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GREG BARRON Let's take this step by step, and let's take the theoretical case of a patient who suddenly-- a person who suddenly collapses on the street outside of Dayton's on Wabasha. The ambulance is dispatched. And if it's a fire department ambulance, there'll be two-way communication with St. Paul Ramsey, where our doctors like Dr. van Tyne can be immediately available to them.

Dr. van Tyne, who's the head of our emergency room, is in charge of a group of full-time physicians who are there 24 hours a day. We have residents and interns and specially trained nurses and technicians so that an acute emergency can be handled here very promptly and with very high quality medical care. If the patient has had some difficulty with his heart or needs care en route, we have a certain number of fire department ambulances that are staffed by paramedics.

These are firemen who have been given a very intensive training program under the aegis of Dr. Brian Campion, the head of Cardiology. And these ambulances are equipped to tell a meter their EKG to a physician at St. Paul Ramsey, and treatment can be prescribed. And Dr. Campion can go into that in detail and explain how that operates.

ROBERT GUMNIT: St. Paul, Minnesota. Dr. Robert Gumnit, head of neurology at St. Paul Ramsey General Hospital. Each year, inevitably, some of us will find ourselves in need of emergency medical treatment, treatment for anything from a broken leg to a heart attack, the most dangerous frequent and critical emergency there is. In most communities and until recently in St. Paul, emergency treatment has meant the dispatching of an ambulance and the delivery of relatively simple first aid.

Once administered, the patient is placed in an ambulance and rushed to a hospital for comprehensive diagnosis and treatment. In most cases, this practice is enough. In many others, it is not. In the case of heart attack and other acute medical emergencies, every second counts, and intense medical care is needed as quickly as possible.

Residents of the city of St. Paul, unlike those living elsewhere in Minnesota and for that matter unlike most other places in the country, have the benefit of a highly trained, fully-equipped, 24-hour paramedic service. Recognizing the need for better emergency medical care, the service was inaugurated in late 1972 by the St. Paul Fire department working with physicians at St. Paul Ramsey Hospital.

Manning four specially equipped emergency vans are firefighters who have undergone an intense 640-hour medical training course, a course emphasizing emergency coronary care. It said the training represents the equivalent of two years of college study. Dr. Brian Campion, head of cardiology at St. Paul Ramsey, was one of the principals in creating the paramedic service, and he's in charge of training.

When he talks about the paramedics, he speaks with admiration and confidence. The paramedic system is really a total emergency system. We're not just interested in this area and people who have heart problems. Anybody who has a serious medical trauma cardiac emergency can be stabilized by these people.

And basically, when you get down to what we've attempted to do through this training is to enable the men to perform procedures that previously have been performed mainly in the hospital to stabilize the patient prior to his being transported. We're trying to avoid the idea of throwing somebody in the back of the ambulance and going as quickly as possible to the hospital.

SPEAKER 1: There is a very fine doctors have come a long way to discuss some new surgical techniques.

SPEAKER 2: It's a cold winter evening at Firehouse Four. I'd been assigned to spend as much time as necessary to record the paramedics in action. After introductions and as the men settled down for the evening, many to watch TV while waiting for the inevitable alarm, Phil Strobel, captain of the station's paramedic team, talked about the types of emergencies his unit responds to.

PHIL STROBEL: Just like an emergency room, you never know what's coming in. We have anything from a young baby that might be suffocating to an old man that has a broken hip, or a man that's had a heart attack, cut lip, cut arm, automobile accidents. Today, if I could just tell you, we had three automobile accidents so far, a man with two broken ankles and a concussion of the head.

We had a boy wrestling a student up at Johnson High School with a dislocated arm. We had a suffocated baby, one-year-old baby, that we assisted medic 14 with. And there were a couple more that I just can't remember.

SPEAKER 2: Captain Strobel and his men take pride in their skill. And according to the captain, they have yet to find themselves unable to cope with even the most critical medical emergency. Equally important, of course, is the equipment they have to work with. The paramedic emergency vans, unlike conventional ambulances, carries sophisticated electronic equipment and a comprehensive array of drugs and other medical supplies. After talking with the captain, Paramedic John Colonna offered me a tour.

