Emergency Medical Services & Injury Prevention Systems Branch

EMSIPSB is the Emergency Medical Services & Injury Prevention Systems Branch — Hawaii’s statewide branch overseeing emergency medical services, injury prevention, trauma systems, and related public health programs.

Who is responsible for providing 9-1-1 Emergency Medical Services (EMS) ground and air-medical ambulance transports within the State of Hawaii?

The responsibility of providing 9-1-1 Emergency Medical Services (EMS) ambulance transports within the State of Hawaii is county dependent.

Hawaii County 9-1-1 EMS ground and air-medical ambulance transports:

9-1-1 Emergency Medical Services (EMS) ground ambulance and air-medical ambulance transports are operated under a contractual partnership with the State of Hawaii, Department of Health (DOH), Emergency Medical Services and Injury Prevention Systems Branch (EMSIPSB) and the County of Hawaii, Hawaii Fire Department.

Hawaii Fire Department maintains jurisdiction over all 9-1-1 EMS ground and air-medical ambulance responses and transports.

The EMSIPSB maintains all regulatory oversight, licensing, electronic medical records, billing and collections, and state patient safety and performance/quality improvement.

Honolulu County 9-1-1 EMS ground and air medical ambulance transports:

9-1-1 Emergency Medical Services (EMS) ground ambulance transports are operated by the City and County of Honolulu, effective July 1, 2022. The City and County of Honolulu is responsible for establishing EMS ground services for its jurisdiction.

The City and County of Honolulu, under Act 208 passed by the Hawaii State Legislature in 2021 can submit to the Department of Health (DOH) to take responsibility the 9-1-1 EMS ground and 9-1-1 EMS air-medical jurisdiction for Honolulu County. As of November 1, 2025, the City and County of Honolulu has not submitted a request to formally maintain jurisdiction over 9-1-1 EMS air-medical jurisdiction.

The State of Hawaii, DOH, Emergency Medical Services and Injury Prevention Systems Branch (EMSIPSB) provides regulatory oversight regarding ground ambulance licensing, training and education, system performance improvement, and 9-1-1 EMS Air-Medical EMS transports. Along with regulatory oversight of state EMT standing orders, licensing, electronic medical records, and state patient safety and performance/quality improvement.

The City and County of Honolulu maintains jurisdiction over all 9-1-1 EMS ground ambulance responses and transports, community paramedicine programs, and billing and collections.

Maui County 9-1-1 EMS ground and air medical ambulance transports:

9-1-1 Emergency Medical Services (EMS) ground ambulance transports are operated by the State of Hawaii, Department of Health (DOH), Emergency Medical Services and Injury Prevention Systems Branch (EMSIPSB). EMSIPSB has contracted with AMR to provide coverage of 9-1-1 EMS ground ambulance transports.

9-1-1 Emergency Medical Services (EMS) air-medical ambulance transports are operated by the State of Hawaii, DOH, EMSIPSB in partnership with Maui County. Maui County assist in by providing the DOH, EMSIPSB in funding to assist in covering 9-1-1 air medical transports. The State of Hawaii, DOH, EMSIPSB has contracted with REACH to provide coverage of 9-1-1 EMS air-medical ambulance transports for Maui County.

The State of Hawaii, DOH, EMSIPSB, maintains all jurisdiction over all 9-1-1 EMS ground and 9-1-1 air medical ambulance responses and transports, along with regulatory oversight, licensing, electronic medical records, billing and collections, and state patient safety and performance/quality improvement.

Kauai County 9-1-1 EMS ground and air medical ambulance transports:

9-1-1 Emergency Medical Services (EMS) ground ambulance transports are operated by the State of Hawaii, Department of Health (DOH), Emergency Medical Services and Injury Prevention Systems Branch (EMSIPSB). EMSIPSB has contracted with AMR to provide coverage of 9-1-1 EMS ground ambulance transports.

9-1-1 Emergency Medical Services (EMS) air-medical ambulance transport services have not been formally established by the State of Hawaii, DOH, EMSIPSB or Kauai County. As such the DOH, EMSIPSB, Branch Chief and State Air Medical EMS Medical Director may authorize use of the State of Hawaii, DOH, EMSIPSB resources, such as but not limited too, the Maui REACH service to assist with Kauai County 9-1-1 EMS air medical ambulance transports.

