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SOG-260EMSMixed

EMS Response & Scope

What level of EMS we provide, who is authorized, and how we integrate with transport.

Read before using

This is a template. It is not your department's policy.

Tailboard templates are drafted as generic starting points aligned to national standards. They are nota substitute for your department's own review or for adoption through your Authority Having Jurisdiction (AHJ). For topics carrying significant exposure (use of force, medical scope, civil rights), route through qualified counsel before adoption.

Every placeholder marked [BRACKETED] must be completed before adoption. Every section must be reviewed against your department's staffing, apparatus, water supply, EMS scope, geography, and the specific laws of your state. What applies to a career department in a city may not apply to a volunteer department in a rural jurisdiction, and vice versa.

Standards, regulations, and best practices are updated regularly. Verify the current edition of every standard cited before adopting this document. Once adopted, this document becomes your department's responsibility — not Tailboard's.

Want this tailored to your department?

Open it in the Policy Builder. Answer a few questions about your staffing, apparatus, and conditions — we'll adapt every section to match.

Number

SOG-260

Version

1.0

Last reviewed

2026-01-01

Next review

2026-07-01

Summary

This guideline defines [DEPARTMENT NAME]'s EMS scope of practice, the credentials required of members operating at each level, integration with transporting agencies, and the relationship with medical direction. EMS scope is ultimately defined by state EMS authority; this document reflects local implementation within those bounds.

Definitions

Scope of Practice
The range of procedures and medications authorized for a given EMS level by the state EMS authority.
Medical Director
The licensed physician responsible for offline and online medical direction of the department's EMS operations.
Offline Medical Direction
Written protocols authorized by the Medical Director governing care without real-time consultation.
Online Medical Direction
Real-time consultation with the Medical Director or designee during patient care.

Purpose

To ensure [DEPARTMENT NAME] delivers EMS care within authorized scope, that members hold appropriate credentials, and that hand-off to transporting agencies is consistent and documented.

Scope

Applies to every member of [DEPARTMENT NAME] providing medical care at any incident, and to all EMS operations delivered by [DEPARTMENT NAME].

Department Service Level

[DEPARTMENT NAME] is authorized at the [BLS / ILS / ALS / MEDICAL FIRST RESPONSE] level. Specific authorized procedures and medications are detailed in the medical protocols issued by the Medical Director, attached as Appendix A.

Credentials

  • Members must hold current state certification at the level they operate.
  • Credential verification occurs on hire and annually.
  • Members operating above their credentialed level are subject to discipline and state EMS agency review.

Protocols and Medical Direction

  • All patient care is rendered under the Medical Director's protocols.
  • Protocols are reviewed at least annually and updated with Medical Director signature.
  • Online medical direction is available at [PHONE/RADIO] for consultation on complex cases or deviations from protocol.
  • Deviations from protocol require Medical Director review and are documented in a QA log.

Scene Command and Medical Oversight

  • EMS operations at multi-patient, hazmat, or complex scenes occur under the Incident Command System.
  • An EMS Branch or Group is established on incidents with more than three patients or complex treatment needs.
  • Triage uses [START / SALT / JumpSTART] at MCIs per the Mass Casualty SOG.

Hand-Off to Transport

  1. When transport is by a separate agency, care is handed off using a structured format (e.g., MIST: Mechanism, Injuries, Signs, Treatment).
  2. A patient care report is provided to the transporting agency before they depart.
  3. Documentation is completed in [DEPARTMENT]'s ePCR system before end of shift.

Patient Refusal

Refusal-of-care situations are governed by the Patient Refusal SOP. Every refusal requires: confirmation of patient decisional capacity, explanation of risks, and a signed refusal form.

Infection Control

Bloodborne pathogen exposure, PPE for patient care, and post-exposure procedures are governed by the Bloodborne Pathogens SOP (and OSHA 1910.1030).

Documentation

  • Every patient contact generates a patient care report (ePCR).
  • Reports are completed before end of shift and submitted to the state EMS registry.
  • HIPAA-protected information is handled per the Recordkeeping SOP.

Quality Assurance

  • The EMS Officer reviews a sample of ePCRs monthly.
  • Protocol deviations, adverse outcomes, and documentation issues are reviewed with the Medical Director.
  • Individual feedback is provided to members; systemic issues drive protocol or training changes.

Responsibilities

Medical Director

  • Authorize protocols and scope of practice.
  • Provide online medical direction availability.
  • Review QA cases and protocol performance.
  • Sign off on protocol updates.

EMS Officer

  • Oversee day-to-day EMS operations.
  • Maintain member credentials and training.
  • Run QA program.
  • Liaison with state EMS authority and transport agencies.

Members

  • Render care within your credentialed scope and within protocol.
  • Document every patient contact.
  • Consult online medical direction when indicated.
  • Report adverse outcomes promptly.

Training Requirements

  • Annual protocol review, signed acknowledgment.
  • Annual practical skills session on airway, BLS, and department-specific interventions.
  • CPR certification current at all times.
  • AEMT/Paramedic members meet state continuing education requirements.

References

  • State EMS Regulations[INSERT STATE] EMS scope-of-practice rules
  • NHTSA National EMS Scope of Practice ModelFederal framework for EMS scope
  • OSHA 1910.1030Bloodborne Pathogens
  • HIPAA45 CFR Part 164 — Privacy Rule

Adapt this template

Before this template becomes your department's policy, review the following items and adjust accordingly. Anything else that does not match your operation should be updated as well.

  • Attach the Medical Director's signed protocols as Appendix A.
  • Insert your state's EMS regulation citation.
  • Specify the ePCR system you use.
  • Cross-reference Bloodborne Pathogens, Patient Refusal, and Recordkeeping SOPs.
  • Medical dosage and specific patient-care protocols must be completed by the Medical Director, not copied from this template.

Adoption signature

Adopted by (Name, Rank)
Signature
Effective date
Next scheduled review

Before adoption checklist

  • ☐Replace [DEPARTMENT NAME] throughout the document.
  • ☐Complete every [BRACKETED] placeholder.
  • ☐Confirm the current edition of every cited standard.
  • ☐Check against your state statutes and state fire marshal rules.
  • ☐Route for chief review. Topics with significant exposure (use of force, medical scope) also go through qualified counsel.
  • ☐Confirm alignment with any mutual-aid agreements.
  • ☐Schedule a training plan for the new policy before effective date.
  • ☐Announce adoption in writing to all members. Archive the prior version.
  • ☐Set the next review date — annually at minimum.