EMS medical direction is a multifaceted clinical practice of medicine by physicians who ultimately ensure the quality of prehospital health care. EMS medicine is a subspeciality recognized by the American Board of Medical Specialties. EMS medical directors affect patient care directly (direct medical oversight) through communication with on-scene clinicians personally or through hospital base station contact. Much of EMS care occurs through the protocols and standing orders of the medical director (indirect medical oversight). EMS physicians also provide direct care in the field. The EMS medical director authorizes EMS clinicians to render care through a local credentialing process that is the summation of the clinicians’ demonstration of proper licensure, education, training, and ongoing performance. The EMS medical director can revoke this authorization if these standards are not met. The EMS medical director should be engaged in all aspects of an EMS system, including emergency medical dispatch.