The State of Hawaii, DOH, EMSIPSB, maintains all jurisdiction over all 9-1-1 EMS ground and 9-1-1 air medical ambulance responses and transports, along with regulatory oversight, licensing, electronic medical records, billing and collections, and state patient safety and performance/quality improvement.

Yes, the State of Hawaii, DOH, EMSIPSB issues a yearly fee schedule for 9-1-1 EMS ground and air-medical transport services. Please review how the fee schedule is applied across each county based on state statutes.

Hawaii County:

9-1-1 EMS Ground Transports and 9-1-1 Air Medical Transports for Hawaii County provided by Hawaii Fire Department. These services are covered under the DOH published fee schedule. Should Hawaii Fire Department request the services of a third-party provider to cover 9-1-1 EMS Ground Transports or 9-1-1 Air Medical Transports this should be under a contractual agreement and must follow the DOH published fee schedule.

Note: All Hawaii County interfacility transports by private third-party ground ambulance providers (AMR) or air-medical providers (Hawaii Life Flight, Life Flight Network, Optimum Air, or REACH) are not obligated to follow the DOH published fee schedule.

Honolulu County:

9-1-1 EMS Ground Transports for Honolulu County are not covered under the DOH published fee schedule. For all questions on the City and County of Honolulu 9-1-1 EMS Ground Transports please use the contact information located at: https://emergencyservices.honolulu.gov/contact-us/

9-1-1 EMS Air Medical Transports, the City and County of Honolulu has not established this service and remains under the jurisdiction of the State of Hawaii, DOH, EMSIPSB currently. No official 9-1-1 EMS Air Medical Transport Services are currently provided for Honolulu County.

Note: All Honolulu County interfacility transports by private third-party ground ambulance providers (AMR) or air-medical providers (Hawaii Life Flight, Life Flight Network, Optimum Air, or REACH) are not obligated to follow the DOH published fee schedule.

Maui County:

9-1-1 EMS Ground Transports for Maui County are provided by DOH EMSIPSB contracted provider AMR. These services are covered under the DOH published fee schedule. Should DOH EMSIPSB or AMR request services of a third-party provider to cover 9-1-1 EMS Ground Transports these transports should be provided under a contractual agreement and must follow the DOH published fee schedule.

9-1-1 EMS Air Medical Transports by DOH EMSIPSB contracted provider REACH are not covered under the DOH published fee schedule. The contract with REACH to provide 9-1-1 EMS Air Medical Transports also called Medevac Transports was excluded from the DOH published fee scheduled. Federal protections under The No Surprise Act(NSA) ensure:
1. For 9-1-1 emergency services provided by air medical providers who are out-of-network the patient cost-sharing is no more than what it would be if the air medical provider were in network, and the provider cannot bill the patient the balance; and
2. Air medical services that are out-of-network have a prohibition on balance billing patients who have private/commercial insurance.

Note: All Maui County interfacility transports by private third-party ground ambulance providers (AMR) or air-medical providers (Hawaii Life Flight, Life Flight Network, Optimum Air, or REACH) are not obligated to follow the DOH published fee schedule.

Kauai County:

9-1-1 EMS Ground Transports for Kauai County are provided by DOH EMSIPSB contracted provider AMR. These services are covered under the DOH published fee schedule. Should DOH EMSIPSB or AMR request services of a third-party provider to cover 9-1-1 EMS Ground Transports these transports should be provided under a contractual agreement and must follow the DOH published fee schedule.

9-1-1 EMS Air Medical Transports, the City and County of Honolulu has not established this service and remains under the jurisdiction of the State of Hawaii, DOH, EMSIPSB currently. No official 9-1-1 EMS Air Medical Transport Services are currently provided for Kauai County.

