quick EMT question ?

EMTs at all levels function under the license of a medical director. ALL of the protocols and policies have to be approved by the medical director and the responsibility for ensuring those protocols are appropriate falls on that doc's shoulders. 

Offline medical direction are those protocols and policies. They are still medical direction: The medical director reviewed and signed off on those. They are valid as standing orders. The medical responsibility for them falls on that doc (so long as the EMT does not deviate from those protocols).

Anything that needs to be done that falls outside the scope of those standing orders requires speaking with a doc. That's online medical direction. 

In both cases the EMT is approved to perform tasks at the direction of a licensed physician. The difference is only in whether they must speak to that physician directly before performing the task.