I think that as long as the training is in place, and the crews are confident to diagnose STEMIs then it's all good. I know when we first started doing this it felt very wrong to bypass an A&E, but the feeling does pass. As for dying in the back of the ambulance - I'd rather stand before the coroner and explain that the patient died because I followed protocol rather than dying after I ignored our protocol. At the end of the day I believe that the protocol is 'right' and by following it I'm doing the best for my patient. I hope this answers your question - if not then feel free to drop me a line.