Although a growing number of EMS systems uses a centralized system for online medical direction with EMS physicians, the majority of online direction is still given by destination hospitals.  EM physicians are asked to provide this online support, often with limited knowledge of local protocols and with a varied background and experience with EMS medical direction. This talk will cover some of the fundamentals involving prehospital scope of practice, clinical and legal pitfalls, as well as some general do’s and don'ts when providing online medical direction.  Whether fresh out of residency or several years in, participants will come away better prepared to provide effective and meaningful online medical direction for our prehospital providers and inbound patients.