firefighter IVs (plan reviewers),
contracts, materials, supplies, equipment,
payment of overtime, travel expenses, and
training that will facilitate plans review, public
education, fire investigation, permit processing,
and inspections.

The Fire Hazard Removal Revolving Fund

provides for the clearing of brush and debris
from parcels that have been deemed as a fire
hazard. The costs are recoverable against the
owner or occupant of the property.

See Table 6

Table 6. Maui Fire Department Plan Review, Processing, and Inspection Revolving
Fund Program Staffing.

Position Title 2024 Adopted

Firefighter IV 2

Program Total 2

37
4.4 MAUI RECOVERY
PERMITTING CENTER

4.4 Maui Recovery Permitting Center

On April 29, 2024, the County of Maui opened a Recovery Permitting Center (RPC) in Kahului. The RPC is
staffed with members from 4LEAF, Inc. the same company that led the recovery effort in Paradise, California,
after the Camp Fire in 2018. Maui’s RPC is expediting the processing of permits for alterations, repairs,
reconstruction, and new construction of structures in areas affected by the August 2023 Maui wildfires. The Maui
Recovers dashboard73 shares permits issued to date.

38
5.0 STATE FIRE
MARSHAL REVIEW
6.0 SUMMARY

5.0 State Fire Marshal discuss the content of the State’s 10 Highest Priority
document (Section 2.0). Regarding the OSFM, FSRI
Review has shared the following recommendations:

On July 5, 2024, Governor Green signed Senate Bill • Substantially increasing the budget from the
2085,74 establishing the OSFM and re-establishing $172,000 allotted within Act 209 for the staffing of
the position of the SFM that had been abolished in the OSFM75
1979 and replaced with the SFC. • Identification of sustainable funding sources to
ensure a functional annual budget
Staffing the OSFM is expected to take time. As
• Bolstering statutory authority required to address
recruitment, selection, and hiring takes place, the
the wide spectrum of fire safety issues and to
state will be required to engage in critical fire
delineate responsibilities and reporting structures
safety work.
between the SFM and SFC
Within FSRI’s 10 Highest Priorities for Enhancing • Creating an organizational structure required
Wildfire Readiness in Hawaiʻi document (Section 2.0), to immediately address the 10 State Priorities
Priority 2 includes recommendations for contracting effectively and other fire safety priorities unrelated
with the HWMO to perform in a project management to those mentioned in Phase Two76
role to ensure the State’s 10 priorities are addressed,
while also serving as an interim leader to address the On November 25, 2024, the Director of Labor and
system components of Phase Two that will, ultimately, Industrial Relations (DLIR) provided the SFC’s, SFM
be the responsibility of the SFM. report to the legislature as per Act 209. The report
includes duties and responsibilities, organizational
Since October 2024, FSRI has met with state structure within DLIR, proposed operating budget,
legislators, Office of the Attorney General staff, and and staffing model options.77
members of the Governor’s Climate Action Team to

39
6.0 SUMMARY

6.0 Summary
In the United States of America, the destruction
and loss of life caused by the Maui fires of August
8-9, 2023, are unprecedented in modern times.
Recognizing the complexity of this incident,
FSRI used a systems analysis methodology to
comprehensively examine the many contributing
factors to the August 2023 fire event in Lahaina. It
is vital to reiterate, as demonstrated throughout this
report, that no single factor is, or set of factors are,
directly responsible for the tragic outcome. The pre-
conditions for these fires have been in the making
for decades, stemming from the changing landscape
of Maui Nui, more frequent extreme weather events,
and the increased frequency of vegetation-fueled
fires. It is important to note these same conditions
exist across the State of Hawai‘i, in numerous other
locations throughout the United States, and around
the globe.

This Lahaina Fire Forward-Looking Report (Phase

Three) details priorities and recommendations that
can begin to be implemented by state and county
leaders today to prevent future tragedies like those
that took place on August 8-9, 2023. Several of these
recommendations will be challenging to implement,
and will demand collaboration amongst local,
county, state, and federal agencies and individuals.
Additionally, the recommendations will likely need to
be addressed on different timelines. For example,
leaders have collaboratively developed and executed
plans on several initiatives to improve coordination
and wildfire preparedness, while hiring an SFM and
completing an SOC, CRA, and CRR plan will take
months to complete. FSRI remains committed to
working through the priorities and recommendations
with the Department of the Attorney General, Federal,
State, and County leaders, community members,
and other partners that can help improve fire safety
across the State of Hawaiʻi.

40
 7.0 APPENDIX

7.1 Lahaina Fire Incident Analysis Report (Phase Two) Findings and Recommendations
(access the full spreadsheet)

7.1 Lahaina Fire Incident Analysis Report (Phase Two) Findings and Recommendations
Reference
Section Relevant Actionable
Finding Recommendations
(Phase Two Department Areas
Report)
2.0 • State of HI Policy, 1. Lack of state policy-making and 1. Pursue integrated solutions using a multidisciplinary team to
Analysis of Organizational investment addressing Cohesive address the entire system of factors that influence wildfire risk
Background Strategy components. and outcomes, including land use and subdivision planning,
agriculture, forestry and environmental protection, emergency
response, economists and tax experts, and policy-makers.
Use the existing and established plans and studies as starting
points for discussion and action.

2. Learn from states that already have existing advanced wild-

fire-fighting policies and procedures in place that are more mature
in their work on wildfire prevention, preparedness, and response.

