I total agree with you EmT. If you're in a position to do something with the ECG result, like thrombolyse, divert the ambulance or call a helicopter, then, of course it is a valid thing to do and should be done as quickly as is safely possible, however, if you're not in a position to do anything about it, then it's a waste of time. A couple of points to remember 1. Andrew had no chest pain when the ambulance arrived (would you really thrombolyse an asymtomatic patient with ST elevation on ECG?) 2. Andrew had already seen a doctor who had diagnosed his condition Dr Crippen probably thought "this man is at high risk of having a heart attack but is unlikely to be having one right now. He needs an angiogram" And, like him or not, the letter shows that the GP was absolutely right - Michael