The reason why I wait for a BP is because (a) The BNF lists hypotension as a contra-indication and (b) Because our Clinical Director (who is a doctor) tells us to. Why would they be hypotensive? Well maybe not because of their current illness, but maybe due to anti-hypertensives, perhaps they'd taken Viagra, perhaps some other reason - you don't know until you check after all. And I can check a BP in under 30 seconds, having been trained many years ago with manual BP cuffs. And yes, I *do* know about Starling's law, having been an A&E nurse. I also know that an ECG isn't definitive to rule out an MI. I can also quote you the times that the various enzymes show up in the blood tests. I do however find it disingenuous that you would want me to do nothing other than be a 'fast taxi' for a relative with chest pain, I take it you wouldn't want a STEMI going to an angioplasty centre but instead to a bog-standard A&E. Except of course that Angioplasty is the gold standard treatment for this sort of thing, but then you wouldn't want us trying to spot ST elevation would you? After all isn't that stepping on the territory of doctors - how about defib? Should we stop doing that as well?. (And see another reply of mine for our 'success rate' on STEMIs, hint - it's 100%). And one last thing, being fully aware that ECGs are not definitive we 'blue in' all suspected cardiac chest pains while giving GTN and aspirin (but not always oxygen now because of the British Thoracic Society's new guidelines).