We're about to start a similar system in the Black Country (Wolverhampton, Dudley, Walsall, etc.). As of 1/4/07 (April Fools' Day....!) any suspected STEMI will bypass (pun intended) what may be the closest A&E and be taken direct to a specialist centre offering PCI. I have a feeling that the slightly longer journey times will cause some anxiety amongst crews, but I'm sure that the benefits will outweigh the disadvantages. I hope. Just playing Devil's Advocate, Tom, how do you think you would have felt if the pt had arrested en route to the hospital with the cath lab, and hadn't recovered? I'm not doubting your defib skills in any way, but it could just happen. That's one part of the new system that worries me, I must admit: I make the decision (OK, the decision has already been made for me by the policy makers, but the diagnosis is down to me) not to transport to an A&E 2 or 3 minutes away, and instead take the extra 15 minutes to get to the cath lab. Patient arrests and dies 10 minutes into the journey. How long am I going to be dogged by "What if?" questions?? Any idea if this scenario happened in LAS?