In the fall of 1996, the National Highway Traffic Safety Administration and the Maternal and Child Health Bureau announced a cooperative agreement with the American College of Emergency Physicians and the National Association of Emergency Medical Services (EMS) Physicians to develop a guide for States' use when implementing medical direction training programs and standards. Developers of the program curriculum considered: roles and responsibilities of medical directors, including injury prevention; planning and protocols; on-line medical direction and consultation; and audit and evaluation of patient care. In addition, the curriculum addresses the issues of non-emergency physicians providing medical direction and medical direction for all levels of EMS providers. An Expert Writing Team provided broad input and multiple perspectives, including: rural/urban/suburban, private vs. municipal services, local vs. State, and adult and pediatrics. Tables, figure, resources