After two sets of bids and protests, the state said contracts for ground ambulance emergency services on Kauai and Maui will be awarded to American Medical Response.

The state Department of Health on Monday announced that the contracts would stand after competitor Falk Northwest Corp. filed notices of protest. The new contracts with AMR, formally known as International Life Support Inc., take effect Jan. 1.

“Our priority remains ensuring high-quality emergency medical services for the residents and visitors of Kauai and Maui and continuing the current (advanced life support) staffing level,” said state Health Director Dr. Kenneth Fink in a news release. “Both bidders submitted excellent proposals with the differentiating factor being primarily price. I am confident that both would provide high-quality emergency medical services.”

The four-year contracts run from Jan. 1 to Dec. 31, 2028. The Kauai County contract is for $38 million, and the Maui County contract is for over $74 million, which includes a second Molokai ambulance.

The final decision from DOH’s Emergency Medical Services and Injury Prevention System Branch ends a back-and-forth saga that began last fall.

In September, unions representing paramedics expressed concerns about whether the state had made a major shift in standards of care after reading the bid issued last summer.

At that time the contract had already been awarded to Falck, a global emergency response and health care services provider.

The unions said they were concerned about the dropping of a required advanced life support unit for every ambulance in the bid, and that in an addendum, DOH said it had no preferred ratio between advanced and basic life support deployment.

For decades, the unions said, anyone who called 911 could rest assured the ambulance responding would have at least one highly trained paramedic — and that this would be available at any time.

AMR, which had held the contracts for decades, also filed a formal appeal.

Falck at the time clarified it had no intention of reducing ALS services — and that no such reduction had been proposed or discussed in that initial contract. DOH, however, decided to cancel the initial RFPs after the concerns were raised.

In April, DOH started over and issued new RFPs for ground ambulance services for Kauai and Maui counties.

Fink said it was never the department’s intent to reduce qualifications, but that the previous RFPs did not make this entirely clear. The newly issued RFPs clearly required every district have an ambulance staffed with a paramedic and responder who is at least an emergency medical technician.

A paramedic is trained to perform all the basic life support functions that EMTs do, but undergo further training and are certified for more advanced lifesaving procedures such as the use of IVs to administer lifesaving medications.

Additionally, the new request added another ambulance for Molokai, bringing Maui County’s fleet to 11.

On May 23, DOH awarded the contracts to AMR. Falck filed a protest, saying there were clear errors in calculating its scores, and inconsistencies in evaluation criteria used to award the contracts.

“We are disappointed that the Department of Health ultimately reversed course after initially selecting Falck to provide enhanced emergency medical services to Maui and Kauai counties,” said Troy Hagen, chief commercial officer of Falck USA, in a written statement Tuesday. “Falck continues to stand ready to serve should the DOH call on us. As a foundation-owned healthcare provider, we 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.”

Speedy Bailey, AMR’s general manager, said in a statement that it has partnered with Maui and Kauai for 44 years to build a strong emergency medical services system.

“We’re excited to continue this partnership and appreciate the due diligence by the Department of Health in choosing a provider,” said Bailey in the statement. “We look forward to providing continuous quality services, working with the State, counties, and others to meet ongoing EMS system needs.”