This article provides a description of the administrative model that enabled a city-wide integration effort between Greater Toronto Area hospitals and Toronto Emergency Medical Services in the care of patients within the city of Toronto with ST elevation myocardial infarction (STEMI). This administrative structure, known as the Toronto Heart Attack Collaborative (THAC), enabled universal 24/7 access to primary percutaneous coronary intervention within Toronto, improving patient efficacy and outcomes. The lessons and administrative enablers from this experience may be useful for regions that are embarking on multi-centre integration efforts. This article presents a five-year perspective on the THAC integration effort.

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