How do companies get permission to use emergency lights and sirens on the streets

Lets say for instance in new york city NYU Langone health
They have ambulances that they take through the street responding to 911 calls with lights and sirens, but how come do they have permission to use emergency lights and sirens on the streets, it just confuses me

I’m assuming that in most cases like government-run emergency services they have full authority to use their lights & siren anytime there’s an explicitly life-threatening call that requires immediate response: who knows about incidents that don’t fit this bill though.

i mean that does make sense

It’s the same way with tow companies. I’ve seen big heavy wreckers responding full lights and sirens before. If the situation calls for that code they are allowed to do it.

If of course it’s a state that allows the use of lights & a siren on tow trucks to begin with, & even then only if explicitly ordered to by first responders from what I’ve read.

I can clear this up.

The state government issues them permission for using emergency equipment.

It’s the same for things like school district police, and other private entities.

Most EMS services are now provided by fire departments.

The state themselves may regulate when usage can be permitted, and the companies themselves may. For example, in my city, we have fire based EMS. However, the city has a contract with well known AMR, AMR is not allowed to run code unless responding to an incident which requires immediate BLS transport, or if responding to a call in the county (where they are the primary EMS provider.)