Who must sign the written operating procedures and protocols used for Tier I transports?

• A. Signed by the EMS Medical Director only.
• B. Signed by the EMS Medical Director and approved for use by IDPH.
• C. Signed by the hospital administrator.
• D. Signed by the regional EMS coordinator.

Answer: (B)

Tier I transport protocols must carry both clinical guidance and regulatory authorization. The EMS Medical Director signs to confirm the procedures reflect current medical practice, provide appropriate clinical oversight, and authorize EMS personnel to implement them in the field. At the same time, the protocols must be approved for use by the state regulatory body (IDPH) to ensure they meet state standards and are legally compliant for statewide deployment. Other signatories, like a hospital administrator or regional EMS coordinator, do not provide the required combination of medical direction and regulatory approval, so they aren’t the correct signatories. This dual sign-off ensures both clinical quality and regulatory compliance of the operating procedures.