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Background Troponin testing is central to the diagnosis of non-ST elevation myocardial infarction (NSTEMI). Pre-hospital point of care (POC) high-sensitivity troponin (hs-cTn) could enable more efficient decisions about cardiac patient care. Our aim was to evaluate the implementation of POC hs-cTn testing, used with the Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid to guide risk stratification.Methods At three ambulance hubs in the North West Ambulance Service, non PPCI-suitable or time critical patients aged 18 or over presenting with chest pain underwent POC hs-cTn testing using capillary blood samples. Results were used to calculate the output of the T-MACS decision aid, assigning patients to one of four risk groups.A mixed-methods analysis approach was adopted. Summary statistics were produced for key metrics including time-on-scene, test validity, and test outcomes. Surveys were carried out with paramedics to understand logistic barriers and testing experiences.Results 65 paramedics were trained, and testing was carried out during 253 calls. 193 produced a valid result (76%). The key logistic challenges were insufficient blood samples, tests failing the analyser’s internal quality control, and difficulties storing testing cartridges at 2-8° Celsius.When compared to non-tested chest pain calls, troponin-tested calls required a median 9 minutes longer on scene.The tested population included 48 very low-risk patients (24 of whom were conveyed to hospital) and 6 high-risk patients, demonstrating a significant population (16% of valid results) that could be affected by a pathway change.Conclusion These results provide an early indication that POC hs-cTn testing can be feasible in a pre-hospital environment. Phase 1 of the trial has highlighted key logistic barriers that must be addressed for POC hs-cTn testing to be sustainable and effective, including temperature control, sampling errors, and invalid results. Further evaluation is required to understand the potential impact of a pathway change.