I think treatment priorities in ?MI differ vastly between prehospital care and hospital care (and between different agencies of the same). In one hospital I've worked at, it would be standard practice to give GTN straight away, without a blood pressure, probably even before oxygen. I've never seen that go wrong (let's face it, you usually have a pretty good idea if a patient was severely hypotensive enough for GTN to cause an adverse effect without actually taking their blood pressure, and in any case regardless of blood pressure nitrates to some degree are still indicated). If it did, by some sheer fluke of nature, go wrong, you have the staff and equipment to deal with it instantaneously, which you don't necessarily have pre-hospital. Whereas in prehospital care, the focus does very much tend to be on oxygen, then aspirin, then obs, then ECG, then nitrates and finally opiates. I don't necessarilly think that either approach is best, although from a patient comfort point of view it has to be kinder to give the GTN as early on as you can. There is a strong case for more thought to be given to how best to handle in-hospital emergencies though. Whilst the response here was clearly poor, even in the nice traditional hospital you talk about, I bet the response isn't that great. Research has shown time and again that management of resuscitation and acute events in hospitals is absolutely dire, no matter if it's done by a junior doctor, a senior doctor, a nurse or a passing porter. That's the real story here, and one which ought to be publicised more. If the public knew the level of incompetence and poor planning surrounding this area, there'd be an absolute uproar.