P H. Seidekn, W. Rintoul. L. McLean, B.D Valiance. Cepartmer!t of Medical Cardiology. Hairmyres Hospnal, Glasgow. UK. We studed whether climcal assessment by ambulance crw and recording of 12 lead electrocardiograph (ECG) with telephonic transmission of ECG was accurate in diignwing AMI and can fadktate direct admission to the Corciwy Cafe Unit (CCU). Ambulance crews were trained in climeal assessment and ECG recording. Clinical assessment of patents was by questionnaire Hean rate and blood pressure were recorded. ECG was recorded by computer assisted ECG analyser and transmw to CCU. The crew discussed the presentabon with CCU staff and patients with definite AMI were brought directly to CCU. 61 consecutive patients wth chest pain referred to the trained and equiped crews were asse& and 49 met criteria for inclusion in the study (29 male mean age 57y: 20 female, mean ege 66~). 8 pabents dii not have ECG recorded (5 refused, 2 wstable, 1 no pan: the average time for pick up witbat ECG was 6.25 mm). 41 p&ii had ECGs performed. average bme for pick up and ECG recording was 18.75 min lt patients sustamed an enzyme provsn AMI. 10 were admitted direct to CCU Computer analysis of ECG stnwd 4 rra AMI, 4 equiwcal and 2 definite AMI (1 refusal). Ambulance crews were required to decide suitability for thrcmtalysis: 7 Tw).3 yes and 1 no decisii. ma ecu nursing Stan correctly assessed the ECG as CanfirmIng AMI in 5 patients and equivocal in 3 patients. with one incorrectly assessed as as no MI. one ECG failure of transmi&On and one refusal. Importantly the system identified 5 (45%) of the patients with AMI who were redirected to CCU despite an open access system for GP referrals Our study shows that ambulance sews suppotted by ECG diagnosis and discussion with CCU nursing staff can safely assess suitability for thrcmbolysis and diagnose AMI This sysIem may be used to (1) reduce in hospital delays by promoting direct admission to CCU of appropriate patiwts. (2) facilitate out of hospital thrcmbolysis by ambulance cw.vs or (3) supfkxt GP administration of thrombolysis in the community.