Whose protocols will you work under?

One state manual covers every level, with scope of practice by level inside it.

Each certified service's medical director approves its protocols (7 AAC 26.650); added medications and procedures need state approval.

Each agency's administrative medical director writes them, within the state scope of practice and formulary (A.A.C. R9-25-201).

Arkansas EMS rules define protocols as the service's own standing orders, signed by its medical director.

Each county or multi-county local EMS agency writes the treatment protocols, and a paramedic must be accredited by that LEMSA before working there (22 CCR § 100096.03).

The agency medical director writes them; anything beyond the state scope in Chapter 2 needs a state waiver.

One state set (version 2025.2); standing orders are used at the provider's discretion.

Paramedic standing orders are one statewide protocol, signed by the State EMS Medical Director.

DC Fire and EMS, the 911 service, publishes its protocols; certification also requires affiliation with a DC-approved agency.

Each licensed provider's medical director writes the standing orders (Fla. Admin. Code 64J-1.004); they differ county by county.

Services write their own protocols; since February 2026 they must meet the state's minimum protocol policy (OEMS-SER-001).

Paramedic standing orders are approved by the Department of Health (HAR § 16-85-60).

The state Physician Commission publishes them; your agency medical director adopts them and decides what you are credentialed to do.

Illinois runs on hospital-based EMS Systems; each System's medical director sets its standing medical orders, and many regions share one set.

Each provider organization's medical director and supervising hospital set medical direction (836 IAC 2-2-1).

The service medical director writes them; they must meet the state's minimum clinical guidelines, and changes are filed with the state.

Each service's medical director writes them; the Board of EMS posts sample protocols but none is required statewide.

Most agencies adopt the state set; any amendment needs written KBEMS approval first. Louisville Metro and Cincinnati-area protocols are also approved.

Protocols are set parish by parish by the medical society, or by the service with the society's approval.

One state set, updated on a two-year cycle; free Maine EMS Protocol app.

One state set from MIEMSS, updated each July.

One state set (version 2026.2); it is the standard of care in Massachusetts.

Regional Medical Control Authorities adopt protocols, most built on the state protocol suite; once approved they have the force of law.

Each licensed ambulance service's medical director sets the standing orders (Minn. Stat. 144E.265); trauma triage follows a state guideline.

Agency protocols are built on the state Model Protocol; expanded skills need state approval.

Each service's medical director writes and annually reviews its protocols (19 CSR 30-40.303).

Board-approved default protocols; service-specific protocols need Board of Medical Examiners approval first.

The state model set is signed and adopted by each service's physician medical director, who can modify it.

Las Vegas (Southern Nevada Health District) and Reno (Washoe County) run their own regional protocols; the rest of the state uses the state manual.

One statewide set from the state Medical Control Board (version 9.0 since June 2024).

One BLS and ALS set (August 2025); New Jersey paramedics are Mobile Intensive Care Paramedics.

Each system or service medical director writes them (7.27.3 NMAC); Albuquerque–Bernalillo County shares one set.

BLS is statewide; ALS protocols come from each region's REMAC (New York City has its own unified set).

County EMS Systems adopt the state standard set and may modify it with state OEMS approval.

The state publishes editable model guidelines; each agency medical director approves the final version.

Each organization's medical director writes them (ORC 4765.41); many regions share a common set.

Each agency's medical director signs its protocols and the state approves them before use.

Each service's medical director (supervising physician) writes them; Oregon has no statewide set outside declared emergencies.

Statewide ALS and BLS sets, plus department-approved regional treatment protocols.

One statewide set (version 2024.01, effective November 2024).

State consensus protocols (2017 edition); local medical control physicians adopt and adapt them.

Service medical directors approve the protocols; trauma protocols must meet the state guidelines (ARSD 44:68:03:04).

Services use the state guidelines as written or as the base for their own.

Each provider's medical director writes and signs them (25 TAC § 157.11); there is no state protocol set.

Voluntary state guidelines that many agencies adopt as written.

One state set; scope of practice for each level is in its Appendix 4.

Each agency's operational medical director sets protocols; most regional EMS councils publish a shared regional set.

Each county's MPD writes and the state approves them; moving counties means new protocols.

One state set (April 2026 booklet), from the state OEMS medical director.

Service medical directors write them within the state scope of practice; the state approves each service's operational plan.

Each service's physician medical director writes and re-signs them at least every two years.