Open research on how American EMS actually works.

There is a broad national foundation for EMS education and certification through the NREMT, but there is no standard for how EMS is delivered in the field. States establish their own regulations and scopes of practice, while individual EMS agencies operate under their own protocols and medical direction. As a result, protocols can vary substantially from one agency to another, even between neighboring communities. There is meaningful overlap, but there can also be significant differences in what clinicians are permitted or expected to do, depending on where they work.

The fragmentation extends beyond clinical practice. There is no single model for who responds to a 911 medical call. Depending on the community, EMS may be provided by a municipal or county service, fire department, hospital system, private company, nonprofit organization, volunteer service, or some combination of these. That means the agency responding, the resources available, the equipment carried, and the clinical care provided can all change depending on where a patient lives.

ProtoQuiz is building a way to make this fragmented system easier to understand.

We organize public agencies' protocols and other public information into a free reference that is easy to search and compare. We also map how 911 EMS is organized and who provides emergency ambulance services in communities across the country.

The goal is to build an accurate picture of the state of EMS in the United States: where systems are standardized, where they differ, how clinical practice varies, and how EMS is organized from community to community.

That information can provide a foundation for identifying opportunities for greater standardization. Greater consistency in EMS education, clinical practice, and system design could help improve the quality and reliability of care while also supporting a stronger, more sustainable profession.

EMS is also unusual among emergency services in the United States because it has historically not been recognized as an essential public service. The CDC states that, unlike police and fire services, EMS is rarely classified and funded as an essential service.

EMS is primarily organized and funded at the local level, contributing to substantial variation between communities.

That is beginning to change. As of July 2026, the National Conference of State Legislatures reported that at least 19 states and the District of Columbia had enacted legislation explicitly using the term “essential” to define EMS in statute. The laws differ considerably in what they require and how EMS is funded.

ProtoQuiz can help make that transition visible: not just what EMS is supposed to be nationally, but what EMS actually looks like across the country.

By improving our understanding of EMS and identifying where greater consistency is possible, we can help improve the quality of care and strengthen the profession itself. Better quality EMS means better pay for those who enter this profession, better quality care for patients, and a more efficient, sustainable future for EMS.