understand it. In these cases, the 'emergency physician' is most commonly an anesthetist, or sometimes an internist or a surgeon. In most areas of Europe, there appears to be little interest in developing emergency medicine as a specialty, although recent developments in Italy suggest that this attitude may be changing. In this model, long 'at scene' times are common. The physician attempts to provide some or all of the intervention that is necessary in place, with transportation to hospital occurring only for those with a legitimate need of a hospital bed, and urgent transportation to hospital being extremely rare. Many patients will never be transported to hospital. In the French version of this model, even the triage of incoming requests for service is physician-led, with a physician, assisted by others, interviewing the caller and determining what type of response resource, if any, will be sent. The German version of this model uses 'conventional' dispatch processes, with the physician being sent to calls as requested by the EMS dispatcher. The Franco-German model operates in most places in Europe and Russia, but not in the United Kingdom. In this model, the medical director is typically more of a leader of physicians, and an advisor on the training of, and quality control for, subordinate staff. In Germany, the term Ärztlicher Leiter Rettungsdienst is used. This physician's role is to oversee EMS personnel in a defined area, typically a bigger city or county, and it corresponds to the position of medical director in North America. Anglo-American The Anglo-American model of care is largely led by the medical director. This model has evolved significantly since its origins in the late 1960s. The development of this role, the professionalization of emergency medical services, the profession of paramedic, and the medical specialty of emergency medicine, have all developed in a symbiotic relationship since the early years. Prior to 1979, there was no formal specialty training certification for emergency medicine. Prior to 1970, there was no concerted effort to formally train physicians in its practice in the U.S. In the U.K., formal consultancies in Emergency Medicine had existed for at least two decades before that time. In the Anglo-American model of care, the physician remains the leader of the care team, but paramedics function much more independently than in the Franco-German model. This has not always been the case. In the earliest days of paramedicine, paramedics were required