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None of the places I've ever worked have I actually met the Medical Director. The BLS company I worked for needed him because we occasionally needed to order certain medical supplies and drugs for the CCT program. I don't think there was anything (except maybe for medical grade oxygen) that required his approval for the BLS side. One of the companies I worked for had a Medical Director that provided us a protocol that would allow us to transport patients that had potassium up to 20 mEq/L in a running IV bag. At the time, no other local company was allowed to do that.