Let's upgrade to a priority one.,,

The other day I was working one of the rescue station when we received a call for syncope. So we respond priority one to the local race track for someone who was probably betting on the ponies.
     So we arrive to find our pt, a sixty-ish cantankerous male that actually would not let the FD even touch him before he dropped a deuce. I think the FD and my partner were a bit over zealous and followed the guy all the way to the stall and would have probably sat on his lap if he let them. So he does his business and walks out in a hurried and a "I can't be bothered" type of way but agrees for us to take a look at him.
      The usual test/procedures are done. V/S, ecg, 12 lead, cbg. All which came back mostly normal. He didn't have any elevation or depression on 12 lead but tells us he was complaining of some heaviness in his chest. So we get an IV going and start the MONA protocol. Since he was stable with no ECG findings consistent with badness, I was comfortable with transporting him to the hospital of his choice that was a super hospital about 20 miles away.
     While we are enroute I ask my pt about his pain, when it started, and how it feels. Getting answers out of this guy was like pulling teeth. He did not want to give up any information. Either he didn't know the answer or he was just in denial about the situation. At any rate, NTG number one had a slight affect on his BP. Nothing too exciting. 5 minutes later NTG number two is given and his pain feels different and he has the typical nitro headache. His pain is now going across his chest from left to right and his BP is 90/40-ish. He gets placed in "ambulance trendellenburg" and gets a fluid bolus. He had clear lungs, it's cool. But his BP continues to fall along with his heart rate and mental status. His v/s are now: BP 74/33, HR 30 and irregular, resp 12 and labored and he looks very ill. Now what?
      Pacer pads! That's what. I get the pads out and put them on this guy and get ready to deliver some "Edison" transcutaneously. However, he converts back to a borderline Brady/sinus rhythm with a rate that goes from 56-61. When we got our initial vitals, he had a similar heart rate when he was pissed. Fluid resuscitation is still going at this point and his BP is still 70s/badness and serial 12 leads do not show any ST changes, flipped T waves, or ectopy. WTF? Oh and at this point we just passed the exit on the interstate that would take us to our parent hospital if we needed to divert to a closer facility. So we are committed to the long haul to the super hospital. I ask my partner to light it up and upgrade to a priority one because I don't want our pt to code. Granted we have an auto pulse on our truck but I don't want to use it.
     I have to say, that stretch of interstate is bad luck for me. I had a pt with a subdural hematoma stop breathing on me on the way to the "D" from the boonies. Gotta love that.
     At any rate, I call a head and give a quick report while I am trying to get a second IV. I tell all my students and new medics "Everyone misses IVs. It happens". It was my turn to miss that day. I tried twice while we were going priority one but no dice. He had good ones too. I was just off that day. Oh BTW, his pressure had reached pucker factor. It was 54/30! Heart rate was maintaining though. I hooked up a quick pressure bag and informed the pt what was happening.
     Thankfully the boluses were finally working and his pressure was climbing. By the time we got to the super hospital his pressure had improved but I was still very concerned. We roll into the facility and I give report. And in true fashion of this place one of the RNs say question why we brought him in priority one. One even said "he doesn't look like a priority one pt". What the "F" ever! I'm just glad he was feeling better. It was an interesting call and a bit of a learning experience.