Virtually all the significant learning that I have experienced in my ambulance career has come from finding out what happened to my patients and if my provisional diagnosis was right or wrong. The relationships that you can have with the docs and nurses in A&E is invaluable and is one of the best resources that we can have for feedback. In this case, even if he had ended up having a MI and needed stenting, you would still have been right in your decision. Ultimately, if you felt that they didn't fulfill the criteria for STEMI, and as an experienced ECG interpreter, who could challenge you? It would be a different story if you weren't fully competent in difficult ECG interpretation, and lets face it, its not every paramedics/technicians forte, and then maybe people would air on the side of caution and take to a PPCI centre and rather get comments for taking someone who didnt need it rather than take someone to A&E who needed PPCI. Good call.