JOHN COLONNA: First of all, the fire department has, at this time, eight ambulances. Four of them are paramedic units, and four of my regular ambulances, OK? All of the people on the fire department, all the firemen are trained in advanced first aid, OK.

All the ambulances carry equipment, of course, for transportation. They carry oxygen, and they have the capability of doing CPR, which is cardiopulmonary resuscitation. They can splint bones, stop bleeding. The men are trained in it. They carry that equipment, OK.

SPEAKER 2: Now, this unit is specially equipped.

JOHN COLONNA: Right. Absolutely. And since we do carry quite a bit of equipment, it's probably easier to talk about our equipment in two veins-- diagnosis and treatment, OK. So our first objective is to find out what the patient has.

To do this, we have various pieces of equipment. Number one, probably one of our most important, is our communications network for the hospital. We have a radio that's mounted in the ambulance and this portable radio.

With this radio, we can speak to our fire dispatcher. We can talk to the emergency room at St. Paul Ramsey. We can talk to the coronary care unit at St. Paul Ramsey. And we have a backup channel that we can talk to all three on should one of the other channels be cluttered with traffic. OK.

Then in addition to that, since we do transmit electrical information, which would be specifically electrocardiogram, we have four channels to transmit that to either the emergency room or the coronary care unit.

SPEAKER 2: How does that show up? In some sort of graph?

JOHN COLONNA: Yes, it does. OK. To do that, we go, first of all, to what's called a Lifepak 2. It's a piece of equipment that's made by Motorola. This is both a cardiac monitor in that it will show us a continuous picture of the electrical activity occurring in a person's heart. And it's also a defibrillator.

SPEAKER 2: OK. We have a heart patient in the back of the van now, let's say, and you would normally pull this open and out. It's a rectangular unit, like a small television set, really.

JOHN COLONNA: Right. When we go to a call, we calibrate this equipment with the hospital. The coronary care unit is notified on the air by us, and we send a calibration signal to them to make sure that our equipment is working properly and theirs is working properly. When we get there, besides taking a history from the patient that is asking them questions about where they hurt and how they feel, whether or not they take any drug, have allergies, who their doctor is, what hospital they go to, how long they've had it, that kind of stuff. Doing a physical examination, taking their pulse their blood pressure, listening to their heart listening to their lungs, making notes concerning whether or not they're diaphoretic, what color they are, and particularly whether they're flushed or cyanotic, whether they're blue indicating they're not getting enough oxygen.

We also take three, what we call, patches. They're pre gelled electrodes. They contain a jelly-type substance that increases or that decreases the resistance to electricity through the skin surface. We place these one roughly on each shoulder and one roughly in the center of the right side of the chest. OK.

From those, we go to what we call our patient cable, which has, of course, on one end three buttons to attach to the patches. And then it plugs into our Lifepak 2. Then we have a screen here that will show us a continuous picture of the electrical activity that's going on in the patient's heart.

The next situation is to get that to the hospital so the doctor can make good decisions on what he wants, what the patient has got, and what he wants done. So what we do is we have a small we call a 1-watt field telemetry transmitter that is at the patient site with us in the house. And all this does is transmit the electrical information from the patient site to the ambulance, where there is a booster radio that is a 80-watt transmitter that sends it to the First National Bank, and then by radio cable to the hospital. OK.

Now, the next thing we want to do concerning the patient's heart rhythm and its recording is to make a permanent copy because naturally, we take people to any reasonable hospital that they want to go to. The thing that generally determines it how far we'll go is if-- we're in this business to handle life threatening emergency, OK. If a patient has got the time to go to Stillwater Hospital to be treated, then it's not a life-threatening emergency. So naturally, we wouldn't go that far.

But we'll take them to any hospital in St. Paul. There are a few hospitals that don't handle emergency cases. We won't take them there. And to various hospitals in Minneapolis.

OK. The only people that have a permanent copy of what we're seeing, of course, is Ramsey Hospital because they have facilities at the other end of this transmission. They have facilities at the other end of this transmission to make a paper copy of it so that they can study it.

OK. So anyway, this machine then makes a permanent copy its heart rhythms the electrical activity. There's so many different variations that often they have to be studied very closely to determine exactly what the problem is with the patient.

