Heart disease carries the highest mortality among disease related deaths in the United States (US) with coronary artery disease (CAD) accounting for the majority of those cardiac fatalities (Roger et al., 2012). Nearly all acute myocardial infarctions (AMIs) are caused by CAD. The purpose of the clinical inquiry project is to review current evidence-based literature for pre-hospital ECG's when STEMI is a concern, and analyze regional barriers and challenges to effective and timely PPCI hospital pre-notification of STEMI arrival.