It’s not surprising that a company successfully meeting the state of Hawaii’s needs for efficient, effective ambulance service over 44 consecutive years would protest being replaced.

What is surprising — make that bewildering — is that the state has not justified its decision to leave longtime provider American Medical Response (AMR) behind, awarding Falck Northwest Corp. the new contract for emergency ambulance services on Maui and Kauai.

The Hawaii Department of Health (DOH), which oversees ambulance service throughout the state, has not released information indicating that the contract change provides cost savings. Nor has it explained how the change in contractors benefits communities served.

It has not justified issuing a request for contract proposals that could lower staffing standards for patient care during transport.

Nor has it indicated why the winning bidder, Falck Northwest Corp., should be considered a superior provider. That’s a burning question, in that the quality of Falck’s service in at least two California service areas has been the subject of intense criticism.

DOH awarded the $91 million in contracts for operations on Maui and Kauai to Falck in August. Services were to begin in December and continue through June 30, 2027.

Questions about the deal were quickly raised by the Maui County Paramedics Association and the Kauai Paramedics Association, unions representing paramedics who partially staff the ambulance service. AMR has concerns, too — and filed an official protest.

That protest suspends the process of transferring the contract to Falck “until a disposition is made,” DOH stated. Frustratingly, however, DOH has not been open on how it will address concerns, or given a timeline for action.

Paramedics’ concerns arose after examining details of the state’s request for proposals, issued in June. In an addendum, DOH states that it has no requirement — “no preferred ratio” — that ambulances be staffed to provide both basic and advanced life support while carrying patients.

For decades, under the current contract, Maui and Kauai ambulances have been required to include an advanced life support unit on each ride. That guarantees that a highly trained paramedic, fully equipped with advanced life support equipment, will be on board. Now, according to DOH contract guidance, no such requirement or “preferred ratio” is a necessity.

In response to paramedics’ protests, Falck has stated that it plans to operate under current standards, and to retain and even hire additional paramedics. But with loosened requirements in play, concerns remain.

The issue of DOH standards also comes to bear because Falck has recently faltered in its contracts with San Diego and Alameda County, failing notably to meet standards for response times and blaming a labor shortage for the issue. In 2022, San Diego fined Falck $1.9 million over the issue, then required the company to add a subcontractor: AMR.

What’s unknown is whether DOH is aware of Falck’s stumbles — or simply unconcerned.

The issue has drawn attention from the Maui County Council, which on Friday heard a resolution urging the DOH to continue its contract with AMR, referring it to the Water Authority, Social Services and Parks Committee.

Falck is a global health care provider, with contracts in the Pacific Northwest and a headquarters in Denmark. AMR has a comforting track record in the islands. Without a full and transparent accounting from the state for its decision-making, it’s an open question as to which company is best for Hawaii.

With the contract under review, Maui and Kauai residents must be assured that Falck has been fully vetted, and is fully capable of delivering on its agreement. The contract itself must incorporate clear benchmarks for response time and staffing, as well as provisions to guard against gaps in service and unbudgeted expenses. That’s all needed to ensure that the contract winner is not only a low bidder, but will deliver the lifesaving service required while meeting the highest standards.