Emergency Medical Services Personnel.
Emergency medical services (EMS) personnel are certified by the Department of Health (DOH).  There are four primary categories of EMS personnel:  paramedics; emergency medical technicians (EMTs); advanced EMTs; and emergency medical responders (also known as first responders).  Emergency medical services personnel may only provide services within the scope of care established in the curriculum of the person's level of certification or any specialized training.
 
Emergency Medical Technicians.
Emergency medical technicians are licensed by the DOH upon completion of approved training and association with an EMS agency, a law enforcement agency, a business with an organized safety team, or as instructors or coordinators with approved EMS training programs.  An EMT is defined as a person who is authorized by the Secretary of Health to render emergency medical care or under the responsible supervision and direction of an approved medical director to participate in a community assistance referral and education services (CARES) program. 
 
Community Assistance Referral and Education Services Program.
Fire departments may establish CARES programs, which provide community outreach and assistance to residents to improve population health and promote injury and illness prevention.  A CARES program identifies members of the community who use the 911 system or emergency departments for nonemergency or nonurgent assistant calls.  A CARES program connects residents with health care professionals, low-cost medication programs, and social services.
 
Ambulance Service. 
Generally, an ambulance service or aid service must be licensed by the DOH in order to operate in Washington.  However, ambulance services and aid services meeting the following exceptions do not have to be licensed:

• services operated by the United States government;
• ambulance services providing service in other states when bringing patients into this state;
• owners of businesses where ambulance or aid vehicles are used exclusively on company property; and
• operators of vehicles pressed into service for transportation of patients in emergencies when licensed ambulances are not available or cannot meet the overwhelming demand.

"Emergency services supervisory organization" (ESSO) is defined as an entity that is authorized by the Secretary of Health to use first responders to provide medical evaluation or initial treatment, or both, to sick or injured people, while in the course of duties with the organization for on-site medical care prior to any necessary activation of emergency medical services.  Emergency services supervisory organizations include law enforcement agencies, disaster management organizations, search and rescue operations, diversion centers, and businesses with organized industrial safety teams.
 
The definition of "emergency medical technician" is modified to include participation in an ESSO.
 
An ESSO is included in the licensure exception for ambulance services or aid services operating in Washington.  An ESSO that employs certified emergency medical services personnel must ensure that such personnel work under the medical oversight and protocols of a medical program director and within their scope of practice, are able to meet certification training requirements, and are provided the necessary medical equipment to provide care at their level of certification.