2.0 • State of HI Policy, 2. Statewide wildfire prevention is 1. Establish dedicated and sustained funding for HWMO
Analysis of Organizational led by the non-profit Hawaii Wildfire to support the coordination and implementation of wildfire
Background Management Organization (HWMO) prevention and preparedness efforts, especially for
without state funding. communities and land stewards.
2.0 • State of HI Policy 3. Lack of standardized and 1. Standardize wildfire data collection process for all counties
Analysis of consistent wildfire data collection and require Incident Status Summary, Form 209 completion for
Background and report submissions to federal wildfires meeting reporting criteria.
organizations.
2. Leverage the impending release of the National
Emergency Response Information System (NERIS) to insti-
tutionalize fire reporting while ample resources are available
and focused to onboarding and supporting fire agencies in this
new federal program.
2.0 • MFD Policy, 4. The MFD and MPD did not initiate 1. MEMA, the MFD, and the MPD should create policies
Analysis of Organizational an AAR for the 2018 Lahaina Fire. that include incident parameters requiring an AAR to
• MPD
Background MEMA did not finalize an AAR for ensure learnings are documented and changes required for
the same incident. improvement are implemented.
3.2 • MFD Policy, 5. Actionable extreme weather 1. Assign a point of contact within the MFD who is tracking
Weather Organizational, forecasts were provided to fire weather conditions, and is disseminating that information to the
• MPD
Preparedness chiefs and emergency managers rest of the department and across partner agencies.
• NWS prior to the August 2023 fires.
• MEMA However, adjusting staffing for 2. Establish standard operating procedures for Red Flag and
extreme weather events and their severe fire weather warning conditions, to include: preparing and
resultant risk of extreme fire pre-positioning supplies, equipment, vehicles, and personnel in
behavior was not standard. high-risk areas; ensuring clear and open lines of communication
within and among agencies to optimize for rapid and coordinated
deployment of resources; and communicating with the public to
aid residents in translating the forecasted conditions and risks into
evacuation readiness. The California Fire Weather Annual Oper-
ating Plan is a good place to start developing a Hawaiʻi plan.
3.2 • State of HI Research, 6. There is little perceptible 1. Engage federal partners to assist in refining Red Flag
Weather Policy, difference between Hawaiʻi Red criteria to be commensurate with appropriate fire danger that
• NWS
Preparedness Flag criteria and a typical summer is actionable by policymakers, emergency managers and
day, which may have contributed to responders, and the public.
the emergency manager’s response
to the forecast.
3.2 • NWS Policy, 7. NWS-Honolulu fire weather 1. Engage policymakers, emergency managers and
Weather Organizational, forecast briefings to fire and responders, and the public with more frequent fire weather
• HI-EMA
Preparedness emergency managers should occur forecast briefings. This will elevate understanding of the
on a more frequent basis. weather, while informing the community of the risk.

41
 7.1 APPENDIX

Reference
Section Relevant Actionable
Finding Recommendations
(Phase Two Department Areas
Report)
3.2 • State of HI Equipment, 8. A lack of RAWS in West Maui, and 1. Install and fund the maintenance for a strategic set of
Weather Organizational, other high wildfire risk areas, limits RAWS that can provide information with resolution across the
• NWS
Preparedness the capability to determine where Red microclimates of high fire risk locations in the state.
Flag conditions may locally exist. The
lack of resolution of fire weather data
and monitoring yields uncertainty
at the local level due to fire weather
forecasts and Red Flag Warnings
being based on data collected at the
Honolulu airport, which is on Oʻahu
(not Maui). It does not represent
the conditions observed in the
diverse and numerous microclimates
across all high fire risk areas across
the state, including Lahaina, and
therefore, serves as a point of
reference (or inference, at best) for
other regions.
3.3 • State of HI Policy, 9. A lack of vegetation management 1. Develop comprehensive vegetation management programs
Vegetative Organizational, programs, including policy, regulation that address the many types of land ownership and risk-
Fuel Preparedness development and enforcement, reduction needs, to include thinning vegetation, removing
and funding support to address invasive species, and creating strategic fuel breaks:
vegetation management needs - On public lands, funding for vegetation management must
across the variety of landowner be commensurate with the personnel, equipment, and
types contributed to a prevalence maintenance costs needed to strategically and consistently
of unmanaged vegetation on the reduce risk.
wildland and urban areas impacted by - On private lands, a combination of tax incentives and
the August 8, 2023, fire. penalties for active land management, as well as a robust and
proactive defensible space code inspection and enforcement
programs are needed.
- Such programs must be funded and staffed at a level
appropriate to adequately ensure risk-reduction measures
are implemented and effectively mitigate the potential for fire
ignition and rapid spread through unmanaged lands.

2. Establish specific governmental authorities, responsibilities,

and goals for the management of vegetative fuels. (Currently,
authority to address vegetation hazards is covered by a vague
responsibility by the mayor and fire chief to address any
number of hazards).

3. Establish a system of penalties to address owners of

agricultural land who are not participating in active agriculture
or vegetation management.

4. Develop programs that support coordination and

implementation of an “All Hands, All Lands” approach, where
vegetation management strategies and projects reduce
risk across land ownerships, according to topography and
anticipated fire behavior, rather than in fragmented or siloed
parcels.

5. Implement and expand use of targeted grazing for

non-native forage grass removal and fuels reduction at
landscape scale.

42
 7.1 APPENDIX

Reference
Section Relevant Actionable
Finding Recommendations
(Phase Two Department Areas
Report)
3.3 • State of HI Policy, 10. Fire risk and protective measures 1. Require integrated land use planning through zoning
Vegetative Organizational, are not generally considered or regulation that requires vegetation management in
Fuel Preparedness integrated into land use planning, high-risk areas.
ordinances, or permitting processes
to ensure adequate defensible 2. Educate homeowners on how to create defensible space
space or consistent management around their properties, and require them to maintain
of vegetative fuels in and around these spaces.
communities.
3. Incorporate community-scale, maintained green spaces
that are multi-use and could act as fuel breaks and public safe
refuge areas.
3.3 • State of HI Policy, 11. The existing landowner and land 1. Provide land steward and community education regarding
Vegetative Organizational, steward risk-reduction programs, vegetation management best practices. Invest in, and grow,
Fuel Preparedness which include best practices for the existing programs of Firewise USA(TM) and educational
vegetative fuels management, have programs for land stewards offered by existing groups, such as
limited capacity and have not been those already led (but underfunded) by the HWMO, University
invested in by the government at a of Hawaiʻi, and their established partners.
level that meets the current need.
3.3 • State of HI Policy, 12. There is no adequate system for 1. Improve monitoring of fuels and utilize drones, satellite
Vegetative Organizational, monitoring fuel loads, fuel moisture, imagery, and ground-based monitoring systems to detect and
Fuell Preparedness, and other relevant characteristics. assess vegetative fuel loads, fuel moisture, and high fire
Research risk conditions.

2. Establish an information dissemination system to fire and

emergency managers to communicate high-risk locations
and periods.
3.3 • State of HI Policy, 13. There is a need for additional 1. This investment can be accomplished as key components of
Vegetative Organizational, public and private investment in integrated land use planning, financial incentive and assistance
Fuel Preparedness, long-term ecosystem restoration programs, and land steward education (all described above).
Research and sustainable land management
practices that promote healthy 2. Invest in watershed partnerships, conservation groups, and
ecosystems, maintain active other existing ecosystem conservation and agricultural initiatives.
agriculture, reduce fire risk, and
control erosion. 3. Invest in and bolster plant material supply chain for bulk
seed production to support adequate fuel conversion and
post-fire mitigation. For example, these programs could include
common native seed collection, plant propagation,
and outplanting.
3.4.1 • County of Policy, 14. At the time of the fire, zoning 1. Review and adjust zoning laws to better reflect the actual
Planning, Maui Prevention, in some areas of Lahaina was not occupancy levels in Lahaina.
Zoning, and Organizational, commensurate with the modern built
Codes Preparedness environment, environmental risks, 2. Implement stricter enforcement to ensure compliance with
and population growth. occupancy limits.

