State awards ambulance contracts to American Medical Response following protests

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The Hawai‘i State Department of Health (DOH) has made its decision on ground ambulance services for Kauaʻi and Maui following its restarted procurement process, awarding contracts to longtime service provider American Medical Response (AMR), which will now be doing business as International Life Support, Inc.

AMR, which has provided ground ambulance services on both islands for over 44 years, had been competing for the contracts alongside Falck Northwest Corp., the previously chosen provider, whose contract was canceled late last year following protests that led the state to restart its application process. 

In August 2023, Falck, an emergency assistance organization with no previous history in the state, had been awarded 3.5-year contracts, totaling roughly $32 million for Kaua‘i and $59 million for Maui to provide ambulance services on both islands.  Both contracts were expected to begin on Jan. 1, 2024, and run through June 30, 2027, with the possibility of a 24-month extension.

AMR immediately protested the decision, which resulted in the DOH restarting the process.

In April, the DOH reissued its Request for Proposals, once again asking vendors to apply to provide comprehensive 911 ground ambulance services.


In the end, the department decided to change back to AMR, with the awarded amount also increasing by over $21 million in total — going up to $38 million for Kauaʻi and $74.6 million for Maui.

Falck USA released a statement on Friday, May 24, shortly after the DOH’s announcement.

“We are disappointed that Falck was not selected by the Department of Health, who found us more qualified than the incumbent to provide emergency medical services to Maui and Kaua‘i counties just last year before canceling the request for proposals in response to a challenge,” said Troy Hagen, chief commercial officer for Falck.

He continued, suggesting that Falck is considering challenging the state’s decision.


“We are carefully reviewing our options and continue to stand ready to serve. As a foundation-owned healthcare provider, Falck would bring a fresh perspective, unmatched financial stability, reliable services developed around global best practices, and a deep commitment to delivering the highest quality care to the communities we serve,” he said.

The DOH did not provide any specific reason for the decision to change back to the original provider. But the department said AMR’s new contracts for Kaua’i and Maui Counties are expected to begin Jan. 1, 2025.

The current contracts in both counties have been extended until then to ensure residents have uninterrupted access to ground ambulance services.

During last year’s protests, AMR had cited errors within the terms of the DOH’s Request for Proposals, including the removal of a previous requirement that every ambulance be an Advanced Life Support unit, instead of just Basic Life Support. 


However, in its announcement, the DOH continued to emphasize, as it did months ago, that the department never intended to cut services.

As stated by the DOH, the new contracts will:

  • Ensure that every district has an ambulance staffed with a paramedic and a second responder who is at least an EMT, which are the current qualifications for, and level of staffing
  • Provide a second ambulance for Moloka‘i
  • Add requirements for a quality assurance coordinator and a pediatric emergency care coordinator, among other improvements in quality and performance.

Emma Grunwald
Emma Grunwald is a reporter for Kauaʻi Now. You can reach her at
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