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'm only going by how London operates, but here we do the ECG because if it's a STEMI then we bypass A&E and go straight to the cath lab. It's one of the real success stories of the NHS. The Cath lab is also superb, and are happy to see us and run a 24hr service. I can't praise it enough. (Case in point, I took in a patient who was borderline STEMI by ECG, it needed them to call in the Consultant and do some repeat ECG to confirm that the patient wasn't having an MI. They made it obvious to me that they were happy with my decision and that I should do the same thing again if I had any concerns - top folks). As for the getting ratty - well, I did try to not get ratty when I posted this. It's why I say at the start that it's not an attack. As is, I have no problem with the actions of the crew or of Dr. Crippen - both had the patient's best interests at heart.