Risks their financial security.
NHTSA makes recommendations; local EMSA's adopt, adapt and enforce them; counties and services districts may add or subtract as long as they don't break the EMSA standards; private companies will have their internal protocols which have to be IAW the above but may also include business-related practices.
Private companies may conceal their protocols due to fear of being "gamed" by service abusers, or because they are embarrassed about some of their dirty laundry. If they are secret from the line workers as well, then get out, you are being set up.