Emergency medical dispatch (EMD) compliance improves when you treat it as a measurement habit, not an annual event. Know which rules apply to your center, review a defined share of calls against your protocol, give dispatchers fast and specific feedback, and show your medical director the trend. This guide walks through each of those steps, with the state requirements that make them concrete.
If you lead a communications center, run an EMS agency that depends on one, or advise a municipality that funds one, the goal is the same: every caller gets the right questions, the right instructions and the right response, every time, and you can prove it.
TL;DR
- EMD compliance means using an approved priority reference system as written, under medical director oversight, with a continuous quality program that reviews calls and feeds results back to dispatchers.
- Review rates are set by state. Ohio and Pennsylvania both name a two percent minimum, so check your own state’s rule before you design a sampling plan.
- A good audit measures protocol adherence, medical instructions and documentation, and it looks for excellence as well as errors.
- Close gaps with timely feedback, targeted retraining and protocol updates, then track the same indicators every quarter.
- Sustained improvement is shown by trend data reported to your medical director and an annual evaluation of the program itself.
Table of Contents
- What EMD compliance actually means
- What your state requires
- A national benchmark to build on
- What a call review should measure
- Closing the gaps you find
- Showing that improvement lasts
- Our perspective
- Where we can help
- FAQ
- Sources
What EMD compliance actually means
Compliance is often described as a binder of policies. In practice it is a loop: a protocol, a way of checking that people follow it, and a way of acting on what the check finds.
Massachusetts gives one of the clearer written definitions. Its regulation requires EMD-certified dispatch agencies to run a continuous quality assurance, improvement and management program. That program must document case reviews, carry written approval from the EMD medical director, include ongoing random case review, and regularly provide performance results to dispatchers.
Missouri’s rule describes the same pieces. Its Quality Assurance and Improvement Program is approved by the EMD medical director and includes random case review, feedback of compliance levels to dispatchers, and continuing education.
So the working definition is simple. You have:
- An approved protocol system, used in its entirety.
- A medical director who owns the medical content and approves the quality program.
- Random, documented case review.
- Feedback and education that reach the people taking the calls.
If any one of those is missing, you are exposed, both in an audit and in a liability review. Our article on dispatch liability in 911 explains why the documentation side matters so much once a call is questioned. For the wider picture of regulatory duty in EMS, see our guide to what EMS compliance is.
What your state requires
There is no single national EMD statute. Requirements come from state EMS offices, state 911 boards, county medical authorities and, in many places, a mix of all three. That is why two neighboring centers can have different review rates and different reporting duties.
Here is what the published rules say in a handful of states:
| State | What the rule requires | Source |
|---|---|---|
| Massachusetts | Continuous QA, improvement and management program with documented case review, medical director approval, random review and dispatcher feedback | 560 CMR 5.06 |
| Maine | State-approved EMD priority reference system and a continuous quality improvement program measured through ongoing random case review | Maine EMS bulletin |
| New Mexico | Bureau-approved priority reference system used in its entirety, under medical director oversight, plus an oversight committee that builds the QA program | N.M. Admin. Code 7.27.10.20 |
| Ohio | Review of at least two percent of calls where EMD pre-arrival instructions were or should have been given, across all operational shifts | OAC 5507-1-20 |
| Pennsylvania | QA/QI program for consistent incident processing, with review of at least two percent of all emergency calls for service and results to the telecommunicator within 30 calendar days | PEMA 2026 requirements |
Two details deserve a second look.
First, the denominators differ. Ohio’s two percent applies to calls where EMD instructions were or should have been provided. Pennsylvania’s applies to all emergency calls for service. A center handling a high volume of non-medical calls will therefore review very different numbers under the two rules.
Second, the Ohio language includes calls where instructions should have been given. That means your sample cannot be built only from calls the dispatcher coded as medical. You need a way to find the misses.
Rules are amended, so confirm the current text with your state EMS office or 911 board before you commit a policy to paper.
