The timely diagnosis and treatment of acute ST-segment elevation myocardial infarction (STEMI) have become paramount to improving outcomes in this population. Many states, including North Carolina, have established systems to guide regional emergency providers in caring for STEMI. We describe the current pathway for diagnosis and treatment of STEMI for providers referring patients to Duke University Hospital, including a system for expedited patient transport and activation of the cardiac catheterization laboratory from a wide referral base. There is also a structured process for review of cases and quality improvement, which incorporates physicians, administrators, and emergency medical personnel.