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Early antiplatelet therapy with aspirin is a cornerstone of STEMI care and is one of the most impactful mortality-reducing prehospital interventions prior to reperfusion. Chewed, non–enteric-coated aspirin inhibits cyclooxygenase-1, reducing thromboxane A₂–mediated platelet aggregation and limiting thrombus propagation in the culprit coronary artery. Routine high-flow oxygen for all MI patients is no longer recommended; instead, oxygen is titrated to maintain SpO₂ ≥ 94% because hyperoxia can cause coronary vasoconstriction and increase oxidative stress without benefit in normoxemic patients. Prophylactic lidocaine has not demonstrated mortality benefit and may cause proarrhythmia. Morphine may relieve pain and reduce sympathetic drive but can mask worsening ischemia, cause hypotension, and possibly interfere with antiplatelet absorption; thus it is not a mortality-reducing first-line step. In the air medical environment, giving aspirin promptly, maintaining hemodynamic stability, and expediting definitive reperfusion remain priorities to improve outcomes during transport.