SPEAKER 2: This is a separate unit now. It looks like a very large transistor radio actually. And there's a sheet coming out of it, a little graph sheet. And this is what you record the information on.

JOHN COLONNA: Absolutely. And not only does it enable us to determine what the problem is with the patient. We're all qualified to read these to very great extent. But we can also take this into the hospital. And we can show the doctor what problems the patient was having when we first got there, what the effects of whatever drugs we gave them had, and what the patient is doing right now. Even as we're walking in the door, they get an up-to-date electrocardiogram.

SPEAKER 2: This machine that's beeping is with you as you're walking through that hospital door.

JOHN COLONNA: Right. And this is beeping to Ramsey Hospital because the doctor at Ramsey that's handling it, whether it be in the ER or the coronary care unit, and it's generally in the coronary care unit if it's a coronary patient, is continuously monitoring this. And should anything happen even if we're in the doorway of another hospital until we turn that patient over to them, we treat them.

SPEAKER 3: MASH unit or an aid station. Come back to the front with us.

SPEAKER 2: My first evening with the paramedics was uneventful. There were no calls. According to the captain, that was unusual as the logbook usually shows at least 10 or 12 runs each 24-hour shift. I returned twice more, but on these evenings too, there was little activity. Calls were infrequent and involved relatively minor emergencies.

A drunk had passed out in a downtown bar. A one-year-old baby had fallen from her crib. She cut her forehead. And a young man had experienced an unexplainable dizzy spell.

Everyone assumed I'd return again, returned to record what they call a heart run. I was told that by witnessing the treatment of a heart attack victim, I'd be able to see the full potential of the paramedic's life-saving capabilities. So return I did.

My fourth visit began like the rest. Dinner at 6:00 PM, endless hands of solitaire, and the constant drone of the TV. Finally, one of the men started to kid me. He said, every time I was around, things got slow. He said maybe they should keep me around, sort of preventive medicine.

What we didn't know was that even as he spoke, a man on the far side of town was having a heart attack.

[BELL RINGING]

SPEAKER 4: A possible heart attack with a medic for coming in with you.

SPEAKER 2: All right. You heard it. We're with medic four on our way to what sounds like maybe a high rise apartment on Cleveland Avenue in St. Paul. Sirens are on. Signals are changing green for us as we proceed on our way.

This one's across town, and it's going to take us a little bit of time to get there there.

[INDISTINCT CHATTER]

SPEAKER 1: Why? If we have to use the disposable blanket when it happens if we go down the unit?

SPEAKER 2: Yeah.

SPEAKER 1: It's just this damn thing is just about as bad as you can get.

SPEAKER 2: Yeah.

[SIREN WAILING]

PHIL STROBEL: Medic 4 to Ramsey CCU.

[SIREN WAILING CONTINUES]

WOMAN (ON RADIO): This is CCU, Medic 4. Channel 5 is open.

PHIL STROBEL: Here tonight with St. Paul Fire. Medic 4 has a heart run at South Cleveland. Our run number 151, are you reading calibration?

WOMAN (ON RADIO): Calibration is good, I can tell.

PHIL STROBEL: 10-4.

GREG BARRON: What's this calibration you've just done here?

PHIL STROBEL: This, right now, this is the calibration. It's a signal that we send over our telemetry gear so that they know that our radios are matching with theirs.

[MACHINE BEEPING]

GREG BARRON: The radio equipment is hooked up to a defibrillator unit and a audio scope and readout mechanism that are capable of monitoring a patient's heart impulses and transmitting those impulses to Ramsey Hospital, where doctors there will be able to monitor and read the same readings they're getting here in the medic unit.

BRIAN CAMPION: We can break the course down, which is approximately now 640 hours of basic training, and then they have continuing education as well, into two components. One would be the emergency medical technician's course, where previously, an individual, well, let's say, who was losing a great deal of blood, might be put in the ambulance and run for the hospital.

Now, an IV can be started where the volume of fluid that he's lost may be replaced so that they can do a more creditable job of stabilizing the patient. The cardiac portion of the training is basically that of-- it's very similar to that of a coronary care unit nurse. In fact, it's a very nearly identical course.

