Early reperfusion significantly reduces mortality and morbidity in patients with acute myocardial infarction [2-6]. Prehospital 12-lead ECG programs significantly decrease time to definitive reperfusion therapy [8-13]. The feasibility and safety of prehospital 12-lead ECG programs are well [figure: see text] established [8,11,13,14]. Additional potential benefits include increased diagnostic accuracy in the prehospital setting [14], providing a comparison ECG to the one obtained in-hospital [15], differentiating arrhythmias [16-18], and sensitive and specific computerized ECG interpretation [31,32]. Prehospital 12-lead ECG diagnostic programs also provide the necessary clinical information to implement system changes or interventions such as prehospital thrombolytic therapy, direct CCU admission, or triage to tertiary cardiac care centers [22,30,34,35]. The information acquired should be used optimally to effect significant improvements in patient care through a well planned and coordinated program.