The National Highway Safety Administration, through various versions of the documents, ‘EMS Agenda For The Future’, publish updated versions of what EMS should become in the coming years. By constantly looking into the future, NHTSA is able to provide recommendations, a curriculum, and develop provider levels based on the ‘Scope of Practice ‘ model.

State agencies must manage EMS operations and training at the local level. In Georgia, the Department of Public Health manages EMS training programs, operations, and trauma centers by virtue of Official Code of Georgia Title 31 Chapter 11

§ 31-11-1. Findings; declaration of policy

(a) The General Assembly finds and determines:(1) That the furnishing of emergency medical services is a matter of substantial importance to the people of this state;(2) That the cost and quality of emergency medical services are matters within the public interest;(3) That it is highly desirable for the state to participate in emergency medical systems communications programs established pursuant to Public Law 93-154, entitled the Emergency Medical Services Systems Act of 1973;(4) That the administration of an emergency medical systems communications program should be the responsibility of the Department of Public Health, acting upon the recommendations of the local entity which coordinates the program; all ambulance services shall be a part of this system even if this system is the 9-1-1 emergency telephone number;(5) That an emergency medical systems communications program in a health district should be operated as economically and efficiently as possible to serve the public welfare and, to achieve this goal, should involve the designation of geographical territories to be serviced by participating ambulance providers and should involve an economic and efficient procedure to distribute emergency calls among participating ambulance providers serving the same health district; and(6) Any first responder falls under the department's rules and regulations governing ambulances and can transport only in life-threatening situations or by orders of a licensed physician or when a licensed ambulance cannot respond.(b) The General Assembly therefore declares that, in the exercise of the sovereign powers of the state to safeguard and protect the public health and general well-being of its citizens, it is the public policy of this state to encourage, foster, and promote emergency medical systems communications programs and that such programs shall be accomplished in a manner that is coordinated, orderly, economical, and without unnecessary duplication of services and facilities.

At the operations level, medical oversight provides direction in the following forms:

1. Offline Medical Control – A standing order or a protocol is a procedure that is approved by a doctor who is acting as the EMS agency’s Medical Director. If the situation fits the standing order or protocol and the EMS personnel are trained in the procedure, the procedure or medication can be accomplished without contacting online medical control.
2. Online Medical Control – A physician acting as medical control gives an order for the EMS personnel to perform a procedure, give a medication, or transport to a particular facility.

The Medical Director also provides clinical oversight of EMS personnel. The Medical Director may determine that the EMS personnel need additional training or maybe a new medication or intervention would work better.

In Georgia, the Department of Public Health (DPH) controls the EMS operations in 10 distinct regions. An ambulance service must go through a review process in order to be awarded a ‘911’ contract. Ambulance services typically perform some sort of administrative review of EMS personnel in order to ensure quality is delivered on each and every call. Direct supervision is sometimes available through supervisors, however, EMS personnel are largely required to work on their own without supervision.

In Georgia, all licensed EMS providers must follow the ‘Scope of Practice’. The scope of practice stipulates what each provider can do as per their training (EMR) or licensure (EMT, EMT-I, AEMT, CT, Paramedic). As one can see from the Scope of Practice document, there is quite an array of skills hat are conveyed with each level.

43-34-20. Medical Practice Act of The State Of Georgia

HISTORY: Code 1981, § 43-34-20, enacted by Ga. L. 2009, p. 859, § 1/HB 509. § 43-34-21. Definitions As used in this article, the term: (1) "Board" means the Georgia Composite Medical Board. (2) "Physician" means a person licensed to practice medicine under this article. (2.1)  "Postgraduate training" means a program for the training of interns, residents, or postresidency fellows that is approved by the Accreditation Council for Graduate Medical Education (ACGME), American Osteopathic Association (AOA), or the board. (3) "To practice medicine," "the practice of medicine," or "practicing medicine" means to hold oneself out to the public as being engaged in the diagnosis or treatment of disease, defects, or injuries of human beings; or the suggestion, recommendation, or prescribing of any form of treatment for the intended palliation, relief, or cure of any physical, mental, or functional ailment or defect of any person with the intention of receiving therefor, either directly or indirectly, any fee, gift, or compensation whatsoever; or the maintenance of an office for the reception, examination, and treatment of persons suffering from disease, defect, or injury of body or mind; or attaching the title "M.D.," "Oph.," "D.," "Dop.," "Surgeon," "Doctor," "D.O.," "Doctor of Osteopathy," "Allopathic Physician," "Osteopathic Physician," or "Physician," either alone or in connection with other words, or any other words or abbreviations to one's name, indicating that such person is engaged in the treatment or diagnosis of disease, defects, or injuries to human beings, provided that the terms "doctors of medicine," "doctors of osteopathic medicine," "doctors of medicine licensed to practice in the state," and similar terms wherever used or appearing in this article or elsewhere shall mean and include only those persons licensed under this article.

All EMS personnel work under the supervision of a physician. In Georgia, the physician has a license to practice medicine. If the EMS personnel decide to operate out of their scope of practice, they could be charged with the crime of practicing medicine without a license. The physician in charge of the EMS organization is referred to as ‘Medical Control’. Sometimes the physician provides written orders in the form of ‘protocols’ or ‘standing orders’. These documents are intended to give very specific direction to highly predictable situations the EMS crew will surely encounter.

EMS are to emulate the medical control physician by being professional. EMS are expected to take care of the patient under the guidance of the medical director. The public expect to see EMS agencies act professionally and be there when called upon. These measure and expectations are in place to protect the public.