Background <p>The purpose of structured medical triage systems, such as SmED (<i>Strukturierte medizinische Ersteinschätzung in Deutschland</i>), is to standardise the urgency assessment and allocation of care levels in the prehospital setting thereby enhancing patient safety. The effectiveness of these systems is contingent on the comprehensiveness of the documented patient-reported symptoms, especially for older patients with comorbidities and atypical presentations.</p> Case presentation <p>An 83-year-old patient with coronary from artery disease, atrial fibrillation and diabetes mellitus was evaluated by emergency medical services personnel subsequent to an influenza-like illness accompanied by coughing episodes and mild thoracic pressure. Clinical examination revealed tachypnoea, with otherwise stable vital signs and an unremarkable 12-lead ECG. Only the infectious symptoms were documented in the SmED, while thoracic complaints were omitted. Although the SmED generated the recommendation “urgent—emergency department,” the patient was referred to ambulatory care following a&#xa0;consultation.</p> Course <p>Four hours later, the primary care practice reactivated the emergency medical services. A&#xa0;subsequent in-hospital evaluation confirmed a&#xa0;non-ST-elevation myocardial infarction, with elevated troponin levels. Coronary angiography revealed a&#xa0;subacute in-stent occlusion of the circumflex artery, which was percutaneously treated.</p> Conclusion <p>This case illustrates that structured triage systems can only work as an effective safety net if all symptoms, including mild or nonspecific ones, are systematically recorded. In elderly patients with comorbidities, incomplete documentation can result in an underestimation of risk and delays in definitive care.</p>