The Operational Medical Directors (OMD) committee promotes optimal and consistent prehospital patient care throughout the region. This is accomplished by establishment and maintenance of regional patient care protocols, training guidelines, quality improvement programs and other policies, plans and practices utilized by or between EMS agencies and hospitals when the committee determines that regional approaches will help ensure optimal and consistent patient care. Members try to address relevant EMS physician responsibilities delineated in the Virginia Regulations Governing Emergency Medical Services using the combined strength of the committee, EMS agency leadership and council staff. Decisions are made by majority vote but compromise and consensus are expected methods used to arrive at decisions which neither oppress the minority nor sacrifice quality patient care.