The care provided by emergency medical services (EMS) varies widely in the United States. The Institute of Medicine report, “EMS at the Crossroads,” notes that an area of improvement for EMS is the need for more uniform quality care and the need to develop measures for EMS quality. A major area of EMS quality that is difficult to measure is the prehospital protocols that EMS personnel follow while taking care of patients. These protocols vary widely between jurisdictions. In the state of California, EMS care is divided into 33 separate local EMS agencies (LEMSAs). These government agencies are a countywide or region-wide system of first responders and ambulance transporters that operate under one set of medical control policies.