Figure 1).

Assessing time to treatment from point of first medical contact. This figure schematically presents reperfusion options and their associated time to treatment measured from first medical contact. In patients who activate the prehospital emergency medical system, treatment delays can be reduced through the use of prehospital fibrinolysis or direct triage to a cardiac catheterization tertiary care centre that is capable of delivering timely primary percutaneous coronary intervention (PCI). In patients who self-transport to a tertiary care hospital emergency department, rapid delivery of primary PCI is the treatment of choice, with fibrinolysis maintained as an alternative. In patients who self-transport to a community hospital, transfer for primary PCI has been employed, although fibrinolysis may be considered reasonable because challenges remain in achieving timely primary PCI. In all situations, first medical contact (either arrival of the ambulance at the scene or patient arrival at the hospital) is the point from which the treatment is tracked