Again, they can start an intravenous, they can give medications, they can use the cardiac defibrillator, all of course, any of these more sophisticated techniques, whether they are on trauma victims or on cardiac victims, are done with hospital communication and the care being directed by the physician.

GREG BARRON: The medics have moved into position here so that they can jump out of the unit very quickly.

SPEAKER 1: Next one, right off the--

[SIREN WAILING CONTINUES]

[RADIO CHATTER]

GREG BARRON: There's a conference in progress here. I can see four members of the unit confer and try to determine precisely where the address is before we get there, so we can get there in as little time as possible. Apparently, the area of the city we're in now is normally assigned to another paramedic unit.

And they apparently are out on another call, so we've had to cross town, a maneuver that does not usually take place. We've been on the road now for a total of about 3 to 4 minutes. I'm told that on the average statistics, over the last two years, have indicated that the medic units generally arrive on the scene within 4 minutes. Tonight, it'll be just a moment longer.

SPEAKER 1: Yeah, Cleveland's down on the end of the--

SPEAKER 2: It's at the end of St. Kate's here on the left, right?

GREG BARRON: In this case, there's a sense of urgency in the van right now. And as much as the dispatcher has indicated to the group--

SPEAKER 2: That's the light there.

GREG BARRON: --that we're dealing with a possible heart attack victim.

SPEAKER 2: This first light is Cleveland.

[SIREN WAILING]

GREG BARRON: All right, we've just found the street we're looking for, Cleveland Avenue. We see another emergency vehicle of some sort up ahead, lights flashing.

SPEAKER 1: That's where they said it.

GREG BARRON: We're about ready to disembark.

[RADIO CHATTER]

One of the members of the crew here has the defibrillator unit in hand, ready to go. We're going to just bail out now. Doors going open.

SPEAKER 1: This is it, here.

GREG BARRON: And out we go.

[WIND HOWLING]

It's pretty cold out tonight, sloshing through the snow into a three-story apartment house.

SPEAKER 1: What you got?

GREG BARRON: Down the steps into a basement apartment, and in we go.

SPEAKER 1: Want to move her over there into another room?

SPEAKER 2: Would you like us to get out of the room?

SPEAKER 1: Yeah, please.

SPEAKER 2: Come on, honey. Come on.

SPEAKER 3: Can we bring him out here?

SPEAKER 1: Are you getting a good exchange?

GREG BARRON: There's a man in his 60s lying on the floor in the doorway just past the living room area. There are two paramedics working on him right now. They're pumping his heart, trying to get it going. And it looks as though it's been determined that it is a heart problem. One of the men has suggested we bring him out into the living room. He's lying face up.

JOHN COLONNA: I suppose our biggest routine is set up around cardiac calls, probably our heaviest training was in that area, where we have kind of, divided up the duties where we all go in and know what we're going to do. I go in and set up the electrical stuff. And we all take turns asking the patient questions.

Bob usually does the physical examination, depending on who gets to the patient first by taking the pulse. He usually takes the blood pressure, listens to the heart and the lungs. And we feed all this information to Phil so he can make decisions. And he talks to the doctor and does the communication there and assists us if things need to be done in a hurry.

GREG BARRON: Defibrillator unit's come out. This is the unit with the scope and devices capable of monitoring any heart action.

SPEAKER 4: The veins.

SPEAKER 1: You want to open that up? Did you have any air at all? Any breaths?

GREG BARRON: The patient is being administered oxygen right now. And there are four, five men working on him right now. The captain has just asked one of his men to go out and get the victim's medical history from one of his relatives. The relatives have been asked to leave their apartment, and they're standing outside right now.

[STATIC MONITOR SOUND]

The sound you're hearing is the device monitoring the patient's heart.

PHIL STROBEL: On the count of three, hold CPR, one, two, three.

[HIGH-PITCHED SOUND]

Continue. Medic 4 to Ramsey CCU. Rudy. Rudy! Rudy!

SPEAKER 1: The captain's calling you, Rudy.

WOMAN: Yes.

RUDY: Yes.

PHIL STROBEL: How long ago was this guy breathing?

RUDY: How long ago was the last you heard of him breathing? When you're talking to him, was he conscious? How long ago?

