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referring facility This online “medical control” or “medical command” model enables clinicians to direct care after assessments are transmitted to them Typically, after the transport team makes contact with the patient and completes an assessment, the team contacts the medical command physician to review the management plan and prepare for the transport back to the accepting institution At that time, additional clinical information may be reviewed between the team and the medical command physician Additionally, electronically transmitted data, such as ECGs, and transferred images, including plain radiographs and CTs may be reviewed and discussed real time Online medical command may be particularly important in tertiary and quaternary care patient populations, where patients may require unique interventions (e.g., patients with complex congenital heart disease, or metabolic disorders) Potential drawbacks include additional reporting time spent at the referring institution (can be mitigated by on communications en route), time demands on the receiving medical staff directing care, potential decision-making inconsistency within variable medical control staff, and technical problems with the communications equipment Accomplished efficiently and appropriately, however, direct online communications (in conjunction with off-line training, guidelines, and protocols) can help support the primary goals of interfacility transport, including stabilization, improvement, and seamless transition to next stage of care via improved awareness (by the most experienced clinicians) of current state, response (or not) to interventions, and preparation of needs at next stage/location of care Indirect Medical Control Indirect medical control includes the medical management of a transport system through the use of established care guidelines in place before the call for help arrives The medical director for a service, who is ultimately responsible for every aspect of patient care, authorizes the personnel to utilize standard protocols for the care of patients in order to save time and reduce the variability of orders This has the benefit of saving time in critical situations, as well as reducing interoperator variability in patient assessment and medical decision making In most systems, the option remains for personnel to speak with a clinician for direct medical control, if they have questions, or if the protocol does not clearly apply This may also be necessary for certain procedures or medications considered to be higher risk to the patient In EMS, the protocols may be established by the regional or state EMS authority, while in interfacility transport, these are determined by the transporting service, often in conjunction with physician content experts Medical control physicians should be literate with transport guidelines, protocols, personnel capabilities, medications, and equipment to be