Thrombolytic therapy is still the fastest and most accessible treatment for patients presenting with acute ST-elevation myocardial infarction. The time to treatment is a pivotal parameter in reperfusion. We examined the effects of implementing a better organized team approach to reduce door-to-needle times in patients with acute myocardial infarction. Fully trained emergency department personnel with special equipment facilitated direct communication between offsite cardiologists and pre-hospital emergency personnel, allowing for patient triage directly to the coronary care unit. Demographic, laboratory, and time interval data were prospectively collected and compared with data from previous years. From April to December 2007, 60 patients with acute ST-elevation myocardial infarction were triaged to the coronary care unit and enrolled in this study. Improvements were seen in mean door-to-needle time (reduced from 80 to 30 min during regular hours, and 85 to 33 min outside regular hours) compared with 2005-2007 data. A better organized team-based approach with specifically trained personnel and equipment for early evaluation and triage of patients with suspected myocardial infarction decreased intervention times, with the potential to be broadly applied in clinical practice and to improve patient survival.