This is difficult. Chest pain in itself is a stressful clinical encounter because of the number of differential and scary diagnoses it may represent. To be honest both the doc and the ambulance men did a credible job on this patient's behalf. As a doctor we're trained to think laterally, if tests and investigations in 'the field' are not going to change the patient's subsequent management at hospital we shouldn't waste time doing them and try and ship them off to their definitive treatment as soon as possible. I do understand that in some hospitals the gold standard PCI is indicated for STEMI's but not every hospital has this facility and quite often they come through A&E and get the ECG and then are transferred quickly to the cath lab or 'clot busted' . I'm not sure that a consultant cardiologist or specialist reg would open the cath lab until they had seen the ECG via fax or had the story corroborated by another medic out in the cardiac ambulance but anyhow. I understand why the amublance men were nervous especially about following protocol as quite often these said protocols have saved lives but I don't think we should get ratty about a GP who was looking after his patients interest and nor do I think the GP should get ratty about the ambulance men who were looking after the patients best interest. To cut the rambling short....it's all about the patient's best interests...and in this story both teams (not sides) were most admirable in looking after this patient. They've just got to step away from the bigger picture and realise that they are both playing for the same side. God sorry, that's an awful post but hopefully the sentiment is conveyed. (Just another junior doc hoping to remain employed this year.)