This patient’s presentation is highly suspicious for acute coronary syndrome (ACS). NREMT education emphasizes that epigastric pain, especially in elderly patients, may represent myocardial ischemia. The lack of relief after three doses of nitroglycerin further increases concern for an evolving myocardial infarction.

Option A (Give aspirin) is correct because aspirin inhibits platelet aggregation and is a cornerstone of early ACS management. NREMT guidelines recommend administering aspirin as soon as possible unless contraindications exist.

Option B (Apply oxygen) is correct because the patient’s oxygen saturation is 92%, which is below normal. NREMT recommends supplemental oxygen for patients with suspected cardiac ischemia who are hypoxic or in respiratory distress.

Option C may provide comfort but does not address the underlying ischemia.

Option D is incorrect because the patient has already taken the maximum recommended prehospital doses of nitroglycerin.

Option E is outside the EMT scope of practice in many systems and is not a priority EMT intervention.

NREMT emphasizes early aspirin administration, oxygenation, continuous monitoring, and rapid transport for suspected ACS.