I'm a retired Battalion Chief Paramedic with 31 years service to Public Safety and feel I have to write on this topic. ST segment elevation myocardial infarction (STEMI) is a heart attack diagnosed by looking at the EKG.  If STEMI is apparent on the EKG, the SINGLE most important thing that emergency care providers can do is insure that each STEMI patient receives timely opening of the blocked artery (reperfusion) as fast as possible.  Truly, "TIME EQUALS MUSCLE."  This reperfusion treatment must take place at a hospital, either by use of clot busting drugs or emergent angioplastly in a heart catheterization lab.
However, STEMI is a rare event that is often diagnosed when least expected, usually under chaotic circumstances. This points to the value of having a triage plan in place for when it does occur, allowing rapid planning and execution to occur.  Indeed, study after study has shown that the single most important factor in improving STEMI treatment (time to reperfusion) is simple:

"Does each emergency provider have a STEMI plan (triage plan) in place for when a STEMI is diagnosed?"

Thus, requiring that each agency have a STEMI ALERT plan in place is vital and essential if Virginia hopes to offer excellence in care to each Virginia resident who in the future suffers from a STEMI.  If agencies do not have these plans of execution in place, then they will be unable to guarantee rapid reperfusion based on a consistent plan.

Please note that the exact plan in place is not as important as simply having a STEMI triage plan in place.  What this implies is that the exact STEMI ALERT triage plan (though required via this change) will still be developed by the care providers in each area who will collaborate together to determine what constitute the best and most exact STEMI ALERT triage plans within their areas of service.

This type of flexible and collaborative "systems engineering" approach to optimizing STEMI care is being enacted throughout the US; by adopting this approach Virginia will be in-step with many areas and states within the US currently striving to optimize care for patients diagnosed with ST elevation heart attack.

More lives will be saved by a simple change of words and policies about STEMI care and education.