A national benchmark to build on
When your state rule is thin, or you want a stronger program than the minimum, the APCO/NENA standard for quality programs is a sensible reference. ANS 1.107.2-2025, approved October 24, 2025, provides a framework for QA/QI programs in emergency communications centers. It includes updated call-taking and dispatch performance practices and enhanced protocols for high-acuity and catastrophic events.
It is also described as flexible and scalable, so a three-position rural center and a metropolitan center can each tailor a program to their size. That matters for budget conversations: you do not need a large staff to start, you need a defined process that you actually run.
What a call review should measure
A county EMD policy such as San Diego County’s EMD program policy shows the intent clearly. The QA/QI program monitors call-taking and medical instructions against the standards the EMD program defines, measures performance related to EMD delivery, and identifies both excellence and practices that do not conform to policy or procedure.
Turn that into a scoring sheet. A workable review covers:
- Protocol selection. Did the dispatcher choose the correct complaint-based protocol?
- Case entry. Were the key questions asked in order and as written, with the answers recorded accurately?
- Determinant accuracy. Did the final priority match the information the caller gave?
- Pre-arrival instructions. Were they offered when indicated, read as written and followed through to completion?
- Documentation. Is the record complete enough that someone who was not there can reconstruct the call?
- Time points. Where your policy sets targets for call processing, were they met, and if not, why?
Notice that the first line of the county policy includes excellence. A program that only reports errors teaches dispatchers to dread review. Pennsylvania’s definition also includes commendation alongside retraining and remediation, which is a good habit to copy.
Choosing the sample
Random is a legal word in many rules, so it needs to be genuinely random. Pulling the calls a supervisor happened to notice does not count.
If you want to go beyond the minimum, APCO’s ECC Service Capability Criteria Rating Scale identifies proportionate stratified random sampling as an advanced criterion. In plain terms, you pull calls in the same proportion as the call types you receive. The same document suggests that superior programs contact callers to learn how they perceived the service.
A practical sampling plan for a mid-size center:
- Set the minimum from your state rule.
- Make sure every shift and every dispatcher appears in the sample over a quarter.
- Add targeted reviews for high-acuity calls, such as cardiac arrest and choking, and for any call that drew a complaint.
- Add a check for calls that should have received pre-arrival instructions and did not.
If you want a lean starting point, our guide to six steps to a minimum viable dispatch QA program walks through how to stand one up without waiting for new staff or software.
Closing the gaps you find
Finding a gap is the easy half. The research and the rules point to four habits that turn findings into improvement.
Give feedback quickly. Pennsylvania requires that review results reach the telecommunicator within 30 calendar days of the event. Even where no deadline exists, feedback that arrives months later feels like discipline, not coaching.
Match the response to the pattern. One missed question is a coaching moment. The same miss across a shift suggests a training or protocol issue. Pennsylvania’s program definition names retraining and remediation as appropriate, which implies a judgment about the cause rather than a single standard penalty.
Tie it to continuing education. The county policy and the Missouri rule both connect QA findings to continuing education. Use your top three findings each quarter to pick your training topics.
Keep the medical director in the loop. A federal NHTSA report on lights and sirens use states that collaboration between the EMS medical director and agency leadership is essential to overseeing the quality of EMD and clinical care. If protocol content is the problem, only the medical director can approve the change. Our piece on EMS medical oversight covers how leaders build that relationship.
Documentation matters in the gaps too. The federal EMS Infectious Disease Playbook recommends documenting and relaying communicable disease information offered during caller interrogation, in line with established policies. A review form that checks whether such information was recorded and passed along is a small addition with real value for responder safety.
Showing that improvement lasts
One good quarter proves little. Regulators, boards and attorneys want to see a pattern.
Pennsylvania’s requirements point to a sensible routine: evaluate the QA/QI program annually, track key performance indicators, adjust processes to current standards and technology, and report QA outcomes regularly to the agency medical director. Data from case reviews then reveals long-term trends instead of anecdotes.