WIFE: It happened just about 10 minutes, I think.

RUDY: About 10--

WOMAN: 15 minutes ago.

RUDY: Shortly about 15 minutes before you called?

WOMAN: No, no--

RUDY: Since then? All right. But--

PHIL STROBEL: Medic 4 to Ramsey CCU.

RUDY: Up till now about 15 minutes, probably 10 minutes before they came.

PHIL STROBEL: We're transmitting a patient rhythm. He's hooked up. Are you receiving? We're getting essentially flatline, possibly interpretated as a very coarse, very fine V-fib.

WOMAN (ON RADIO): I am getting asystole, Medic 4.

PHIL STROBEL: We're getting essentially the same thing. He looks to be in his 60s. We're gathering a history now of previous medical problems. We have an IV established. An airway is in. CPR is being conducted.

GREG BARRON: The man is in his pajamas. And they have his pajama tops pulled back. And one of the paramedics from another unit is pumping his heart. And a heart massage exercise is designed to get that heart going again.

WOMAN (ON RADIO): We are receiving your cardiac massage.

RUDY: No heart history.

SPEAKER 2: John, pinpoint.

JOHN COLONNA: Hey, hold it. Go ahead.

GREG BARRON: We've been watching the scope monitoring the heart action. And as you may have heard a moment ago, the little electronic dot going across the screen is essentially flat right now. The men are in communication with the hospital. And the hospital at this point is reading the victim's heart pulses by way of a transmitter connected from the unit in the apartment here to the hospital.

SPEAKER 2: Just a minute, John, here.

GREG BARRON: One of the medics has indicated to the hospital through the radio link that he'll get back in touch with them over standard telephone lines.

JOHN COLONNA: Did we have a-- let me see that.

SPEAKER 2: Yeah, let's put him on medication--

PHIL STROBEL: What do you want, Rudy?

RUDY: I'll get some of the medications.

PHIL STROBEL: Describe his pupils.

JOHN COLONNA: They are pinpoint. They're not fixed and dilated. We've got flat line.

PHIL STROBEL: John.

GREG BARRON: We're listening to one of the paramedics conveying the information on the scene here to the doctor at the hospital.

JOHN COLONNA: No.

SPEAKER 2: He has high blood pressure, apparently.

JOHN COLONNA: Oh, OK.

SPEAKER 2: Bicarb in, Rudy.

RUDY: The bicarb is in.

JOHN COLONNA: They want 400 Watt-seconds.

GREG BARRON: They're going to bring out the defibrillator unit. The doctor has apparently ordered the paramedics use the device to try and electronically shock the heart back into a rhythm.

JOHN COLONNA: There are two paddles located on the machine here, as you can see. They're probably 4 inches around, circular. And we can use these, first of all, for what we call quick-look paddles. Say, that the patient is in such condition that we don't feel we have the time to place patches on his chest, hook him up to a semi-permanent cable that's going to be there all the time.

We want to find out what his heart's doing right now. He looks in really serious condition. We can place these paddles on his chest, and it'll show us what his heart rhythm is. We can make a determination right then. They are also defibrillator paddles. And they will deliver 320 Watt-seconds of electricity to the patient, which is roughly equivalent to 6,000 volts for a fraction of a second.

Then the time that we use this is when the patient is in ventricular fibrillation, which is a condition of uncoordinated electrical activity, also uncoordinated heart muscle activity, which is not pumping blood. And that is the primary treatment for it along with a number of drugs that are given.

GREG BARRON: This shocks the heart and establishes a beat for it.

JOHN COLONNA: Hopefully, yes.

PHIL STROBEL: What do you think? Stand clear. Charged. Patient's been shot with--

JOHN COLONNA: 400 Watts-- 400 Watt-seconds.

GREG BARRON: He's being shocked right now. They just gave him the first pulse, and his whole body shocked in a convulsion here. You'll be able to hear the next shock by the sound of the tone.

JOHN COLONNA: Epinephrine. One intracardiac epinephrine.

PHIL STROBEL: We've got IVs going, as if you can still do it.

SPEAKER 2: Still do it.

