INTRODUCTION
Ischemic Heart Disease (IHD) continues to be the single most common cause of death worldwide. The estimated incidence of a myocardial infarction (MI) in the US remains high and is approximately 605,000 new attacks annually. MI and coronary heart disease were two of the ten most expensive conditions treated in 2013 with an estimated total healthcare cost of 218 billion dollars.1 Mortality rates have declined in part due to timely percutaneous coronary interventions (PCI) for ST segment elevation myocardial infarction (STEMI) but the burden and risk factors remain significant.2 Guidelines continue to evolve with increased emphasis on the rapidity of infarcted-related coronary artery recanalization.3-5Health care systems continue to strive for improvement in door-to-first ECG and door-to-balloon (D2B) times and the identification of system, provider, and patient barriers is paramount to improved patient outcomes.3,4,6-8