There are two different governing entities over EMS in Pennsylvania. On the state level, the Department Of Health, Division of EMS, develops state-wide guidelines such as which drugs may be used and what equipment is required on an ambulance.
Some regions consist of several counties.
Other parts of the state, like southeastern PA, have regions consisting of only 1 county in size due to the higher population and number of providers within that geographical region. Act 45 is a set of guideline governing EMS that was adopted into law by the State government. Act 45 outlines such policies as response times, required equipment on ambulances, and skills allowed by certain levels of provider certification. Providers were originally only given the option to re-certify by challenging the exam or taking refresher courses every three years. Act 82 ensures that certification as a provider is good for life as long as certain continuing educational requirements are met.