It is early October and you are the flight doc in C-pod on a brisk but clear Saturday morning. The day starts out with several challenging patients with vague complaints and has just begun to ramp up in volume when a patient rolls into your pod by EMS, restrained face-down to the cot, covered in feces and urine, screaming about hearing voices. You begin to take report from EMS when, as if by divine intervention, the tones drop and you are dispatched for an inter-facility transfer. You gleefully (almost too gleefully…) give a brief patient sign-out to your staff, grab the blood cooler, and head to the roof.

You scan the horizon from your seat in the back of the EC145 and admire the bright oranges and deep reds of the changing early-fall foliage that paints the rolling hills along the Ohio River Valley as your aircraft quickly follows the winding course of the river. You receive a page that says that you will be responding to an outlying hospital for a "Code STEMI”. A follow-up page informs your team that the patient is “Alert, not intubated, 280 lbs, a 63 y/o M, and on two drips”. You land at the hospital, unload the stretcher and equipment with your flight nurse, and walk into the ED.

You are unable to find the referring physician, but the nurse at the bedside of your patient informs you that he presented to the OSH with 2 hours of chest pain that began while he was working on repairing his barn. He initially thought that it was heartburn and jaw pain from a “rotten tooth”, but his wife made him come to the ED for evaluation. He has a 50 pack year smoking history, hypertension, and hyperlipidemia as well as DMII that is controlled by Metformin. She hands you the following EKG: