I had a call the other day for a person with a syncopal episode, however presenting with some ACS symptoms. 12 lead performed with Junctional Rythmn/ RBBB (and what the hospital is calling an Inferior Infarct). Patient is unstable so we transported to the local facility only to have our heads nearly ripped off by the charge nurse, even after explaining the nature of the call. Patients subsquent 12 leads do not show any signs of an AMI/ STEMI, and patient refuses chest pains/ pressure throughout the call. Basically poor diagnosis on the part of the hospital (my opinion), then they treated the patient and tried to get EMS to perform an interfacility w/ heparin, and tridol bolused. EMS advised they would need a nurse to transport with the patient. They refused so EMS refused. Who is right, and is there any violation that has occurred. (Outcome of patient: No STEMI/ AMI; Troponin, CPK and CK are all normal; Patient refused catherization at cath lab) Patient is now suffering from issues associated with heparin administration. Patient was on coumadin at the time.