3. Enforce building codes and zoning regulations that require

sufficient road width and access points in new developments to
ensure better planning for future developments.

4. Increase the availability of off-street parking solutions to

reduce the reliance on narrow streets for vehicle parking.

5. Emergency responders should have pre-determined plans,

as well as uniquely adapted equipment (if available), tactics,
and strategies for specific areas with narrow streets, outlining
alternative access points, water supply strategies, and
evacuation procedures.

43
 7.1 APPENDIX

Reference
Section Relevant Actionable
Finding Recommendations
(Phase Two Department Areas
Report)
3.4.1 • County of Policy, 15. At the time of the fire, the County 1. Review and ensure adoption process meets requirements of
Planning, Maui Prevention, of Maui was enforcing the 2006 state statute (HRS 107-28).
Zoning, and Organizational edition of the International Residential
Codes Code and International Building Code.
3.4.2 • MFD Preparedness, 16. Emergency responders did not 1. The MPD and MFD should develop an assessment of its
Road Training, have ready capability to unlock ability to access local utilities (Hawaiian Electric), flood control,
• MPD
Networks Equipment, emergency gates at various locations, waterworks, farms, resorts and public facilities (ex. private
Operational including schools, to facilitate and public schools), flood control roads and gates, agricultural
evacuations. They were often forced roads and gates, harbor areas, etc.) for emergencies. Create a
to rely on a third-party response for system of universal lock security access that is available to all
such access. emergency responders and landowners.
3.4.2 • MPD Preparedness, 17. Severe congestion due to parked 1. The MPD and county authorities should assess the parking
Road Policy, cars along neighborhood streets needs and challenges within neighborhoods. This may include
• County of
Networks Preparedness, hindered evacuation and response evaluating factors, such as population density, housing types,
Maui
Operational efforts. availability of off-street parking, street width, proximity to
commercial areas or public transportation, and existing
parking issues.

3.4.2 • MPD Preparedness, 18. Limited written traffic plans or 1. Develop a pre-incident plan for the MPD to manage traffic
Road Policy, guidelines for emergencies and during a wildfire that involves coordinating efforts to ensure
• County of
Networks Organizational, escalating incidents. public safety, facilitate evacuation if necessary, and maintain
Maui
Operational traffic flow in affected areas. Update MPD G.O. 405.1 Traffic
• MEMA Section and G.O. 405.7 Traffic Direction and Control to include
instruction on wildfire evacuation.

2. Implement and enforce strict no-parking zones on critical

streets and encourage the use of off-street parking solutions to
reduce the number of vehicles parked on narrow streets.

3. Where possible, redesign traffic flow in congested areas,

including implementing one-way street systems, to optimize
vehicle movement.

4. Residents in areas with narrow streets should be educated

on fire safety procedures, importance of clear buffer zones/
defensible spaces, and evacuation plans to ensure a more
coordinated response.
3.4.2 • County of Preparedness, 19. Roadways and evacuation routes 1. Identify, name, map, and provide signage on dirt roads that
Road Maui Operational were not adequately maintained prior serve as alternate egress/evacuation routes so residents and
Networks to August 8, 2023, to sustain effective emergency responders refer to them by the same name.
• MPD
evacuation efforts during the fire
• MFD event. 2. Inspect and maintain dirt roads annually. Modernize,
standardize, and maintain barriers on dirt roads to help ensure
they can be used during emergencies.

3. Where feasible, widen roads to accommodate more parking,

traffic, and provide room for emergency vehicles.
3.4.3 • State of HI Operational 20. The County of Maui Department 1. Given the increasing threat of wildfires and wildfire-
Water of Water Supply was seemingly in initiated urban conflagrations, it may be necessary for the
• Maui Water
compliance with the Water System State of Hawai'i to revisit its design standards and guidelines
Design Standards for the State of for storage and distribution systems that could be used for
Hawaiʻi in August 2023. firefighting purposes.

44
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Reference
Section Relevant Actionable
Finding Recommendations
(Phase Two Department Areas
Report)
3.4.3 • Maui Water Operational, 21. No pumps are used outside of the N/A
Water Equipment water production facilities to provide
pressure in the system. Both systems
had uninterrupted electrical power
during the August 2023 fires and
produced water at capacity for the
duration of the fire.
3.4.3 • Maui Water Operational, 22. The amount of drinking water in N/A
Water Equipment storage tanks at the beginning of
the August 2023 fires seemingly met
standard design requirements as
required by the Water System Design
Standards for the State of Hawaiʻi.

3.4.3 • Maui Water Operational, 23. As per the Phase One report 1. Develop, install, and maintain a resilient drinking water
Water Equipment (pages 237-239), the water supply tank level monitoring system for the Lahaina and Māhinahina
monitoring system failed at 15:30 storage and distribution systems that can be monitored from
(3:30 p.m.) on August 8, 2023, and the County of Maui EOC and other locations.
no storage tank data was recorded
for the duration of the fire event.
Once this data connection was lost,
the County of Maui Department of
Water Supply did not know how
much stored water was available for
firefighting during the fire.
3.4.3 • Maui Water Operational 24. As homes and other structures N/A
Water were damaged and destroyed by fire,
household plumbing (e.g., plastic and
other piping) inside of the buildings
failed, allowing unrestricted flow of
water from one (1) or more locations
in each home or structure, resulting
in water freely flowing from more
structures and diminishing the
overall water pressure and flow in the
fire area.
3.4.3 • Maui Water Operational, 25. As per the Phase One report (page 1. Develop a plan to coordinate with the County of Maui
Water Training, 239), County of Maui Department Department of Water Supply to address water system needs at
Equipment of Water Supply employees were the incident command post (ICP).
unable to enter the fire area to assist
firefighters due to multiple factors,
including traffic congestion and
the danger presented by the fire.
Firefighters did not have the time,
training, or tools to shut off water.
3.4.3 • Maui Water Operational 26. Due to the hydraulics of the 1. Perform a hydraulic analysis of both the Lahaina and
Water drinking water storage and distribution Māhinahina storage and distribution systems. Use the
system, and given the excessive results of this analysis to design larger and/or multiple
demand caused by the flow from interconnected pipes between the two (2) drinking water
damaged/destroyed structures, water storage and distribution systems. Consider the use of
was not provided with sufficient pumps, as appropriate, to supplement pressure and volume.
volume and sufficient pressure (i.e., Determine pressure and volume limits for a major fire event
the system could not meet the required that stakeholders understand and can operate to.
demand) for use in firefighting for the
entire August 2023 fire event.

