The RPPEO's Base Hospital Physicians play a vital role in the delivery of prehospital care in the form of online medical direction.  Though paramedics are able to practice with relative independence, there are occasions where they need to consult a Base Hospital Physician before they can proceed with an intervention.  This usually occurs when a paramedic exhausts his or her offline medical directives (standing orders).  However, there are a small number of "supercontrolled" acts such as trasncutaneous pacing, synchronized cardioversion, and needle thoractostomy that require Base Hospital Physician authorization.