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Emergency medical services (EMS) in the United States are primarily provided by nonphysician clinicians with varying levels of certification, scope of practice, and education. 1 The National Registry of Emergency Medical Technicians currently identifies 4 main levels of certification in increasing education and scope of practice: emergency medical responder, emergency medical technician, advanced emergency medical technician, and paramedic. 2 Scope of practice and treatment protocols are also determined at different levels of oversight whether at the state, regional, or local/agency level. Jurisdictions vary widely in their amount of staffing, dispatch protocols, and resources. Some states formally or informally involve registered nurses, physician a Department of Emergency Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street Suite 6-100, Baltimore, MD 21287, USA; b Department …