Family members, close friends, or advocates also should be enlisted as reinforcement for rapid action when the patient experiences symptoms of possible STEMI.60,61 Discussions should include a review of instructions for taking aspirin62 and nitroglycerin in response to chest pain. Emergency medi- cal dispatchers are trained to instruct patients with possible STEMI symptoms to chew non enteric-coated aspirin (162 to 325 mg), unless contraindicated, while personnel are en route. If nitroglycerin is prescribed, the patient should be advised to take 1 nitroglycerin dose promptly. If symptoms are unim- proved or worsening 5 minutes after 1 dose, the patient should be instructed to call 9-1-1 immediately. 3.2. Mode of Transport to the Hospital Even though >98% of the US population is covered by 9-1-1 patients with STEMI often do not call EMS or 9-1-1 and are not transported to the hospital by ambulance. 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. 