(PALS) courses, but many will still admit to being uncomfortable with younger patients due to the lower volume of and limited exposure to pediatric patients Medical Oversight of EMS Due to the sophisticated nature of emergency medical care delivered by EMS personnel, EMS systems require physician oversight EMS medical directors exist at local, regional, and state levels Their primary role is “to promote continuous quality improvement and patient-centered delivery of medical care by the EMS service,” and their responsibilities are numerous ( Table 134.2 ) In exchange for performing these responsibilities, EMS systems typically provide the medical director with compensation for services and liability insurance for the actions performed in this role