45
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Reference
Relevant Actionable
Section (Phase Finding Recommendations
Department Areas
Two Report)
3.4.3 • Maui Water Operational 27. Water quality and cost 1. Provide alternate means of firefighting water supply for
Water concerns make it impractical to extreme events. This may include portable pumps to draw
size a drinking water treatment, water from public and private pools, ponds, and other bodies
storage, and distribution system of water (including sea water), large diameter hose equipped
to accommodate the firefighting apparatus, sites, or connections for marine vessels to draw
demands for a urban conflagration water from the Pacific Ocean, and other means.
event similar to the one that
occurred in August 2023.
3.4.4 • Hawaiian Organizational, 28. Hawaiian Electric (in 1. Hawaiian Electric should work closely with the MFD and
Electrical Electric Operational partnership with the MFD and MPD) MPD to develop a staffing plan in preparation for high fire
did not have an adequate staffing danger days. The plan should include implementing spotters
plan to prepare for the wildfire and an artificial intelligence-enabled camera network, which
conditions of August 8, 2023. can assess vulnerable areas of the infrastructure so failure
points can be addressed quickly; operating a dedicated phone
line to the MFD and MPD to communicate power and repair
status; and assigning a representative to the ICP.
3.4.4 • Hawaiian Prevention, 29. A lack of electrical utility 1. Hawaiian Electric should continue to work closely with the
Electrical Electric Policy vegetation abatement regulations PUC to execute the Climate Adaptation Transmission and
and enforcement may have Resilience Program and develop a long-term investment plan
• MFD
contributed to vegetation at the to protect infrastructure from high wind events and wildfire.
• State of HI base of utility poles and near The plan should include immediate vegetation management
transmission lines, creating a and enforcement requirements, a phased approach for
receptive fuel source for arcing undergrounding transmission lines in vulnerable areas,
electrical wires. strategic replacement of bare overhead wires with covered
conductors, and a Public Safety Power Shut-off program.
3.4.4 • Hawaiian Prevention, 30. Hawaiian Electric did not have 1. Establish a Public Safety Power Shut-Off and
Electrical Electric Policy a Public Safety Power Shut-Off communication protocol in collaboration with the community.
program in place at the time of the Shutting off power to vulnerable areas of the grid reduces the
• County of
fire. chance of ignition due to electrical infrastructure failure.
Maui
• State of HI
3.4.4 • Hawaiian Preparedness, 31. The lack of execution of 1. Hawaiian Electric to prepare a staffing plan that is
Electrical Electric Policy, a Hawaiian Electric pre-event coordinated with the pre-event incident action plan (IAP).
Organizational, organizational plan led to having
• Maui Water
Operational to staff more field positions during
the event to address problems with
electrical and water infrastructure.

3.5 • MFD Preparedness, 32. Central Dispatch (“Central”) 1. Expand Central’s surge capacity by increasing the
Communications Organizational, was limited by the availability of terminals/necessary equipment for call taking and dispatching
• MPD
Operational equipment and personnel. operations and consider training personnel (including
members from the MFD or MPD) to serve as “call takers”
capable of transferring emergency 911 calls, and managing
the non-emergency/administrative calls.

2. Complete a comprehensive study of Central Dispatch to

assess staffing, workloads, and technology to identify any
gaps or additional resource needs to help ensure resilient
communication during major emergencies and disasters.
3.5 • MFD Organizational, 33. Central Dispatch, and many 1. Continue providing opportunities for individuals and crews
Communications Policy, other responding personnel, were to meet for a “report back/debrief.” Ensure members know
• MPD
Operational deeply affected by this incident. warning signs for PTS, PTSD, depression, suicide, and
• County of related impacts on personnel mental health. Provide access
Maui to Employee Assistance Programs (EAP) and peer support
• MEMA networks—encourage use when warning signs are present.

46
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Reference
Relevant Actionable
Section (Phase Finding Recommendations
Department Areas
Two Report)
3.5 • MFD Organizational, 34. Dispatchers were responsible for 1. Staff a MFD fire officer and a MPD officer at the
Communications Operational monitoring multiple large fires and rank of lieutenant (or higher) in Central Dispatch to aid
• MPD
other associated events. Most of the with operational monitoring, EOC/DOC coordinations,
dispatchers were experienced, but all incident tracking, communications, and assistance with
dispatchers were overwhelmed and command decisions when the EOC is activated.
some expressed lack of adequate
knowledge, ready access to needed
information, and concern about
the safety of the instructions they
were providing callers. There were
persistent communication challenges
between Central, the MPD’s
Department Operations Center (DOC),
and the EOC.
3.5 • MFD Equipment, 35. Private equipment operators 1. Create a formal communication plan for private
Communications Organizational, primarily communicate with response contractors to use during emergency situations that
• County of
Operational entities and field personnel using includes resilient hardware and appropriate training.
Maui
personal cell phones.
• State of HI Or-
ganizational,
Operational
3.5 • County of Preparedness, 36. Many residents did NOT receive 1. Assess the resiliency of communication systems and
Communications Maui Organizational, a text notification from the county establish redundant public alert program and warning
Operational regarding the high winds and high processes, including best practice messaging guidance.
• State of HI
fire danger.
3.5 • Hawaiian Preparedness, 37. Only one (1) siren from the 1. Implement a statewide sustainable program for
Communications Electric Organizational, All-Hazard Outdoor Warning Siren the All-Hazard Outdoor Warning System, which
Operational System was operable within the burn includes functioning hardware resilient against mass
• County of
perimeter of the Lahaina area on communications failure, regular maintenance, public
Maui
August 8, 2023. education, additional resources and staffing.
• State of HI
3.5 • County of Preparedness, 38. The All-Hazard Outdoor Warning N/A
Communications Maui Operational Siren System had not been utilized
for warning of WUI fires prior to
• State of HI
August 8, 2023. As of the publication
• MEMA date of this report, MEMA has
implemented a process for activating
sirens for wildfires.
3.5 • MFD Preparedness, 39. Even when people were told to 1. Engage the community to provide additional public
Communications Policy, evacuate and conditions seemed education regarding the importance of what to do in an
• MPD
Organizational, obvious that evacuation was emergency and to heed all evacuation instructions.
• MEMA Operational necessary, many refused because
• County of there did not appear to be official
Maui notification that danger was imminent.

3.6 • MFD Policy, 40. Although there were opportunities 1. Review and modify the dispatch algorithm to reflect
Incident Organizational, for the MFD to provide staff support the resource availability.
Management Operational for the battalion chief(s) managing
the incident, a formal command team 2. Provide the resources and training necessary to
was not established. The ICs were establish and maintain effective support for the initial
overwhelmed with the demands of incident commander (IC).
the event and possessed limited
situational awareness during a 3. Within MFD Hazard Zone Command SOG, include
rapidly expanding emergency, which requirements for all chief officer engagement within the
included a mayday; these factors incident command structure for large complex incidents.
contributed to challenges with
tactical decision-making throughout
the Lahaina PM fire.

