The number of paramedic education programs participating in the national accreditation process has nearly tripled in the past several years. Although accreditation standards describe program director roles and responsibilities, nothing has been formally studied regarding their leadership practices. The purpose of this study was to explore leadership practices of program directors in nationally accredited paramedic education programs. The qualitative study explored the perceptions and observations of twelve uniquely qualified experts to determine the leadership practices of nationally accredited paramedic education program directors. Elite individuals were selected to participate based on their professional knowledge and experience in EMS education. A series of in-depth, semi-structured interviews were conducted to explore the context, challenges, and best practices of program director leadership. Participants ranked positive leadership and leadership skills approaches (human, technical, and conceptual), as important to the role of program director. Findings revealed context and best practice themes of a need for understanding and a culture of quality, while challenge themes were an EMS identity crisis and generational dissonance. Conclusions revealed a program director's leadership is responsible for 75% of a program's success, yet no formalized leadership curriculum or training exists. Subsequently, there is both a need for the development of a program director leadership curriculum as well as program director leadership training. This study adds to the research literature and identifies leadership practices that may improve paramedic education programs. Further study in the field of paramedic education program director leadership practice is recommended. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]