Oh dear EDdoc, you really are out of your depth aren't you? A single normal ECG in the context of chest pain does indeed mean jack all. A single ABnormal ECG in any context that shows a barndoor MI means the patient is then transported not to the big building marked 'Hospital' but to the big building marked 'PCI' (look it up if you don't know what it means) where they will be seen by people who unlike you are extremely well trained in the diagnosis and management of chest pain. That seems to me a pretty good reason for training paramedics in ECG interpretation. If like me you had ever looked after a patient in cardiogenic shock you would know that the only adverse sign is often a low BP. I would not recommend giving GTN to this type of patient (because they will die). You don't reference your claim that 'up to 30% of patients with AMI have normal ECGs'. This is nonsense. You may be referring to research about Troponin as a marker for AMI which is quite a different thing. For the record I am an A&E nurse in the same neck of the woods as Tom and if you were really a A&E doctor and gave a patient GTN without knowing their blood pressure, I would inform your boss, complete an incident form and email your consultant and quite possibly remove you from duty for imcompetence if I happened to be in charge. GTN is a useful drug in the treatment of chest pain caused by ischeamia but if your family member has chest pain I would insist on an ECG, some baseline obs (how long does that take?), some Aspirin, GTN and anagesia if indicated. This might well take 20 minutes but it is 20 minutes well spent. I am amazed I managed to reply to you without losing my temper considering it was such a troll like response.