Just point and click. Is your system ready for point-of-care testing?

Your ALS service is called to evaluate a 47-year-old female with epigastric pain that came on suddenly about six hours ago; she has vomited once. She thought it was the flu and that it would subside, but it has not. She smokes, is overweight and has a family history of early cardiac disease. Her vital signs are unremarkable and her belly is nontender. You perform a 12-lead ECG that shows nonspecific ST-T wave changes inferiorly. You place a few drops of blood obtained as part of your field-drawn bloods into an i-STAT cartridge. The result surprises you: Her cardiac enzyme (troponin I) is markedly elevated. Should she be transported to the closer facility without primary coronary intervention (PCI) capability or further down the road to a facility that has it?