Abtract Background Myocardial infarction is a critical and potentially deadly condition which requires immediate treatment in hospital. Ambulance personnel shall follow prehospital guidelines of care when examinating and treating patients with chest pain and the ambulance is equipped with ECG-monitoring for early identification of infarction in order for rapidly transport to hospital. Previous studies indicate deficiency in compliance to prehospital guidelines and patients with chest pain don´t always receive an ECG in prehospital care. A report from region Västerbotten have shown that 66,3% of patients with chest pain receive ECG in ambulance care. Aim To examine compliance to prehospital guidelines in care of patients with chest pain. Methods A retrospective medical record review (N=204). Inclusion criteria The journals that was reviewed are patients who in 2019 were cared by ambulance staff and taken to hospital as priority one with chest pain. Result The mean age of patients in this study was 70,3 year (SD+/-14,1) and the majority where men (59,3%). Most of the patients presenting with prior heart or vascular disease (67,2%). A total of 42,4% experienced secondary features such as nausea, sweating or dizziness and in 32,4% of the journals these symptoms where not documented. In ambulance 80,9% did receive ECG and 35,8% got ASA, with no significant differences between gender and time of day. Most of the patients (73,5%) required pain relief one or several times during ambulance transport and 21,6% of the patients experienced pain but didn't receive treatment. Conclusion This study indicates that not all patients with chest pain get treated by the prehospital guidelines. Not every patient received an ECG and few patients received ASA. Lack of documentation regarding patients exhibited symptoms and reasons for not treating pain were found in the journals. In summary these deficiencies can negatively affect patient safety, cause medical hazards and increase health care costs.Keywords: Prehospital care, prehospital guideline of care, chest pain, myocardial infarction, ECG