Because patients with STEMI may first present with cardiac arrest, regional systems also should emphasize early access to care (recognition of the problem and bystander activation of EMS), rapid dispatch, bystander cardiopulmonary resuscita- tion(CPR),defibrillationwhenindicated,advancedcardiaclife support,andanorganizedapproachtopostresuscitationcare.In addition, family members of patients who have had STEMI or other manifestations of coronary artery disease should be referred to CPR training programs that have a social support component and can familiarize them with the use of auto- mated external defibrillators. 3.4.1.2. Strategies for Shortening Door-to-Device Times The D2B time interval includes 3 key components: door-to-ECG time, ECG to catheterization laboratory time, and laboratory arrival to device time.132 All 3 inter- vals are dependent on system factors that may vary across Public reporting and national initiatives have focused much and the many reasons for sys- Studies have shown marked differences in the timeliness of primary PCI across hospitals. Focusing on the processes of care at the top-performing institutions, research has revealed characteristics of institutions associated with Top hospitals have specific cultural attributes that include 1) a commitment to an explicit goal of improving D2B times that is motivated by internal and external pressures, including senior management support; 2) innova- tive protocols; 3) flexibility in refining standardized protocols; 4) uncompromising individual clinical leaders; 5) collab- orative teams; 6) data feedback to monitor progress, identify problems, and successes; and 7) an organizational culture that fosters resilience to challenges or setbacks to improvement In addition, several key processes are associated strongly with more timely treatment (Checklist). 