You Are Active in Your Local Rural Rescue Squad as a Paramedic

You are active in your local rural rescue squad as a paramedic. Your small town of 500 people does not have a hospital. There is a small community hospital 25 miles away and a large urban hospital 70 miles away. Recently, you have had two chest pain patients go into cardiac arrest and die after reaching the local community hospital, which does not have a cardiac catheterization lab or fibrinolytic therapy available. Given your rural setting, which of the following should you suggest to the medical director and rescue squad council as a solution?

A) Allow paramedics with the rescue squad to perform 12-lead ECGs and carry bedside cardiac marker assays, heparin, and fibrinolytics.
B) Suggest fund-raising activities to build a cardiac catheterization lab at the community hospital.
C) Develop a general protocol that states that all patients with chest pain of suspected cardiac origin should be transported directly from the scene to the urban hospital 70 miles away.
D) Develop a general protocol that states that all patients with chest pain of suspected cardiac origin should be transported to the community hospital for evaluation by the nurse practitioner before transporting to the urban hospital.