Driving past the nearest A&E department to get a patient to a hospital offering primary angioplasty increases pain to treatment time. Admittedly, delay is not quite so critical for balloon/stenting [as opposed to thrombolysis, when 'minutes = muscles'] unless the patient arrests, of course. We recently had a VF arrest when an 'out of area' patient took 30 minutes before the crew finally got him to the cath lab [he went off in the hospital corridor]. Even so, despite various logistical issues, including the possibilty that paramedics will be required to resuscitate more patients, the research evidence suggests that angioplasty is the treatment of choice http://eurheartj.oxfordjournals.org/cgi/content/full/24/1/21 It is also great to hear of the rapport between crews and hospital staff, it must make a refreshing change fromthe unmotivated shufflers in some of the nursing homes.