Editing Emergency medical technician (section)

=== Medical direction ===
In the United States, an EMT's actions in the field are governed by state regulations, local regulations, and by the policies of their EMS organization. The development of these policies are guided by a [[physician]] [[medical director]], often with the advice of a medical advisory committee composed of paramedics and other health professionals.<ref>{{cite web |url=http://www.ochealthinfo.com/medical/ems/ |title=About us |access-date=18 September 2011|publisher=Orange County EMS Agency |url-status=dead |archive-url=https://web.archive.org/web/20110903235813/http://ochealthinfo.com/medical/ems/ |archive-date=3 September 2011}}</ref>

In California, for example, each county's local emergency medical service agency (LEMSA) issues a list of standard operating procedures or protocols, under the supervision of the [[California Emergency Medical Services Authority]]. These procedures often vary from county to county based on local needs, levels of training and clinical experiences.<ref>{{cite web|url=http://www.emsa.ca.gov/aboutemsa/mandate.asp |title=EMS Authority's Mandates Summary |access-date=11 March 2008 |publisher=California Emergency Medical Services Authority |url-status=dead |archive-url=https://web.archive.org/web/20070711160118/http://www.emsa.ca.gov/aboutemsa/mandate.asp |archive-date=11 July 2007 }}</ref> New York State has similar procedures, whereas a regional medical-advisory council (REMAC) determines protocols for one or more counties in a geographical section of the state.<ref>{{cite web |url= http://www.health.state.ny.us/nysdoh/ems/about.htm|title=What is the Bureau of Emergency Medical Services |access-date=11 March 2008 |publisher= New York State Department of Health }}</ref>

Treatments and procedures administered by paramedics fall under one of two categories, off-line medical orders (standing orders) and on-line medical orders. On-line medical orders refers to procedures that must be explicitly approved by a base hospital physician or registered nurse through voice communication (generally by phone or radio) and are generally rare or high risk procedures (e.g. [[vasopressor]] initiation).<ref>{{cite web |url=http://www.ochealthinfo.com/medical/ems/guidelines/ |title=Treatment Guidelines |access-date=11 March 2008 |publisher=Orange County EMS Agency |url-status=dead |archive-url=https://web.archive.org/web/20081012215549/http://www.ochealthinfo.com/medical/ems/guidelines/ |archive-date=12 October 2008 }}</ref> In addition, when multiple levels can perform the same procedure (e.g. AEMT-critical care and paramedics in New York), a procedure can be both an on-line and a standing order depending on the level of the provider.<ref>{{cite web |url=http://www.aarems.org/regionalALS.php|title=AAREMS 2007 Regional ALS Treatment Protocols |access-date=18 September 2011 |publisher= Adirondack - Appalachian Regional Emergency Medical Services Council}}</ref> Since no set of protocols can cover every patient situation, many systems work with protocols as guidelines.<ref>{{cite web|url=http://www.rivcoems.org/downloads/downloads_documents/Protocol102904/7000.pdf |title=Patient Care Policy (ALS) |access-date=11 March 2008|publisher=Riverside County Emergency Medical Services Agency |page=1 |url-status=dead |archive-url=https://web.archive.org/web/20080724033742/http://www.rivcoems.org/downloads/downloads_documents/Protocol102904/7000.pdf |archive-date=24 July 2008}}</ref> Systems also have policies in place to handle medical direction when communication failures happen or in disaster situations.<ref>{{cite web |url=http://www.ochealthinfo.com/docs/medical/ems/P&P/330.15.pdf |title=Advanced Life Support Treatment In Communication Failure or Without Base Hospital contact |access-date=11 March 2008 |publisher=Orange County Emergency Medical Services Agency |url-status=dead |archive-url=https://web.archive.org/web/20080817013116/http://www.ochealthinfo.com/docs/medical/ems/P%26P/330.15.pdf |archive-date=17 August 2008}}</ref> The NHTSA curriculum is the foundation Standard of Care for EMS providers in the US.