JOHN COLONNA: Giving an intracardiac epinephrine directly into the heart.

GREG BARRON: All right, apparently, the shocking of the heart has not done any good. And they're about to inject a stimulant directly into the heart by way of a long needle directly through the chest. This, I'm told is done only when the victim is in a more or less hopeless state and for all practical purposes, dead, it's a last-ditch effort.

JOHN COLONNA: We also give inner cardiac drugs, which is--

GREG BARRON: Directly into the heart?

JOHN COLONNA: That's directly into the heart, through the chest wall. And it's on some of those that we have pre-loaded. It's a 3.5-inch needle. And let's see. I think all of these-- yeah, these are all covered. You can't see the needles. It's a 3.5-inch needle, and it is the drug is injected directly into the heart.

And that's done, in our case, only during one circumstance. And that's when the patient is already clinically dead. It's not the kind of thing that anybody feels. If they need an inner cardiac drug, it's-- the injection itself isn't going to hurt them a bit. They're not going to feel it.

GREG BARRON: It's a last-ditch effort to get that heart moving again.

JOHN COLONNA: Right, right.

Zyloprim, yeah.

GREG BARRON: Paramedic is now conveying to the doctor at the hospital the nature of the drugs that the victim generally takes. These were found in the medicine cabinet.

[RADIO CHATTER]

JOHN COLONNA: There you go. You got it? And your 30 epinephrine going in. It's in?

SPEAKER 2: Epi's in.

PHIL STROBEL: Give me a thump.

[POUND THUD]

GREG BARRON: And the medics just pounded the victim's chest with his fist. That was the sound you heard. It looks like they're going to try another shock with the defibrillator.

PHIL STROBEL: What'd you say, Rudy?

RUDY: In a position that I am--

[HIGH-PITCHED SOUND]

PHIL STROBEL: Charged. Stand clear.

[THUD]

Why don't you check his pupils--

GREG BARRON: That little pop you may have heard was victim in a convulsion with the electric shock. He convulsed so much that he knocked the oxygen mask off himself.

PHIL STROBEL: We're not getting anything.

SPEAKER 2: Still almost pinpoint, but they're not-- no reaction.

GREG BARRON: When you hear the-- as you listen to the tone, it indicates the pulsing of the heart. Now the variation in the tone you're hearing is due to the fact that one of the paramedics is pumping on the victim's chest. If and when you hear that tone go perfectly flat, it means that there is just no heart action, whatsoever.

JOHN COLONNA: 2/10 of a milligram.

PHIL STROBEL: 2/10 milligram of what?

JOHN COLONNA: A 2/10 milligram bolus a Isuprel, another bicarb, and as soon as we do about five CPRs after the Isuprel, he wants to shock him again.

GREG BARRON: These are instructions being relayed from the doctor at the hospital through one of the paramedics on the telephone here to the men who are working directly on the victim.

[CHATTER]

PHIL STROBEL: You got anybody on 4?

SPEAKER 2: What do you want?

PHIL STROBEL: Go up to the ambulance push the button for channel 4, and I'll switch to channel 4 in here.

SPEAKER 2: Make sure that it's on--

PHIL STROBEL: That's the telemetry now, not the-- Yeah, make sure it's on repeat also. Isuprel is going in.

JOHN COLONNA: 2/10 of a milligram.

PHIL STROBEL: Isuprel is in. You want another--

JOHN COLONNA: Bicarb.

PHIL STROBEL: Another bicarb.

GREG BARRON: The physician at the hospital is continuing to prescribe drugs. These drugs are being administered through an IV tube, which has been inserted into the victim's blood vein.

JOHN COLONNA: We carry various types of needles to start IVs and give drugs. And we carry IV fluid, which is intravenous fluid. But we don't carry it for intravenous feeding. Generally, what we use is D5W which is 5% dextrose in water. And we use this to establish a direct route into the bloodstream for the injection of drugs.

There's a rubber piece close to the injection site, and the drug is administered there. And then it goes directly into the bloodstream. Of course, it gets to the heart and to the brain and the places that it's going to affect a lot quicker than were it injected into the muscle.

PHIL STROBEL: Bicarb's in. I'm charging the paddles. How long he was down before we got here? I can find out from the-- we had another ambulance crew.

