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Flight paramedics practice under medical direction and approved protocols. When requested to perform an intervention outside those protocols, the appropriate action is to consult online medical control or your medical director for authorization. This maintains legal and professional accountability, ensures patient safety, and preserves the integrity of your scope of practice. Declining outright without seeking guidance may delay necessary care; accepting a non-authorized order exposes both crew and agency to legal risk and undermines clinical governance. “Consensus” with a partner does not confer authority to deviate. Clear communication, situational awareness, and documentation of the request, assessment, and the guidance received are key components of professional conduct. In air medical transport, where resources are limited and risk is elevated, adherence to medical oversight structures safeguards patients and crews, aligns with accrediting expectations, and ensures continuity of care between sending and receiving facilities across jurisdictional boundaries.