In the mid-1970s, as EMS services rapidly evolved throughout the United States, the EMS dispatch process was identified as the weakest link in the chain of survival. In response to this identified deficiency, the use of emergency medical dispatch (EMD) programs expanded and the programs evolved. Public safety telecommunicators at public safety answering points represent the first opportunity for the prehospital care system to meaningfully interact with those requesting service. EMD programs assist telecommunicators in caller interrogation, call prioritization, and the provision of medically directed prearrival instructions. Prearrival instructions, including care of the choking victim, CPR, and tourniquet application, deliver potentially life-/limb-saving instructions over the phone. EMD programs can decrease inappropriate EMS lights and sirens responses, thereby lowering the chance of accidents involving the responding vehicles and others using the roadways. A robust quality improvement process with physician oversight is an essential component of an EMD program.