How do states implement requirements for vehicle standards?

Every state has a lead agency responsible for Emergency Medical Services. In most, but not all, states, the lead EMS agency has the authority to establish the requirements for personnel, service, and vehicle licensing.

In some states licensing requirements are in the law, which can only be changed by legislative action. In other states, the requirements may be established through regulations and rules promulgated by the EMS agency or a governing board. While the latter may be more responsive in terms of contemporary changes, legislative review may also be required before adoption.