This is an interesting topic, and I’m going to chip in my 2pence worth. This all comes down to one principal, one that we are taught in medical school and again and again throughout our careers as doctors: Will the results of your investigation (in this case an ECG) change what you do to your patient? If the answer is NO, then the investigation is a waste of time and should not be done. So, whether you think he is arrogant or priggish or whatever, Dr Crippen is absolutely right in not doing an ECG at his GP practice. He would have called for an ambulance whatever the ECG showed. It would be totally negligent and unacceptable if didn’t call for ambulance even if the ECG was normal. Regarding the ambulance crew, whether or not they should do an ECG depends on the local circumstances. If the ECG decides whether the go to cath lab, CCU or A&E; or whether they thrombolyse at the scene or not – then, they too are absolutely right and correct to do the ECG. If they are going to take the patient to A&E REGARDLESS OF WHAT THE ECG SHOWS, then they are wasting time and potentially endangering the patient by waiting to do one. The point is that protocols aren’t sensitive enough to allow people to make clinical decisions like this. Btw, all those who said “I remember a patient who looked fine but the ECG showed a big MI, therefore they are always worth doing” are missing the point. The point being that even if it does show a big MI, are you in a position (in an ambulance in a GP carpark) to do anything about it? If the answer is “no” then the patient needs to go to place where there are people who can do something about it as quickly as possible. Simple, really. Bear in mind that EVERYONE admitted to hospital with chest pain gets an ECG on arrival. The question here is how useful is a pre-hospital ECG in this scenario?