Here is the story.
Patient is a 76 year old male. No known medical history, no meds, excellent physical condition, walks every day.
Two days prior the patient experienced some shortness of breath while walking, but the sensation went away with rest. Approximately 30 minutes prior to EMS arrival, patient walked outside to get the newspaper, bent down, and experienced some mild chest discomfort. The patient walked back inside and felt like someone was "standing on his chest." At this time the patient's spouse called 9-1-1.
At the time of EMS arrival, the patient appears acutely ill. He is slightly diaphoretic but not overly anxious. He admits to 8/10 chest pain and mild dyspnea. He denies nausea, vomiting, or palpitations. No JVD. Breath sounds are clear bilaterally.
Vital signs are assessed:
SpO2: 98 on RA
The cardiac monitor is attached.
A 12 lead ECG is captured.
Let us assume for the sake of discussion that you live in a rural community.
You are 25 minutes away from your local receiving hospital (no cath lab) and 55 minutes away from a hospital in the next county over that is capable of primary PCI.
Do you bypass the local community hospital?
Should the cardiac cath lab be activated prior to your arrival?
Who makes the decision?