A simple scorecard might track, by quarter:
- Percentage of reviewed calls with full protocol compliance
- Percentage with correct determinant
- Percentage of eligible calls where pre-arrival instructions were delivered
- Median time from review to dispatcher feedback
- Number of corrective actions and how many were closed
For larger incidents, borrow from the wider EMS community. HHS/ASPR TRACIE’s EMS supplement to its medical operations toolkit suggests system-wide quality improvement methods, including post-incident hot washes and After-Action Reports, to evaluate coordination and clinical outcomes. Dispatch belongs in those debriefs.
Our perspective
After more than 32 years in public safety, we see the same pattern in struggling programs. They rarely lack a protocol. They lack a rhythm. Reviews happen when someone has time, feedback comes late, and the medical director sees data only when something goes wrong.
We would start smaller than most leaders expect. Pick a sample you can actually complete, score it consistently, and return results to dispatchers within weeks. A modest program run every month beats an ambitious one that stalls in the spring.
We also think compliance is a leadership question before it is a technical one. Dispatchers take the hardest calls in the system, often with no visible outcome. When review is framed as support, with recognition for good work alongside correction, people engage. When it is framed as fault-finding, they protect themselves. The numbers follow the culture.
Finally, treat dispatch as part of the system, not a separate box. Response time, deployment and billing all depend on what happens in the first minute of the call. That is why we look at the center together with the EMS system it serves.
— Mike
Where we can help
At The Public Safety Consulting Group, we work alongside communications centers, EMS agencies and municipalities to assess where their quality program stands, close gaps and build review routines their teams can sustain. That can include a dispatch and communication center evaluation, risk and compliance consulting, and professional education for supervisors and QA staff. See how we approach dispatch center consulting and EMS quality improvement, or start a conversation about our operational risk reduction services.
The PSCG logo above links to our full service list at thepscgroup.net. Reach out through the site to discuss your center.
FAQ
How many calls do we have to review for EMD compliance?
It depends on your state. Ohio sets a minimum of two percent of calls where EMD pre-arrival instructions were or should have been provided, and Pennsylvania requires review of at least two percent of all emergency calls for service. Other states, such as Massachusetts and Maine, require ongoing random review without the excerpts we reviewed naming a percentage. Confirm the current figure with your state EMS office or 911 board.
Who has to approve our EMD quality program?
In the states we reviewed, the EMD medical director. Massachusetts requires written approval of the program by the medical director, and Missouri defines its program as medical director approved. New Mexico adds an oversight committee that helps develop protocols and the QA program.
What should we do first if we have no formal QA program?
Confirm your state’s requirements, name your medical director’s role in writing, and start a small random review with a simple scoring form. Return results to dispatchers promptly and report totals to the medical director each quarter. You can refine sampling and scoring once the routine is running.
Is there a national standard we can follow?
Yes. APCO and NENA published ANS 1.107.2-2025, a framework for QA/QI programs in emergency communications centers, which is designed to scale to agencies of different sizes. It does not replace your state rules, so use it to strengthen your program above the legal minimum.
How do we prove to auditors that we are improving?
Keep documented case reviews, feedback records and training records, and trend them over time. An annual evaluation of the program, with key performance indicators reported to the medical director, shows the direction of travel and gives auditors evidence in one place.
Sources
- 560 CMR 5.06, Quality Assurance of Emergency Medical Dispatch
- Maine EMS revised EMDPRS bulletin
- N.M. Admin. Code 7.27.10.20
- Ohio Administrative Code 5507-1-20
- Missouri 11 CSR 90-4.150
- PEMA 2026 training, certification and QA/QI requirements
- APCO announcement of the QA/QI program standard
- APCO ECC Service Capability Criteria Rating Scale
- San Diego County EMD programs policy
- NHTSA Lights and Sirens Use by EMS
- EMS Infectious Disease Playbook
- EMS Supplement for the Medical Operations Coordination Cells Tool Kit
