ALL: 12-lead EKG as early as possible. O2 ONLY if SpO2 <94%. ASA 324mg chewed (if no allergy). Position of comfort.
ALL: STEMI: ST elevation >1mm in 2 contiguous leads, new LBBB, or posterior pattern. Notify receiving hospital IMMEDIATELY — activate cath lab.
AEMT: IV access. Nitroglycerin 0.4mg SL q5min x3 if SBP >100. HOLD nitro if inferior MI suspected — get right-sided leads first.
PARAMEDIC: Right-sided EKG for inferior MI (II, III, aVF elevation) to rule out RV infarct BEFORE giving nitro. Fentanyl 1mcg/kg IV for pain if nitro ineffective.