RUDY: About 10 minutes.

PHIL STROBEL: About 10 minutes before they got here? Charged.

GREG BARRON: They're going to give the victim another shock.

PHIL STROBEL: Stand clear.

[THUD]

400 given.

GREG BARRON: Oh, my god. It's a sight I've never seen before. The men here, of course, have gone through this many times. And they're very professional about it.

What kind of life is this?

PHIL STROBEL: Well, you see a lot of misery and despair, I suppose. But you-- I'm sure that most of the people that are involved in an emergency treatment situation, whether it's firemen or policemen or people that work in a hospital, look at the situation, not so much on a personal basis.

It's not a person by name and age that you're helping. It's somebody that's got heart problems, or it's a person that's having a gallbladder attack, or it's somebody that was involved in a car accident. And you're so concerned with finding out where they hurt, what's wrong, what can be done for them that the hospital knows what's going on, that the doctor's got adequate information to make decisions, that the things move smoothly, and that you get them to the place, to the hospital that can best treat them, where their doctor is, where their records are.

That most of the cases, you don't even think about, other than on a clinical, logical basis.

Yeah, OK, OK. Do you mean they want to take him to another hospital? I don't know. Can I have your name, Doc? Dr. Feliz, OK. I sure will. It's 10:45.

GREG BARRON: Apparently, no response.

[HIGH-PITCHED SOUND STOPS]

It looks as though they've given up. I'm not sure yet.

JOHN COLONNA: If he'd brought to Ramsey if that's possible, but I told them that we'd let them know either way.

RUDY: Well, there's a Dr. Altman, but he has a clinic downtown.

JOHN COLONNA: Uh-huh.

PHIL STROBEL: Is his wife out there? Who-- is that a relation out there?

RUDY: We've got-- St. Joe's would be--

PHIL STROBEL: Rudy?

RUDY: Yes.

PHIL STROBEL: Who are the two ladies out there?

RUDY: One is the wife.

GREG BARRON: We're going to just stand back here and ask questions a little later.

WIFE: Is he already--

PHIL STROBEL: Yes, it is, ma'am. It is. I'm sorry. We did everything we possibly could. We gave him drugs, and we jolted him. And his heart just wouldn't take it. He's just a straight line. We talked to a cardiologist at Ramsey Hospital. And we did CPR, and--

WIFE: Oh, my god.

PHIL STROBEL: Is there anyone that we could call for you?

WIFE: Well, a lady just went upstairs. And she's calling somebody. And my niece and her husband, they aren't home right now, but I'll call them. [SOBS]

PHIL STROBEL: Of course, there are always cases that get to you sometimes. I don't think there's anybody that gets so clinical in a job like this that when you get a little kid that's hurt, that you don't think about that afterwards, or sometimes the things you're doing for people just don't seem to help them.

You get somebody that's having a heart attack, and you do all the things that you think are right and that the doctor thinks are right, but people just don't make it anyway. And you wonder, what the hell? It just isn't working out this time.

SPEAKER 2: I got bicarb and a--

PHIL STROBEL: Usually what we do in a place like when there isn't a doctor in attendance, we'd have to call the police. Now the doctor suggested that if we took him down to Ramsey Hospital, at least the doctor would look at him and pronounce him dead, rather than have the police come and have the coroner come.

WIFE: All right. Well, whatever you think best.

PHIL STROBEL: I think that would be better for you, really.

WIFE: I just can't grasp it.

PHIL STROBEL: I know. I know what you're going through, ma'am. I really do.

WOMAN: She's a heart patient.

WIFE: I just had my pacemaker changed.

PHIL STROBEL: Well, that's the way God wishes it, I guess. There isn't much we can do. My wife passed away about three years ago. So I know what you are going through, ma'am. But I think that's the best. I think we'll put them on a stretcher and take them down to Ramsey Hospital.

WIFE: I'll be on the way.

PHIL STROBEL: No, no, you just stay. You're fine. But we want you to know what the procedure is. And otherwise, it just gets a little long. And this way, we'll take him down there. And then you can make the arrangements down there.

WIFE: Down there.

PHIL STROBEL: Rather than--

WIFE: When would I have to do that? Tonight?