47
 7.1 APPENDIX

Reference
Relevant Actionable
Section (Phase Finding Recommendations
Department Areas
Two Report)
3.6 • MFD Policy, 41. The MFD and MPD never 1. The MFD, MPD, and other assisting and cooperating
Incident Organizational, connected to establish a unified agencies should include guidance within their respective
• MPD
Management Operational command. incident management SOGs on when unified command
• Hawaiian should be considered and how it could be established.
Electric
• Maui Water
3.6 • MFD Organizational, 42. Available public safety 1. Provide sufficient staffing to establish and maintain
Incident Operational resources were inefficiently an effective incident management organization, while
• MPD
Management utilized. This resulted in the failure maintaining the capacity to conduct unit-level tactical actions.
to establish and scale an effective Once established, develop a robust incident action plan (IAP).
incident management organization An IAP should outline objectives, strategies, and tactics for
during the first 24 hours of the managing the incident, including evacuation procedures,
incident. traffic management, and resource allocation. Communicating
the IAP to all responding personnel and stakeholders
ensures a shared understanding of roles, responsibilities, and
priorities.
3.6 • MFD Policy, 43. There was no comprehensive 1. Develop a comprehensive plan in coordination with
Incident Organizational, plan for the MPDʻs wildfire the MFD for MPD’s response to a wildfire that prioritizes
• MPD
Management Operational response. public safety, efficient evacuations, and effective traffic
management.
3.6 • MPD Policy, 44. Limited sharing of critical 1. Review and update policies and develop new processes for
Incident Organizational, information occurred between information flow between MPD Command Personnel on site,
Management Operational field operations units, the MPD command staff, dispatch, and the EOC.
Department Operations Center
(DOC), and the EOC. 2. All commanders, captains, and above should receive
training on activation of the DOC and a Department
Operations Center quick reference guide should be
developed for commanders to be utilized for any crisis.
3.6 • MPD Policy 45. The MPD Natural and Man-Made 1. Update policy to include plans specifically related
Incident Disaster Plan, G.O. 411.4, does not to wildfires.
Management include wildfire incidents.

3.6 • MFD Preparedness, 46. There was limited pre-event 1. The MFD, MPD, and MEMA should update the current
Incident Policy incident action planning for policies and procedures regarding pre-event planning
• MPD
Management anticipated events or incidents by (including preparing pre-event incident action plans), staffing,
• MEMA the MFD, MPD, and MEMA. and equipment.
3.6 • MFD Policy, 47. There were no written 1. The County of Maui, MPD, and MFD to prepare Continuity
Incident Preparedness, procedures or guidelines for of Operations Plans (COOP) that outline procedures to
• MPD
Management Organizational Continuity of Operations (COOP). ensure essential functions can continue during and after
• MEMA various types of emergencies or disruptions.
3.6 • MEMA Preparedness, 48. Communication was limited 1. Additional resources are needed to have a persistent
Incident Organizational between MEMA and HI-EMA EOC. durable communication link prior to, and during, a major
• HI-EMA
Management emergency or disaster event.
3.6 • MEMA Preparedness, 49. Given the known conditions 1. Under similar conditions, and given appropriate resources,
Incident Operational forecasted for the County of consider full activation earlier to aid collaboration between all
Management Maui on August 8, 2023, agency relevant emergency support functions.
representatives self-reported to the
EOC throughout the day, but full
activation of the EOC did not occur
until 16:30.

48
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Reference
Relevant Actionable
Section (Phase Finding Recommendations
Department Areas
Two Report)
3.6 • MEMA Preparedness, 50. MEMA does not have a 1. EOCs fulfill essential functions during emergencies and
Incident Policy, sufficient budget/personnel must be properly staffed and operationalized with (A) qualified
Management Organizational, allocation to effectively and overhead personnel to perform emergency management-
Operational sustainably perform the wide range related functions and (B) designated representatives from
of preparedness, response, and all cooperating/involved agencies/organizations to provide
recovery missions assigned to it. subject matter expertise, resource coordination/tracking, and
immediate information relays to ICs in the field.
3.6 • MEMA Organizational, 51. During the EOC activation on 1. Provide clearly defined roles and responsibilities for each
Incident Training, August 8, 2023, there was a lack staff member during EOC activations. Staff members should
Management Operational of clarity regarding the roles and be trained and fully competent to fulfill their designated role.
responsibilities among MEMA MEMA should also ensure staff training for secondary roles
personnel. and responsibilities for when personnel are expected to shift
to a different position (e.g., when vacancies occur).
3.6 • MEMA Training, 52. Some MEMA personnel were 1. Ensure all personnel are fully trained and proficient with
Incident Operational unfamiliar with the software use of the designated EOC software program (WebEOC
Management platform used for documentation or any other software program designated by the MEMA
and incident tracking during EOC Administrator).
activations.
2. Ensure all MEMA EOC personnel understand the NIMS-
ICS requirements for documentation during EOC activations.
3.6 • MEMA Operational 53. The EOC was overcrowded and 1. MEMA should examine the needs for the physical location
Incident personnel had to find alternative and expand the EOC.
Management work locations.
3.6 • MFD Policy, 54. Both the MPD and MFD were 1. MPD roll calls should be initiated by dispatch and/or
Incident Operational, unable to maintain personnel command staff as needed to maintain accountability. A policy
• MPD
Management Equipment accountability for officers, should be established with defined roll call procedures.
firefighters, and crews during the
Lahaina PM fire. 2. Ensure sufficient resources are available to support MFD
Cs and division/group/unit-level supervisors with all functions
of command/management, including personnel accountability.

3. Adoption and consistent use of a common and resilient AVL

platform on all MPD, MFD, and cooperators’ (e.g., DOFAW,
ARFF, and EMS) vehicles would assist dispatchers and
command officers with personnel accountability and incident
management.
3.6 • MFD Operational, 55. The MFD sponsors a Type 3 IMT 1. Consider pre-deploying the Type 3 IMT when severe
Incident Training that was not used August 8-9, 2023. weather and/or fire danger conditions are forecasted.
Management
2. Enhance training and expand participation to include
personnel from multiple disciplines, reinforcing the value of an
all-hazards IMT and fostering collaboration across agencies.
Consider securing training and experiences for Ocean Safety
personnel to be able to perform in specific IMT overhead
roles.
3.6 • Hawaiian Policy, 56. Hawaiian Electric should be 1. Create and follow a protocol to embed Hawaiian Electric
Incident Electric Operational at the incident command post representatives in the incident command post (when
Management (ICP), or tied in closely with the established) as liaisons.
incident commander if an ICP is not
established, to inform command of
safety issues, other coordination
opportunities, and act as a liaison
to their organization.

