A 56-year-old man living in a remote First Nations community presents to the nursing station with 45 minutes of crushing chest pain and an ECG showing 3 mm ST elevation in leads V1-V4. The community is accessible only by air; the nearest PCI-capable hospital is 3.5 hours away under ideal conditions. Weather is marginal and air transfer may be delayed. According to reperfusion strategies applicable in rural and remote Canadian settings, what is the most appropriate next step?