Ambulances must operate with sufficient personnel for adequate patient care.  At least one of the personnel must be an emergency medical technician, who is responsible for ambulance operation and the care of patients.

Generally, the driver of the ambulance must have at least a certificate of advanced first aid qualification.  The driver is not required to have a certificate in two circumstances.  First, the driver does not have to have a certificate if there are at least two certified emergency medical technicians in attendance of the patient.  Second, with approval by the Department of Health, an ambulance service established by a volunteer or municipal corporation, or by an association made up entirely of two or more municipalities, in a rural area with insufficient personnel may use a driver without any medical or first aid training if the driver:

• is at least 18 years old;
• passes a background check;
• possesses a valid driver's license with no restrictions;
• is accompanied by a nondriving emergency medical technician while operating the ambulance during a response or transport of a patient; and
• only provides medical care to patients to the level that they are trained.

The types of ambulance services in rural areas that may use a driver without any medical or first aid training, if certain criteria are met, are limited to ambulance services that do not provide advanced life support.