49
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Reference
Relevant Actionable
Section (Phase Finding Recommendations
Department Areas
Two Report)
3.6 • MFD Operational, 57. The MPD and MFD did not 1. Follow G.O. 304.11 to ensure the mobile incident
Incident Equipment deploy or use the mobile command command vehicle is used for appropriately sized
• MPD
Management vehicle as per MPD G.O. 304.11. incidents, such as the Lahaina PM Fire.
Deployment and use of the vehicle
in Lahaina before the PM fire may 2. Deploy the mobile command vehicle at planned
have initiated the unified command events to exercise the deployment process and
organization that was absent equipment.
throughout the PM fire.
3.6 • MFD Policy, 58. There were no established unit 1. Create a call sign procedure for identification of off-
Incident Operational identifiers for off-duty MPD officers duty MPD officers who self-deploy and MFD personnel
• MPD
Management or supplemental MFD units. assigned to supplemental MFD units. The existing
MPD G.O. 301.5 policy should be revised regarding
the establishment of call signs for incoming off-duty
officers and self-deploying officers. The MFD should
establish a policy to standardize identification of staffed
supplemental resources.
3.7 • MFD Preparedness, 59. The MFD did not have an 1. Ensure effective sensemaking of forecasts and real-
Fire Supression Policy, organizational pre-plan for an time conditions through training and pre-planning.
• MPD
Organizational anticipated high wind or extreme
• MEMA fire weather event. 2. Implement organization-wide start-of-shift briefings to
• Maui Water discuss extreme fire weather conditions.

• DLNR-DOFAW 3. Ensure the ICS can scale up quickly, integrating

• Hawaiian additional support, including personnel normally serving
Electric in administrative roles or other functions (e.g., fire
prevention, ocean safety, and training), as needed.
Provide training and protocols for pre-deployment.

4. Communicate anticipated environmental conditions,

risks, and performance expectations across
organizations. This includes the MPD, MEMA, County
of Maui Department of Water Supply, DLNR-DOFAW,
and Hawaiian Electric, who reacted to environmental
conditions only after problems arose.

5. Develop a system for ongoing situational awareness

that includes continuous monitoring of weather forecasts,
fuel moisture levels, and fire behavior through real-time
data and predictive models.
3.7 • MFD Preparedness, 60. With the impending forecast 1. With the potential impact of hurricanes like Dora and
Fire Supression Policy, of severe fire weather, there Red Flag conditions, the MFD, MPD, DLNR-DOFAW,
• MPD
Operational, was limited pre-deployment of and their cooperators should consider deploying
• DLNR-DOFAW Equipment additional public safety resources additional resources across Maui Nui.
• Hawaiian prior to the first fire event.
Electric 2. Identify fire apparatus, incident management, and
law enforcement resources for upstaffing and pre-
• Maui Water deployment when severe conditions are forecasted.

3. Ensure sufficient fire apparatus, response vehicles,

portable equipment, PPE, and radios are available to
resource the pre-deployment of additional response units
and overhead assets. Whenever possible, standardize
the equipment loadout on similar apparatus/vehicles to
facilitate use by callback personnel.

4. Consider providing dedicated personnel and resources

for staffing management and callback, on a daily basis and
before/during major incidents, to make command-level
resources readily available for strategic/tactical ICS roles.

50
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Reference
Relevant Actionable
Section (Phase Finding Recommendations
Department Areas
Two Report)
3.7 • MFD Preparedness, 61. There appears to be a statewide 1. Establish a culture of respect for extreme conditions
Fire Supression Prevention, culture of dismissing and/or and the need for operational adjustment.
• MPD
Policy, under-recognizing wildfire risk.
• County of Organizational, The underfunding and under-
Maui Training, addressing of preparedness,
• State of HI Operational planning, and mitigation efforts
significantly impacts all parts of
• HI-EMA the system and fire outcomes.
• MEMA This cannot be overstated.

3.7 • MFD Preparedness, 62. DLNR-DOFAW resources, 1. Incorporate land ownership maps into incident reporting
Fire Supression Policy, specialized wildfire equipment, and tracking to ensure that state and federal agencies
• MPD
Organizational, and trained personnel were with response duties and wildland firefighting capacity are
• DLNR-DO- Operational underutilized due to restrictive fire notified and activated.
FAW response zone guidelines.
2. Review and revise master mutual aid agreements for all
fire suppression resources on Maui Nui, including, but not
limited to, the MFD, ARFF, DLNR-DOFAW, and National
Park Services to ensure optimal readiness and response
for multi-hazard disasters.
3.7 • MFD Preparedness, 63. Densely populated and narrow 1. Responding MFD units should have pre-determined
Fire Supression Policy, roadways hindered both MFD and plans and operating practices for specific areas with
• MPD
Operational MPD movement during suppression narrow streets, outlining alternative access points, water
• County of (as well as evacuation and rescue) supply strategies, evacuation procedures, and addressing
Maui efforts. Apparatus positioning was the needs of vulnerable members of the community.
not always optimal, due in large
part to an overall lack of situational 2. Place hardcopy maps, mapbooks, and pre-incident
awareness about the location, plans in all response vehicles to provide redundancy if
severity, and trajectory of the cellular network communication is unavailable.
fire(s).
3.7 • MFD Policy, 64. The uncertainty around the 1. As previously mentioned, Hawaiian Electric should have
Fire Supression Operational status of power in the area created a representative at the ICP (when established).
• MPD
numerous impacts on MPD and
• Hawaiian MFD response to the incident.
Electric
3.7 • MFD Policy, 65. Private heavy equipment 1. Strengthen the coordination with private contractors
Fire Supression Operational, contractors lacked appropriate and address limitations in training, equipment (including
• DLNR-DO-
Equipment, training, PPE, equipment, and standardizing equipment to ensure compatibility with all
FAW
Training communications. fire suppression resources), PPE, and communication.
3.7 • MFD Policy, 66. A portion of the mopup area 1. Include DLNR-DOFAW resources on initial response to
Fire Supression Operational, was difficult to access and posed vegetation and WUI fires.
• DLNR-DO-
Training safety threats.
FAW
2. Ensure all personnel have the training to identify and
establish safety zones and escape routes, and have
protocols in place for communicating this to crews.

3. Communicate the wildfire risk to all department

members to set and/or reinforce expectations related to
fire mopup procedures.
3.7 • MFD Policy, 67. MFD firefighters performed 1. Revise policies, procedures, and trainings (E.O. 302.14)
Fire Supression Operational, mopup as proven successful that address wildland firefighting (specifically mopup
Training under typical weather conditions. operations) to be in alignment with NWCG guidelines.
However, under the severe weather
conditions on August 8, 2023, this 2. Implement schedules to manage responder fatigue,
level of mopup appears to have ensuring adequate rest periods and meals.
been insufficient.

