Abstract: Spanning 1,727,000 km2 and with a population of nearly 5 million people, 40% of whom live outside major cities, Queensland continues to pursue health equality and equity. Sometimes, very appropriately, an option for improvement can come from the people most affected. To improve or idealise patient care, clinicians in rural and smaller centres often seek collegial and expert clinical advice and support from larger site clinicians by telephone. Queensland is fortunate having invested in integrated telehealth technologies throughout the state, including equipment primarily located in rural and remote facility resuscitation areas. Rural communities and clinicians asked whether this technology could be used for such ad hoc consultation’s to ‘add a visual’—it happens for an outpatient endocrinology clinic 800kms away, then why not when the local doctor calls the base hospital for advice? Why wasn’t it occurring and how do we reduce barriers and increase utilisation? Whether it could be done in a way that enhanced patient safety through simplified requesting and connecting, minimised work impact on isolated clinicians, and importantly, aligning with individual hospital processes within different health services. From this, the Telehealth Emergency Management Support Unit (TEMSU) was born. This presentation offers an overview of how TEMSU evolved into a 24/7 service, supporting over 165 sites in 13 Hospital and Health services, and continues to expand. Examining generalist/acute presentation models of care will lead to appreciating the flexibility of applying TEMSU models to a vast variety of clinician-to-clinician interactions including: paediatrics, nurse-to-nurse, midwifery, mental health, wound care, deaf interpreting, multi-disciplinary team handovers, aged care, etc. TEMSU contributes to, and complements, existing local networks of clinicians who, while separated by distance, are working together to achieve better patient care. There will be opportunity to touch on the experience of growing a unique acute telehealth service, the barriers, successes, surprises and failures, including what we would/will do differently. Equally, how other areas could apply some aspects of our experience to their patient groups. TEMSU is not the panacea for the rural-urban health disparity, nor tyranny of distance. However, it has a place in the suite of options available to rural Queensland clinicians and their patients for support and advice.