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, which may be obtained by demonstrating completion of advanced Red Cross training or its equivalent.  
 
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 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 he or she is trained.

The types of entities that may use an ambulance driver with no medical or first aid training are expanded to include an association made up entirely of two or more municipalities in a rural area with insufficient personnel.  Such an association may utilize a driver with no medical or first aid training under the same conditions as a volunteer or municipal corporation.