As they should be; they have an MD after their name, and if they feel the need to override you, it's their call. But I would imagine they would only override you if it was clear that you were wrong if the hospital wants to transmit all 12 leads, go nuts. it's a second set of eyes. I'm hoping they are transmitting (at least the suspected STEMI) it to the cardiology department, and not just to the regular ER. After all, you want an expert to review them.... Be wrong too many times, and the hospitals stop trusting your diagnosis (and I can't blame them for that either). Cry wold too many times and don't be surprised if your warnings get ignored. But transmitting a questionable 12 lead or calling for a consult should never be frowned upon, especially if you are just looking for confirmation to your conclusion. My former NC agency bypasses the ER completely and takes the patient directly to the cath lab (on the EMS stretcher, we could actually watch them do the cath and see their rhythm return to normal). When I was up in NJ, we could activate the CATH lab, but still stopped in the ER first, transferred the patient, and they brought them up stairs. There needs to be a high level of oversight in cath lab activations, and if you are activating incorrectly, than you need to be sent back for retraining. Someone once told me that a paramedics knowledge of EKGs needs to be on par with a cardiologist, because they could be the first person to identity problems and initiate early intervention.