Current guidelines recommend that transfer occur immediately with an overall goal of FMC-to-device time of 120 min; this can be best achieved by shortening the time in the first ED and transferring the STEMI patient within DIDO of 30 min.20,98,99,106 Clinical Recommendation(s) 2013 ACCF/AHA Guideline for the Management of Patients With ST-Elevation Myocardial Infarction12 1. Immediate transfer to a PCI-capable hospital for primary PCI is the recommended triage strategy for patients with STEMI who initially arrive at or are transported to a non PCI-capable hospital, with an FMC-to-device time system goal of 120 minutes or less.*93,94,98,99 (Class I, Level of Evidence: B) 2. Immediate transfer to a PCI-capable hospital for coronary angiography is recommended for suitable patients with STEMI who develop cardiogenic shock or acute severe HF, irrespective of the time delay from MI onset.107 (Class I, Level of Evidence: B) *The proposed time windows are system goals. For any individual patient, every effort should be made to provide reperfusion therapy as rapidly as possible. ACCF indicates American College of Cardiology Foundation; AHA, American Heart Association; AMI, acute myocardial infarction; CABG, coronary artery bypass graft; DIDO, door-in-door-out; ED, emergency department; FMC, first medical contact; LBBB; left bundle branch block; MI, myocardial infarction; LOE; level of evidence; PCI, percutaneous coronary intervention; and STEMI, ST- elevation myocardial infarction. Appendix A. 