Table 1.

Barriers and Solutions for Low and Middle Income Countries.

	Solution 1	Solution 2	Solution 3
Patient Education	Multi-pronged approach to educate; both cardiologist and family physician should provide unified strategy with clear delineation of care responsibilities	Effective communication tools to educate about warning symptoms and early diagnosis and treatment	Foster trust with patient and family
Lack of Insurance	Government sponsored insurance bundling all the costs of STEMI including transportation	Adequate coverage, including pre-existing disease and cashless facility (for more affording)	Awareness and education about treatment costs and importance of insurance (for all)
Ambulance Deficits	Approach private and public ambulance systems individually	Have strategic plan at each PCI center regarding ambulance system; continue to improve their reliability and efficiency	Essential components in both public and private ambulance systems include Telemetry monitoring and paramedic training?Prehospital EKG
Hospital related Issues	Data: If you don't measure, you cannot improve.	Stakeholders: develop trusting relationships with stakeholders; share progress, advances and challenges.	Feedback and Education: Disseminate STEMI management and its vital contribution to the community and to society
Technology Gaps	Making available high definition but low cost ECG machines at first medical contact	Tele-transportation of data from point of first contact to higher center	Organization of systems for first medical contact down to Cath-lab systems that work
Physician Issues	Empower the General Physician	Overcome financial disincentives or create financial incentives	24/7 Cath lab availability
Simply Chaos	ECG analysis program and continued training	Better penetration of benefit schemes	Bypassing hurdles at tertiary care & technology development