Haw. Rev. Stat. § 321-228
The department shall determine, in consultation with the advisory committee under section 321-225, the levels of emergency medical services that shall be implemented in each county within the service area. The department may contract to provide emergency medical services, including emergency aeromedical services, or any necessary component of the emergency services system of a county within the service area in conformance with the state system. If any county within the service area shall apply to the department to operate emergency medical ambulance services within the respective county, the department may contract with the county for the provision of those services. The department shall operate emergency medical ambulance services or contract with a private agency in those counties within the service area that do not apply to it under this section. Any county or private agency contracting to provide emergency medical ambulance services under this section shall be required by the department to implement those services in a manner and at a level consistent with the levels determined under this section.
HRS § 321-228