Timely reperfusion is the primary treatment goal for ST-segment elevation myocardial infarction. The recent American College of Cardiology/American Heart Association guidelines utilize time since symptom onset, anticipated time to treatment, patient risk factors, and center volume and experience to determine the optimal reperfusion strategy. There continues to be a considerable number of patients who do not receive reperfusion therapy and treatment delays are still too long. Institution-specific protocols which reflect current guidelines may increase the number of ST-segment elevation myocardial infarction patients who receive timely reperfusion.