The EMS Act of 1973, and its subsequent grant funding, changed the way physicians could communicate with field EMS staff through voice and biotelemetry capabilities, and as a result, extend greater guidance and capability to them as they provided increasingly sophisticated interventions. This EMS communications revolution then essentially stalled until the next millennium with the onset of work toward the creation of the nationwide public safety broadband network FirstNet. Signed into federal law in 2012, and now available in much of the country, it promises a second revolution in EMS communications. It will enable improved situational awareness, optimize the common operating picture among all responsible for an EMS patient, allow parallel processing of information during an emergency, and enable use of a broader array of medical technology, including telehealth platforms and remote real-time imaging and other diagnostics for emergency and community paramedicine purposes. This chapter focuses on current-day capabilities, future capabilities, and the path and resources to move from one to the next.