TABLE 134.1 NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION, U.S DEPARTMENT OF TRANSPORTATION, NATIONAL EMERGENCY MEDICAL SERVICES EDUCATION STANDARDS: MINIMUM PSYCHOMOTOR SKILLS Medical direction of field clinical practice occurs in two forms: indirect, or offline , and direct, or online Offline medical direction typically occurs through established protocols, or a set of standing orders for a specific condition or presenting symptom ( Fig 134.2 ) Offline protocols guide rescuers’ actions in the field, standardize patient care, and can facilitate rapid and effective treatment They can also serve as a gauge to measure adherence to guidelines, furthering the quality of prehospital care Medical directors are responsible for every action outlined in offline protocols, and for every patient outcome resulting from proper adherence to these protocols An example of a protocol for allergic reaction/anaphylaxis is provided in Figure 134.2 Note that there are a