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Colorado Department of Public Health and Environment | Emergency Medical and Trauma Services

Medical Direction




All EMS Providers in Colorado are required by rules promulgated by the Executive Director of the Colorado Department of Public Health and Environment (CDPHE) and the state Board of Health to have a Medical Director if they are providing direct patient care as an EMS Provider in any setting. EMS Providers in Colorado may function in pre-hospital and in facility settings with appropriate medical supervision.

EMS Providers offer patient care through delegated medical acts, defined by CDPHE. The department regulates this practice through 6 CCR 1015-3 Chapter Two, which defines the roles and responsibilities of a Medical Director and the scope of practice for each of level of EMS Provider in the State of Colorado.


Physicians supervising EMS Providers must be registered with the Colorado Department of Public Health and Environment.  Registration is required as defined in Rules Pertaining to EMS Practice and Medical Director Oversight, 6 CCR 1015-3, Chapter Two, Section 4.


Medical Director Roles and Responsibilities



Medical Director Registration and Affidavits



Both forms are required for every Medical Director in Colorado and must be updated once per year, or if there are any substantial changes in status or contact information.


Medical Directors may request waivers from the scope of practice set forth in the Rules Pertaining to EMS Practice and Medical Director Oversight.  Typically, waiver requests are for exceeding the scope of practice of an EMS Provider as defined in the rules.  Waivers are submitted to the Department’s advisory council, the Emergency Medical Practice and Advisory Council (EMPAC) at its next quarterly meeting for consideration and recommendation, and then submitted to the Department for approval.  The EMPAC advises the Department as to its recommendation on approving, denying, or imposing special conditions on the waiver. The Department makes the final decision actions regarding waiver requests.

Waiver Process


Waiver requests must be submitted on the following form.  Please refer to the instructions for completing this request.



Medical Directior registration forms must be submitted prior to or with any waiver request forms.


Completed waiver requests must be submitted in electronic format by the established deadline in order to be considered by the next EMPAC meeting.


If there are any questions, comments or concerns about waiver request forms, please contact Joni Briola at 303-692-2989 or email her at joni.briola@state.co.us.


Frequently Asked Questions


Do I need to submit a waiver for each procedure or drug used in RSI for my Paramedics?


No. Submit one waiver for the entire procedure. However, be sure to include a detailed RSI protocol including all medications.


Do I have to submit a copy of the quality control plan and protocol for the procedure or medication being applied for, or for the entire agency being supervised?


The entire agency being supervised. The purpose of this requirement is to have the supervising medical director demonstrate his or her compliance with the current rules, prior to a waiver being granted. The EMPAC and the Department may not provide a waiver to a physician who cannot demonstrate adequate supervision of the prehospital personnel as required in the rules.


Can a waiver request be submitted for any level of EMS Provider?




Is the waiver process a one-time event?


No. The EMPAC meets every three months. Waivers will be processed as quickly as possible to assure review by the EMPAC and the Department. Submission deadlines for waivers are posted on this page and on the "Waiver Request Form Instructions."

In order to assure timely delivery of your completed RSI Report Form, please make sure you are using Version 2013.1 available here. All previous versions of the RSI Report Forms should be discarded.



After completing this form, do not hit submit. Instead, save the document for your files and then send an attachment copy with a return receipt to cdphe.emtcert@state.co.us.


If you need any assistance, please contact Joni Briola at 303-692-2989 or joni.briola@state.co.us.