51
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Reference
Relevant Actionable
Section (Phase Finding Recommendations
Department Areas
Two Report)
3.7 • MFD Policy, 68. MFD wildland firefighting 1. Conduct a comprehensive audit and gap analysis of
Fire Supression Operational, training, equipment, and staffing existing MFD operating procedures/practices against
Training should be commensurate with relevant Occupational Safety and Health Administration
the level of wildfire risk faced by (OSHA) regulations, National Fire Protection Association
firefighters. (NFPA) standards, fire service best practices, and NWCG
standards/guidelines to help ensure compliance with
industry regulations and best practices. By conducting
an audit and implementing recommended improvements,
the MFD can create a safer working environment for its
personnel and enhance the effectiveness of its firefighting
and rescue efforts for all incident types.

2. Review the implementation of the MFD’s 36-hour rule

for alignment with operational needs during disasters and
major emergencies.

3. Consider developing a WUI firefighting playbook to

address the increasingly severe wildfire threat across
Maui Nui. Look to departments that respond to WUI
incidents for expertise and protocols, such as California.

4. Deliver training on, and provide a copy in all response

vehicles, the NWCG Incident Response Pocket Guide
(IRPG), PMS 461.

5. Provide additional wildfire and WUI firefighting

training and experiences (such as shadowing incident
management personnel in other areas) for MFD
personnel.

6. Continue providing medical monitoring and behavioral

health support for responders and support personnel.
3.7 • MFD Policy, Training, 69. Many initial attack resources 1. Train firefighters about the impact of wind on fire
Fire Supression Operational were burned over due to fighting progression and fire suppression techniques as per
fire from a downwind position. evidence based information and best practices.
3.7 • MFD Policy, Training, 70. Standard wildland firefighting 1. The DLNR-DOFAW and MFD should collaborate to
Fire Supression Operational operating procedures for the update and integrate standard operating guidelines and
• DLNR -DO-
DLNR-DOFAW and MFD are not in training for wildland firefighting.
FAW
alignment.
3.8 • MFD Policy, Training, 71. Unified coordination of 1. Create, review, and implement an interagency
Evacuation Operational evacuation procedures among the comprehensive evacuation plan based on risk and
• MPD
MPD, MFD, and other agencies resources. Integrated emergency response plans
may have facilitated more efficient involving local, state, and federal agencies, as well as
egress of residents. non-governmental organizations, should be developed,
with regular joint training exercises to ensure smooth
coordination during actual emergencies.

2. The MPD should regularly train for wildfire evacuations,

familiarizing themselves with evacuation procedures and
protocols. This training enhances response capabilities
and ensures a swift and organized evacuation process
when wildfires threaten communities.

52
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Reference
Relevant Actionable
Section (Phase Finding Recommendations
Department Areas
Two Report)
3.8 • MFD Preparedness, 72. During the evacuations, there 1. Pre-plan evacuation routes. Effective evacuations during
Evacuation Policy, were lapses in coordination and a wildfire, such as the Lahaina PM fire, require planning,
• MPD
Operational communication that could have coordination, and adherence to best practices. A key aspect
• County of reduced efficiency. is comprehensive pre-event planning, which involves
Maui identifying evacuation routes (including unnamed dirt roads),
establishing communication protocols, and conducting drills to
ensure readiness.

2. Sufficient personnel are needed to manage traffic, provide

assistance to evacuees, and maintain public safety. Adequate
staffing levels enable timely and orderly evacuations,
reducing the risk of congestion and confusion.

3. Create and implement comprehensive traffic management

plans that account for limited access and egress routes,
including pre-planned alternate routes and strategies to
manage congestion.

4. Ensuring gates blocking potential evacuation routes

are equipped with standardized locks and that emergency
responders have the necessary keys or access codes is also
vital.

5. Develop comprehensive support systems for residents

who need to evacuate–especially those with access and
functional needs–including temporary housing, transportation
assistance, and access to essential services. By addressing
these key areas, the Maui community can improve its
preparedness for future wildfires and other emergencies,
ensuring better protection of lives and property.

6. Volunteer training programs, such as those for Community

Emergency Response Teams (CERT), should be expanded
to assist with evacuation efforts and provide support during
emergencies. Additionally, specific evacuation plans for
vulnerable populations, including the elderly, disabled,
and those without transportation, should be created,
with community support networks established to assist
these individuals during evacuations. Engage community
organizations and CERT teams to provide additional support
in evacuation efforts.
3.8 • MPD Policy, 73. While some Body-Worn 1. Update the MPD’s G.O. 304.12 policy to have BWCs
Evacuation Operational, Cameras (BWC) were activated (in activated upon dispatch and include a quality-control program
Equipment keeping with the current policy), to ensure all equipment is functioning properly and producing
several files provided by the usable audio visual assets.
County of Maui were unreadable.
2. The MPD should follow G.O. 304.12.
3.8 • MPD Equipment, 74. MPD officers experienced 1. Issuing radio earpieces to all officers will enhance
Evacuation Training difficulty hearing radio traffic due communication, allowing them to stay informed and
to the wind and noise from the fire. coordinate effectively during incidents. Officers should
receive training on the proper use and maintenance of these
earpieces to maximize their benefits.

53
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Reference
Relevant Actionable
Section (Phase Finding Recommendations
Department Areas
Two Report)
3.8 • County of Preparedness, 75. The alert systems in place did 1. Developing and implementing multiple alert systems,
Evacuation Maui Policy, not adequately inform residents of including sirens, radio broadcasts, and door-to-door
Equipment, inherent dangers. notifications, can ensure that evacuation orders reach all
• MEMA
Operational residents, especially when cell service and electrical power
are lost.

2. Expand community engagement and preparedness

efforts with public awareness campaigns that emphasize
the importance of evacuation and the risks of staying behind
during wildfires, encouraging residents to have a personal
evacuation plan that includes considerations for pets and
family members with special needs.

3. Educate the public about evacuation procedures and safe

routes, and the importance of establishing family evacuation
plans and having prepared “go-bags.” Regular drills and
informational sessions can reinforce this knowledge, while
localized communication networks, such as neighborhood
watch groups or community liaisons, can assist in
disseminating information.
3.8 • MFD Preparedness, 76. MPD officers encountered 1. Perform annual status checks of emergency gates
Evacuation Policy, barriers to roads that could have throughout the community.
• MPD
Equipment, been (and eventually were) used
Operational as alternate egress routes and 2. Equip police vehicles with disaster response kits, including
lacked equipment to navigate these appropriate PPE, to be able to facilitate evacuations and
barriers. remove barriers from potential escape exits, such as chain
link fences, gates, and boulders.

