All communities should create and maintain a re- gional system of STEMI care that includes assess- ment and continuous quality improvement of EMS and hospital-based activities. Performance can be facilitated by participating in programs such as Mission: Lifeline and the D2B Alliance.71,76 78 (Level of Evidence: B) 2. Performance of a 12-lead ECG by EMS personnel at the site of first medical contact (FMC) is recom- mended in patients with symptoms consistent with (Level of Evidence: B) 3. Reperfusion therapy should be administered to all eligible patients with STEMI with symptom onset within the prior 12 hours.81,82 (Level of Evidence: A) 4. Primary PCI is the recommended method of reperfu- sion when it can be performed in a timely fashion by (Level of Evidence: A) 5. EMS transport directly to a PCI-capable hospital for primary PCI is the recommended triage strategy for patients with STEMI, with an ideal FMC-to-device time system goal of 90 minutes or less.*70 72 (Level of Evidence: B) 6. 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 (Level of Evidence: B) 7. In the absence of contraindications, fibrinolytic therapy should be administered to patients with STEMI at non PCI-capable hospitals when the an- ticipated FMC-to-device time at a PCI-capable hos- pital exceeds 120 minutes because of unavoidable (Level of Evidence: B) 8. When fibrinolytic therapy is indicated or chosen as the primary reperfusion strategy, it should be ad- ministered within 30 minutes of hospital arrival.*89 93 (Level of Evidence: B) Class IIa 1. 