Unions representing paramedics are concerned about a major shift in standards of care after the state awarded contracts to a new provider for emergency ambulance services for Maui and Kauai counties.

The state Department of Health recently selected Falck Northwest Corp., a Danish-based company, as the winning bidder for emergency ambulance services serving 911 dispatch centers for both counties, starting in late December.

Falck would replace longtime provider American Medical Response, which has had the counties’ contracts for decades.

“We’re stunned,” said Speedy Bailey, regional director for AMR in Hawaii. “We’re very concerned by this decision because we believe it is not in the best interest of the state of Hawaii.”

AMR has held the contract for the past 44 years, Bailey said, and for all those years has met and exceeded contract terms. He said AMR actually extended its contract to June 30 at the state’s request so that it could put out its request for proposals.

“We have a proven track record of providing decades of exemplary service to our communities,” said Bailey, who appealed the decision Tuesday. “We, AMR and our medics, have provided ALS care continuously for 44 years, without breaking service during COVID. In fact, during COVID we added units to support the needs.”

He added, “It appears tone-deaf in the aftermath of the heroic work that our teams did on Maui during the wildfire.”

The multiyear contracts awarded to Falck — roughly $59 million for Maui and $32 million for Kauai — begins in late December and lasts through June 30, 2027, according to state records.

After examining the bid the state issued in June, the unions say they are most concerned about the dropping of a required Advanced Life Support unit for every unit.

The details were in an addendum responding to questions, they said, where DOH said it had no preferred ratio between advanced and basic life support ambulance deployment.

For decades, the unions said, anyone who called 911 could rest assured the ambulance responding would have at least one highly trained paramedic with all advanced life support equipment — and that this would be available for any neighborhood on any island at any time.

“There’s never been a diminishment of the fact we have comprehensive Advanced Life Support across the state, ” said David Kingdon, spokesman for the Maui County Paramedics Association. “We were not expecting, and not informed of any change of that magnitude.”

Kingdon added that this is the main concern and that the unions are not taking a position on any one company versus another.

“Our foremost concern,” he said, “is we want to see our communities have the benefit of the highest level of care.”

A paramedic is trained to perform all the basic life support functions that Emergency Medical Technicians do, but undergo further training and are certified to perform more advanced lifesaving procedures such as intubation, the use of EKGs to identify cardiac conditions and IVs to administer lifesaving medications.

The associations represent both paramedics and EMTs, and emphasized both are valuable but that removing the standard for comprehensive ALS is “grossly irresponsible.”

Currently, DOH said, Maui has eight ALS ambulance units and one rapid­-response unit, while Molokai and Lanikai have one ALS ambulance unit each. Molokai is slated to get a second ambulance unit in 2024.

During the recent fire­storms, the unions said, Maui paramedics treated about 60 patients and transported 32 to hospitals. They provided advanced life support to more burn patients in one night than most EMS systems see in a year.

Kingdon said one ambulance had two serious burn patients on board but that major routes to the hospital were blocked. The paramedic on board provided advanced life support to the two patients for hours as the ambulance traveled along a treacherous, 40-mile route to the north.

“EMS providers performed valiantly despite innumerable challenges and threats to their own lives,” they said.

Falck, a global health care provider, offers ambulance services in Denmark, Germany, Spain, Sweden and the U.S.; fire services in other parts of Europe; and community health services in Colombia and Ecuador.

The company called last year a solid year in its 2022 annual report, and attributed its organic growth rate of about 6% to the addition of the ambulance contract in San Diego.

But Falck has had a string of compliance issues in areas it serves in California, including San Diego and Alameda County, according to past media reports.

The San Diego Union-­Tribune reported struggles by the private ambulance provider that resulted in $1.2 million in fines for failing to meet response-time goals in the last three months of 2022.

In San Diego, Falck also replaced AMR as the city’s private provider, according to the Union-Tribune. The city of San Diego eventually shifted its model to take control of ambulance serv­ices directly, and required Falck to subcontract serv­ices out to AMR.

Alameda County in California also reported issues with Falck’s delayed response times to life­-threatening emergency calls, which took up to 25 minutes instead of within 10 minutes as expected, reported ABC7 news.

Bailey questioned the state’s decision to select a provider with no service history in Hawaii as well as documented failed contract implementations and response time penalties.

The state Health Department said due to AMR’s timely appeal regarding the contracts, further action and execution of the awards would be suspended until “a disposition is made of the protests.”

”Until that time, DOH is unable to provide comment or other information regarding the RFPs and protests,” the department said in a statement.

Bailey said the unions’ concerns for Maui and Kauai regarding the standard of care are valid.

“We don’t believe this is good for the state,” he said.