3. The MFD to establish new policy/General Order for the

provision of fire- and disaster-related emergency tools for
patrol, such as bolt cutters, tow straps, etc.
4.0 • MFD Prevention, 77. Numerous stakeholder 1. Hold a statutory organization accountable for executing
Built Environment Preparedness, organizations (state, county, the preparedness plans commensurate with the risk identified
• County of
Policy community, and HWMO) have through these efforts.
Maui
collaborated to evaluate wildfire
• State of HI risk per West Maui CWPP. 2. Adopt and enforce contemporary codes and standards for
building construction in wildfire prone areas.
4.0 • MFD Prevention, 78. Codes and standards exist for 1. Update, implement, and enforce fuel management and
Built Environment Preparedness, addressing fire hazards of exterior defensible space around structures.
• County of
Policy vegetation (16.04D Subsection
Maui
10.13.10), but they require
• State of HI enhancement based on risk and
current guidelines.
4.0 • MFD Research, 79. Some vegetation adjacent to 1. Additional research is necessary to understand the
Built Environment Prevention, structures survived where the potential for lush, well-watered, and well-mainted vegetation
• County of
Policy structure was not destroyed. to provide benefits (e.g., radiation shielding) that is not
Maui
outweighed by the hazard.
• State of HI
4.0 • MFD Prevention, 80. Ember penetration through 1. Buildings should be constructed and maintained to resist
Built Environment Policy building envelopes, including roofs, ember intrusion. This will include construction features (vents,
• County of
vents, and windows, is a common roofs, etc.).
Maui
pathway for building ignition.
• State of HI 2. Adopt stronger WUI codes (e.g., ICC International
Wildland-Urban Interface Code and NFPA 1140: Standard on
Wildland Fire Protection) or WUI Structure/Parcel/Community
Hazard Mitigation Methodology guidance.

54
 7.1 APPENDIX

Reference
Relevant Actionable
Section (Phase Finding Recommendations
Department Areas
Two Report)
4.0 • MFD Prevention, 81. Window and doors were left 1. Residents and citizens should be educated on the
Built Environment Policy open prior to evacuation. importance of closing building openings as an important
• County of
component of preparation for, and departure from, a home
Maui
during an evacuation—part of a “Ready, Set, Go: Close
• State of HI Before You Go” campaign.
4.0 • MFD Prevention, 82. Age of construction is not 1. Ensure properties and areas around structures are well-
Built Environment Policy a primary indicator of structure maintained, despite the structures’ age (i.e., newer structures
• County of
survival (correlation not causation). are not exempt).
Maui
• State of HI
4.0 • MFD Prevention, 83. Defensive actions appear to 1. Identify fire suppression strategies and tactics
Built Environment Policy, have lessened fire impact in the commensurate with resources and infrastructure capabilities
• County of
Operational built environment. and availability. Preplan based on these limitations and local
Maui
conditions.
• State of HI
4.0 • MFD Prevention, 84. Fuel breaks, such as Kahoma 1. Investigate zoning changes to incorporate fuel breaks in
Built Environment Policy Stream, Kauaʻula Stream, Keawe areas within the community to slow fire progression and to act
• County of
Street Apartments at the Villages as safe refuge areas for evacuating residents.
Maui
of Leialiʻi construction site, and
• State of HI grass athletic fields by the Boys
and Girls Club/Lahaina Recreation
Center, appear to have impacted
fire progression.

55
8.0 ACRONYMS
AND MEANINGS

Acronym Meaning

AG Hawaiʻi Attorney General

ARFF Aircraft Rescue and Firefighting

ATF United States Bureau of Alcohol, Tobacco, Firearms, and Explosives

CAD Computer Aided Design

CRA Community Risk Assessment

CRR Community Risk Reduction

CWRM Commission on Water Resource Management

CWPP Community Wildfire Protection Plan

DAGS Department of Accounting and General Services

DCCA Department of Commerce and Consumer Affairs

DHRD Department of Human Resources Development

DLE Hawaiʻi Department of Law Enforcement

DLIR Department of Labor and Industrial Relations

DLNR Department of Land and Natural Resources

DOAG Department of the Attorney General

DOFAW Hawaiʻi Division of Forestry and Wildlife

DOT Hawaiʻi Department of Transportation

DLIR Director of Labor and Industrial Relations

EMS Emergency Medical Services

FSRI Fire Safety Research Institute

HAB Hawaiʻi Association of Broadcasters

HBBC Hawaiʻi Building Code Council

HI-EMA Hawaiʻi Emergency Management Agency

HPUC Hawaiʻi Public Utilities Commission

HRS Hawaiʻi Revised Statutes

HWMO Hawaiʻi Wildfire Management Organization

IECC International Energy Conservation Code

IBC International Building Code

ICC International Code Council

IRC International Residential Code

MAT Maui Wildfire Mitigation Assessment Team

MFD County of Maui Fire and Public Safety, aka Maui Fire Department

56
8.0 ACRONYMS
AND MEANINGS

Acronym Meaning

NFPA National Fire Protection Association

NGO Non-Governmental Organization

NIMS National Incident Management System

NWCG National Wildfire Coordinating Group

NWS United States National Weather Service

OPSD Office of Planning Sustainable Development

OSFM Office of the State Fire Marshal

OWSS All-Hazard Outdoor Warning Siren System

RAWS Remote Automatic Weather Stations

RMS Records Management System

RPC Recovery Permitting Center

SFC State Fire Council

SOC Standards of Cover

SFM State Fire Marshal

UHERO UH Economic Research Organization

UL Underwriters Laboratories

ULRI UL Research Institutes

ULSE UL Standards and Engagement

WUI Wildland-Urban Interface

57
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60
As this report deals with topics related to Hawaiian culture, geography,
environment, and language, FSRI chose to include Hawaiian diacritical
marks, such as the ʻokina (ʻ) and kahakō (macron) over vowels,
throughout this report when writing Hawaiian words. These markings
are essential features of modern, written Hawaiian language, serving to
represent the proper pronunciation and meaning.

While we have made our best effort to use these marks properly, we
acknowledge there may be unintentional errors. We did not include
diacritical markings where we were unable to identify the proper spelling
of a particular Hawaiian word (eg., Aa Street) or in instances where the
information is from a third party’s direct record (e.g., social media posts).

By including these marks, we aim to honor the Hawaiian language and

show respect for its linguistic traditions – and for the people of Maui.

61
Lahaina Fire
Forward-Looking Report

Steve Kerber, Ph.D., P.E.

Vice President and
Executive Director, FSRI

Derek Alkonis
Research Program Manager

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