In the United States, pre-hospital immediate care generally is practiced by paramedical personnel. These individuals are either firemen or civilians who have specific training in the assessment and management of acutely ill or injured patients outside the hospital. In most systems, once the initial evaluation of the patient is made, radio or telephone communication occurs between the pre-hospital team and a hospital-based physician or specially trained nurse. These hospital-based personnel are the responsible medical authority for the care delivered by the paramedical staff. Based on data reported by the field unit, the hospital team gives medical direction and specific therapeutic orders to the paramedics. This style of immediate care seems to work well for us in America although it is different in many ways from immediate care schemes elsewhere in the world, in that the physician or nurse is rarely on the scene, able to assess firsthand and provide medical care to the victims.