A bit of a loaded question, and while EMTALA may side with the crew, agency protocols are important to take into account here, as well as ethics and patient advocacy. Several variables are not clear. One of which is, was this an ALS unit or a BLS unit. Most ALS units have the ability to do an EKG prior to arrival at the facility, which can detect a STEMI but not always definitively. Also, most services I have worked for and training that I have received, teaches Paramedics that making appropriate receiving facility decisions is the responsibility of the Paramedic. I personally would be less likely to take a chest pain patient to a hospital without interventional cath lab capabilities without extenuating circumstances, peri arrest or patient refuses transport anywhere else. The ethics side of the situation is just an argument about doing what is right for the patient. At this point the crew knows two things, the patient may be experiencing an MI and this hospital does not have the capabilities of stabilizing that. The ONLY right thing to do here is to continue transport to an appropriate facility, unless your leadership says absolutely not. Time is heart, while you argue about who's gonna help this person, his heart is dying and will continue to die until he gets to the appropriate facility. So what is right vs wrong, continue on and have the argument later, or unload him onto a hospital bed for the hospital to make arrangements for an emergency transfer from a different ambulance. This is just how I handle this situation hypothetically. There are always aspects of every call that I cannot see because I was not there. Just my two cents based on the description.
