different set of actions for basic, intermediate, and paramedic providers, and separate sections for adult and pediatric patients This protocol also clearly highlights when to contact online medical control for additional guidance This enables the providers in the field to have a pre-established, physician-evaluated course of action for most patient care situations Online medical direction requires real-time communication between an EMS provider and a physician or delegated surrogate (physician assistant, nurse practitioner, registered nurse) EMS systems should have protocols for when online medical direction is required Situations may include when additional doses of medication are required, when patients are not responding to the steps outlined in offline protocols, or when patients or parents are refusing EMS transport Hospitals that provide online medical directions are commonly referred to as “base” hospitals In some cases, a physician may serve in the role of a field responder This may be a physician who is serving as a service’s medical director, or a specialized provider or an EMS trainee/fellow in a larger system Although the field is not the typical practice environment for physicians in the United States (it is much more common in other countries), there are distinct advantages to having a physician responder in certain situations The first is that they may provide direct medical control to the intermediate and paramedic providers on a scene Second, they may bring the ability to perform advanced interventions for patients with specialized needs, such as a field amputation of an entrapped extremity Third, they may play an important role in the management of complex incidents, such as a mass casualty incident EMS fellowship training programs have been present since the early 1990s The American Board of Medical Specialties approved EMS medicine as a recognized subspecialty of emergency medicine in 2010, and fellowships became accredited thereafter The first board examination for recognition of EMS-specialized physicians, administered by the American Board of Emergency Medicine, was offered in 2013 EMS fellowships are open to physicians trained in multiple fields, including pediatrics A list of available EMS fellowships can be found at https://naemsp.org/career-development/fellowship-programs/ EMERGENCY MEDICAL DISPATCHERS AND DISPATCH PRINCIPLES When an EMS system is activated, this places into motion a chain of events to efficiently deliver the most appropriate personnel to the patient for safe transport to the most appropriate receiving hospital There are many steps to achieving this ideal goal It is typically the parent, caregiver, or bystander who recognizes that a child requires emergency medical help, and contacts EMS through the 9-1-1 emergency number Ninety-nine percent of the U.S population has 9-1-1 services, with many having enhanced 9-1-1 (E-911) services that provide the dispatcher with the address of the caller Using a cell phone to contact 9-1-1 is increasingly common, and improving technologies (wireless E-911 systems) can allow for the localization of the caller using the global positioning satellite (GPS) technology built into many wireless phones