Among patients with a suspected acute coronary syndrome the early phase is particularly critical. At that stage, pain is most intense and the risk of life-threatening arrhythmia is greatest. Also at that stage, the prospect of limiting infarct size and maybe even protecting patients from developing myocardial damage is at its best. Thrombolytic treatment initiated prior to hospital admission has been shown to more effectively reduce mortality in acute myocardial infarction than thrombolytic therapy initiated after admission. Swedish pre-hospital care appears to have adapted relatively well in this aspect of clinical care.