ST-elevation myocardial infarction (STEMI), one of the complications of cardiovascular disease, which if not treated immediately using reperfusion therapy, carries a poor prognosis.Reperfusion therapy with thrombolysis remains the only option in most of the rural setting of India due to non-availability of required infrastructure including cardiac specialist. Those who were thrombolysed, they undergo it after great delays at different level subject to financial barriers, transportation problem, limited healthcare infrastructure and poor accessibility to medical services. We have identified various variables leading to the delay at facility level in initiating reperfusion therapy in case of ST-elevation Myocardial Infarction (STEMI). Time lost during registration process, Health protection card activation, transportation of patient from causality/OPD to CCU (non-availability of trolleys in causality), getting ECG done at OPD /causality/CCU and purchasing of thrombolytics can be significantly reduced. So we propose to implement a Fast-Track-Protocol for acute coronary syndrome (Chest pain/discomfort) patients in order to reduce door to needle time in ST-elevation myocardial infarction.