Hi... no IM MS to ?MI's. IV MS is fine. Oxygen and more importantly sufficient doses of GTN remain the most effective first off pharmaceutical interventions, with GTN having the greatest physiological benefit In fact, research (I can't find it at the moment) suggests practitioners are too quick to adopt morphine without adequate GTN amounts. CCU staff would prefer that we did not give IM injections in situations of ?MI as: * The release of the medication is less predictable with IM vs IV, and therefore delivering the right therapeutic level becomes harder to assess * The body during an MI is often cardiovascularly compromised and therefore uptake from the muscle structure may be impaired (similar reasoning to above), therefore the rule concerning shocked patients could apply. * However the main reason is that the administration of an IM injection causes a potential false positive cardiac enzyme result, specifically IM injections raise CK (Creatine Kinase) which is a less costly measure of myocardial injury. It sounds like your management is trying to adopt the "hub" model our management tried and failed to adopt. Fight it...KPI's will only be reduced when ambulance managers realise they need more geographically spread stations consistent with workload hotzones. It will also destroy station comeraderie and mean more fluid deployment/system status management.