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Weeks after devastating wildfires killed at least 155 people and destroyed Lahaina, the Hawaii Department of Health has awarded a $58.9 million, multi-year contract for the island’s ambulance services to a Danish company that’s been under scrutiny for failing to provide adequate service in San Diego and the San Francisco Bay Area.

Under the contract, the  will replace Maui’s longtime provider, American Medical Response. Falck also will take over ambulance service on Kauai under a separate, multi-year contract worth $32.1 million. The contracts for both islands begin in late December and run through June 2027.

The Department of Health Emergency Medical Services and Injury Prevention System Branch awarded the contract to Falck despite recent reports of poor response times by Falck in San Diego and the Bay Area.

According to , Falck was fined $1.9 million by the city for failing to meet response times for three months in 2022. In April, the newspaper reported that the city has taken over staffing, ambulance dispatching and patient billing from Falck.  called Falck’s performance “an utter disaster.”

In 2022, the  reported, “The response times for hundreds of critical 911 calls failed to meet compliance standards in Alameda County this past December — And it’s been that way for months.”

Falck’s media office did not respond to a request for comment.

Meanwhile, unions representing paramedics and emergency medical technicians on Maui and Kauai criticized the Department of Health for issuing a request for proposals which the first responders say could result in a lower standard of care for neighbor island residents who need an ambulance. 

The previous practice for decades was to require at least one paramedic trained in Advanced Life Support along with necessary equipment to be aboard each ambulance, the Maui County Paramedics Association and Kauai Paramedic Association said in a joint statement.

But DOH’s request for proposals for the current contract didn’t require that. Instead, ambulances could be staffed entirely with emergency medical technicians trained in Basic Life Support.

“DOH unilaterally advised bidders for EMS service delivery in these counties that there will now be no minimum level of ALS coverage,” the unions said. “In fact, when bidding companies themselves sought clarification, DOH doubled down on diluting the level of care, publishing: ‘DOH does not have a preferred ratio between ALS and BLS ambulance deployment.’”

Proposed Care Level Has Not Been Made Public

It is not clear how Falck plans to staff its ambulances. The Department of Health has not posted Falck’s winning proposal on its website yet, although the department said it awarded the contract on Aug. 29.

Robert Lau, who procurement documents list as a contact with DOH’s Emergency Medical Services and Injury Prevention System Branch, didn’t respond to a call and email for comment.

The issue isn’t what the contractor might do but that DOH lowered its requirements for neighbor island residents, said David Kingdon, a member of the Maui County Paramedics Association.

Unlike EMTs, he said, paramedics can do things like insert breathing tubes in patients with respiratory failure, use EKGs to respond to life-threatening cardiac conditions and insert IVs to administer dozens of different medications.

Kingdon said the unions are not taking a position for or against Falck or AMR. The state is to blame for making the change without reaching out to the first responders, he said.

“They should have been reaching out to us,” he said. “For them to have made that drastic change and not to reach out to us is just unthinkable.”

Ron Kouchi, the Hawaii Senate President who represents Kauai, said he knew nothing about the change until Saturday and that he has not been able to contact the Department of Health because of the Labor Day Holiday. 

“Anything that might impact the quality of medical services for our constituents will be of utmost concern,” Kouchi told Civil Beat. “I will wait for a response.” 

Civil Beat’s coverage of Maui County is supported in part by grants from the Nuestro Futuro Foundation.