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LIHUE, Kauai — Maui and Kauai counties could each lose two ambulances and cuts could be scattered across supporting emergency medical services on Hawaii island and Oahu under budget reductions threatened by the COVID-19 pandemic.

Details of the potential cuts emerged Monday from the general manager of AMR, which provides all emergency medical services for Maui, Molokai, Lanai and Kauai and staff supporting ambulance and medical transfer services in the rest of the state.

The cuts were also confirmed by the Kauai Paramedics Association and the Maui County Paramedics Association. The reductions are being developed after the state Department of Health ordered service providers to propose cuts of 10% to 20% because of feared reductions in state expenditures due to the coronavirus pandemic.

The gutting of ambulance services in two counties is among the first concrete possible cuts to emerge in Hawaii from ongoing concern about the huge coronavirus-induced government deficits that could grip the entire country.

Gov. David Ige’s office declined to comment on the threatened EMS reductions and referred questions to the health department.

DOH declined on Monday to provide details of the ambulance and other cuts under consideration. But the agency confirmed it had ordered the four county EMS providers to prepare for the possibility of statewide budget reductions due to the ongoing pandemic.

The department said it had asked for budget scenarios based on various possible funding restrictions. DOH said “these are models for discussion purposes, and no action is being taken at this time. Sharing the details of this initial modeling would be premature.”

Officials of the two paramedics organizations, however, said they had been briefed in detail on specific cuts to ambulance and EMS services in the two most affected counties.

“None of this is temporary and I believe that this year is only the beginning,” said Kapena Hill, vice president of the Maui County organization. “This is not based on rumors or assumptions.”

Later Monday, Bobby Perreira, assistant chief of the Hawaii County Fire Department, said his agency and the emergency services department in Honolulu were told they are subject to the same possible statewide ambulance service cuts as AMR.

He confirmed that DOH had given AMR and safety agencies until Tuesday to come up with plans for service reductions of 10%, 15% and 20 percent.

“This is a bad day for ambulance service in Hawaii,” Perreira said.

‘There’s Just No Funding For It’

Errol McGowan, president of the Kauai paramedics group, said the effects on Kauai would be particularly acute in and around Lihue, the island’s government center.

In 2018, Kauai got its first new ambulance station assignment since the 1970s, he said, but the Legislature never made the unit a permanent part of the island’s EMS budget. A bill that would have done so failed in that year’s legislative session.

The additional ambulance was assigned to Lihue, McGowan said, so at least one of Kauai’s losses would be there, heavily degrading responses from Kapaa on the east side to Waimea on the west side.

“The bottom line is there’s just no funding for it,” McGowan said. “Had this COVID stuff not happened, this would not be an issue.”

He said AMR had been directed by DOH to find about $4 million in ambulance savings for Maui and Kauai counties.

William “Speedy” Bailey, AMR’s general manager for Hawaii, said, “We’re all concerned. We have to go to the Legislature and work to advocate for service, funding and upgrades. It’s pretty complicated because we have been providing service in Hawaii for over 40 years under state contracts.”

Bailey said the current state budget allocates about $90 million for emergency medical services, a figure that, before the epidemic hit, had been projected to rise to nearly $100 million a year.

But Bailey noted that the state’s EMS network also produces revenue by charging for ambulance and related services. He said the service produces revenues of about $45 million a year.

He said AMR had been directed to get its final budget cut proposal to DOH on Tuesday. Officials of the two paramedic organizations said they were first told of the potential cuts on July 23 and held membership meetings last week to discuss details.

Hawaii relies on two different EMS models. In Honolulu and Hawaii counties, county agencies like emergency services and fire departments are the primary providers of ambulance service and rely on AMR for stand-by service, a backup in case fire department units are fully committed and need non-emergency patient transportation.

Kauai and Maui counties, on the other hand, rely on AMR to provide the full breadth of emergency response services. Neither fire department is capable of ambulance transportation. In both counties, fire department units are typically dispatched to emergency calls first, with ambulances arriving later. Frequently, though, for reasons of proximity, ambulances are first on scene.

In Kauai County, firefighters are also prohibited from employing some advanced life support services, such as intubation, which can only be administered by AMR personnel.

Kauai has six ambulances scattered across the island.

Because its geography is different, Maui County has the equivalent of 8.5 ambulances. The county’s contract with AMR also allows for air transportation between islands.

While all Kauai ambulances deploy two-person crews staffed by emergency medical technicians, on Maui, one ambulance is staffed entirely by paramedics while the others rely on EMTs. The paramedic unit can be dispatched islandwide and does not transport patients to the hospital. Because of those differences, the effects of the cuts in Maui County would be different from Kauai.

Although AMR personnel are unionized, they are not public employees and have no direct contract protections with public agencies. AMR does not release its salary scales publicly, but in Honolulu, EMTs earn a minimum of $47,628 a year and paramedics get $60,888, according to the Honolulu Emergency Services Department.