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An important and key component of STEMI systems of care is the performance of out-of-hospital 12-lead ECGs with transmission or interpretation by EMS providers and with advance notification of the receiving facility. Use of out-of-hospital 12-lead ECGs has been recommended by the AHA Guidelines for CPR and ECC since 2000 and has been documented to reduce time to reperfusion with fibrinolytic therapy.
More recently, out-of-hospital 12-lead ECGs have also been shown to reduce the time to primary PCI and can facilitate triage to specific hospitals when PCI is the chosen strategy. When EMS or ED physicians activate the cardiac care team, including the cardiac catheterization laboratory, significant reductions in reperfusion times are observed. [29] | 
