The process begins with a serious self-assessment of an EMS agency, comparing its operations to the accreditation standards. The agency then purchases an application package that guides them through the process of developing supporting documentation. The documentation is submitted to CAAS for an off-site review to determine the level of compliance of the paperwork submitted. An on-site review by a team of EMS experts, including a board certified emergency physician, spends at least two days at the agency to review all operational aspects of the service. Agencies report that this experience alone is worth far more than the costs of accreditation. The site review team then generates a report to CAAS. When all standards are successfully achieved, the agency’s report and follow-up material goes before the Panel of Commissioners, an independent, impartial group of individuals from EMS law, business, and healthcare, for accreditation determination.