Should DOH, EMSIPSB request the use of the Maui 9-1-1 EMS Air Medical Transport provider REACH, these services would not be covered under the DOH published fee scheduled. The contract with REACH to provide 9-1-1 EMS Air Medical Transports also called Medevac Transports was excluded from the DOH published fee scheduled. Federal protections under The No Surprise Act(NSA) ensure:
1. For 9-1-1 emergency services provided by air medical providers who are out-of-network the patient cost-sharing is no more than what it would be if the air medical provider were in network, and the provider cannot bill the patient the balance; and
2. Air medical services that are out-of-network have a prohibition on balance billing patients who have private/commercial insurance.

Note: All Kauai County interfacility transports by private third-party ground ambulance providers (AMR) or air-medical providers (Hawaii Life Flight, Life Flight Network, Optimum Air, or REACH) are not obligated to follow the DOH published fee schedule.

The DOH, EMSIPSB, can only answer this question for Hawaii, Maui, and Kauai County 9-1-1 EMS ground ambulance responses.

Currently we do not charge for non-transport 9-1-1 EMS ground ambulance responses to the scene. However, this may be subject to change in the future.

For all City and County of Honolulu questions please use the contact information located at: https://emergencyservices.honolulu.gov/contact-us/

The DOH, EMSIPSB, can only answer this question for Hawaii, Maui, and Kauai County 9-1-1 EMS ground ambulance responses.

Yes, all 9-1-1 EMS ground ambulance transport services would be changed either an ALS or BLS changer plus the ambulance milage fee.

For all City and County of Honolulu questions please use the contact information located at: https://emergencyservices.honolulu.gov/contact-us/

The DOH, EMSIPSB, can only answer this question for Hawaii, Maui, and Kauai County 9-1-1 EMS ground ambulance responses.

No, currently we do not bill for others services outside of the ALS or BLS and milage fees for 9-1-1 EMS ground ambulance transport services.

For all City and County of Honolulu questions please use the contact information located at: https://emergencyservices.honolulu.gov/contact-us/

Patients with decision making capacity can refuse Emergency Medical Services (EMS) care are under Hawaii law and national EMS standards, if a patient is alert and oriented; has decision making capacity; and understands the risk, benefits, and alternatives. The patient may legally refuse assessment; treatment, transport, and any other EMS service. Hawaii EMS provider must obtain a signed refusal of service document when possible.

Exceptions: Situations where a patient cannot decline Emergency Medical Services (EMS) may not accept a refusal when:
1. The patient or patient’s legal representative lacks decision making capacity (e.g. altered mental status, severe intoxication, confusion, head injury, stroke, or medical condition impairing judgment.)
2. The patient poses a danger to self or others
3. The patient is a minor. A parent or legal guardian must refuse on their behalf, unless a: life-threating emergency; or no guardian is present, then EMS may treat and transport under “implied consent.”
4. A court order or law enforcement directed medical evaluation (e.g. police protective custody or mental / behavioral health authority hold)

Hawaii Medicaid covers 9-1-1 ambulance service fees, Hawaii Medical recipients have no patient liability.

Medicare recipients are only responsible for assigned deductibles, copays, and coinsurance amounts. Each recipient would need to reach out to their Medicare program to identify their cost for 9-1-1 ambulance service fees.

The DOH, EMSIPSB, can only answer this question for Hawaii, Maui, and Kauai County 9-1-1 EMS ambulance responses.

No, currently we do not negotiate 9-1-1 ambulance service fees with private insurance plans.

For all City and County of Honolulu questions please use the contact information located at: https://emergencyservices.honolulu.gov/contact-us/

The public should review and be fully informed of the following:

• Hawaii Revised Statutes (HRS) §321-234 and HRS §46
• Hawaii Legislation Act 208 (2021) for Honolulu County
• Hawaii Administrative Rules (HRA) Title 11-72
• Patient Rights: Refusals and Fees
• Federal No Surprises Act (NSA) 2022 (Air Ambulances Only)
• Federal Medicare Rules provided by Center for Medicare and Medicaid Services (CMS)
• Hawaii Medicaid (Hawaii Med-QUEST) covers emergency transports and patients can not be balanced billed

Email: [email protected]
For program-specific inquiries, use the contact links in the “EMS Related Links” section above.