We have STEMI patients that are transferred from another facility but usually go to our Ed when transferred, however they have already had lytics, so its not a rush to get them a PCI if the lytics work. If the lytics do not work, then its an emergency. They start off in the transferring Facility’s ED and that is where they get Lytics. Should these patients be included in the denominator and would we count the transfer from our ED to transfer out of the ED and if that is greater than 45 minutes outcome would not be met?