In a 2011 observational study from the ACTION Registry GWTG that used data reported from a limited number of predomi- nantly PCI-capable US hospitals, EMS transport was used for Older US surveys reported EMS activation rates of 23% to 53%, with substantial Patients with possible ischemic symptoms should be trans- ported to the hospital by ambulance rather than by friends or relatives because 1) 1 in every 300 patients with chest pain transported to the emergency department (ED) by private vehicle suffers cardiac arrest en route67 ; and 2) there is a sig- nificant association between arrival at the ED by ambulance and earlier delivery of reperfusion therapy.64 66,68 In addition, the performance of prehospital ECGs by trained personnel is associated with shorter reperfusion times69 and lower mortal- ity rates from STEMI. The use of prehospital ECGs, particu- larly when coupled with communication of STEMI diagnosis and preferential transport to a PCI-capable hospital, has been shown to result in rapid reperfusion times and excellent clini- 3.3. Patient Education The AHA and National Institutes of Health Act in Time to Heart Attack Signs campaign73 stresses that patients can increase their chance of surviving STEMI by learning the warning symptoms, filling out a survival plan, and discuss- ing risk reduction with their physician. These materials are available on the National Institutes of Health Heart Attack Web page (http://health.nih.gov/topic/HeartAttack/).74 Health- care providers should target their educational interventions to patients at increased risk for ACS.75 3.4. Community Preparedness and System Goals for Reperfusion Therapy 3.4.1. Regional Systems of STEMI Care, Reperfusion Therapy, and Time-to-Treatment Goals: Recommendations See Figure 2. Class I 1. 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. 