PHIL STROBEL: Not necessarily, no. You can do it tomorrow morning.

WOMAN: You won't have [INAUDIBLE]

PHIL STROBEL: Yeah, maybe you could stay with your friend or something.

WIFE: My niece, she'll come here soon. My other friend's friend is here. Yeah, you better go home.

WOMAN: No, no.

PHIL STROBEL: Do you understand what we're going to do now?

WIFE: You're going to take him to Ramsey--

PHIL STROBEL: Ramsey Hospital.

WIFE: And then a doctor will check him over.

PHIL STROBEL: Yes, right.

WIFE: You know what happened? Do you know what happened?

PHIL STROBEL: No, we don't. Right now, we know that his heart stopped. Evidently, he did have a heart attack of some sort, just like that. Yes, ma'am. And there's nothing that-- we gave them every possible drug that we could to revive the heart. And we gave him CPR and everything that they would do at a hospital. And he just didn't respond to the drugs.

WIFE: Mm-hmm.

PHIL STROBEL: We counter-shocked him also, which stimulates the heart, which you would start it beating also. And this didn't start it back up either.

GREG BARRON: Well, we're just going to have to leave them be. The voice you heard was the voice of the captain talking to the-- talking to the victim's wife. [SIGHS] Well, a tragic end to a very dramatic scene, a scene that's repeated, I suppose, all too many times, this, and they did what they could.

Captain Strobel, that incident took place several weeks ago now. And I'm still not sure what to make of it. When I became involved in the story, frankly, I assumed I'd be able to show the listeners how, because of your training and equipment, you're able to save lives and otherwise hopeless situations. But the man died.

And I can't pretend that it didn't happen. So what do I tell the listeners? Is this a story about the paramedics and how they save lives, or is it a story about the inevitability of death?

PHIL STROBEL: I think it's a little bit about both. I think it's about life in general because we aren't made here on Earth to live forever. And I think that's part of our daily bringing up. At least we're so conscious of this. Every day, we see little children get killed in automobile accidents, and we ask ourselves why.

And I think when we see smaller children that they've never had a chance, that really has to hurt. There's no chance that we can help them whatsoever. And yet, we do the best we can. We don't play God. We have intelligence, and we have training. And we do what we're told, more or less.

And if this is-- you may think that-- this is-- I don't know how to explain it. But I really believe in God. I believe there's a supernatural power bigger than myself. And I think if you are a paramedic, you have to believe this. I think that because we see sometimes He takes someone that we don't feel should go. And then again, He lets someone live that should have died maybe 15, 20 minutes before we arrived.

And you talk about, is this death, or is it life? We can't say. We just can't do that. When we save someone, we actually don't do it. It's our knowledge that-- we pump in the drugs, or we stop the bleeding, or we give them mouth to mouth. I don't think that's really the answer. I think that God lets the person live or die.

GREG BARRON: Yet some people say, look at these paramedics, the equipment and the training. The stories that are written in the newspapers about the paramedics, most of the time when we hear about them, we say, look how many lives these people save.

PHIL STROBEL: That's true. I don't belittle our paramedic program. In fact, I think it's the greatest thing that's happened to this community, and we can get there. But we don't play God. If we can get there and save a person's life because he's bleeding or having a heart attack, certainly, that's wonderful. And these are the stories that we hear, and these are the stories that we like to see.

But when a person does pass away, we can't stop doing the good work that we do. If we did that, then I don't think anybody would be in any type of program. A doctor would quit surgery. I happen to have gone through some traumatic experiences personally. My first wife had cancer. And I had a heck of a time living with that until I gave that problem to God. And once I did, it was easy to accept death, then.

And I think no one wants to look at death because we're so wrapped up in material things and whatnot here. That that's what we should every day look and live that day as it comes.

GREG BARRON: So you do what you can, and you leave it at that?

PHIL STROBEL: That's right. I think there's a prayer that they call it the Serenity Prayer. Lord, grant me the serenity to do the things that I can do, the courage to accept those that I can't, and the knowledge to know the difference. That's what it's all about

[SOFT MUSIC]

GREG BARRON: Anybody who has a serious medical trauma, cardiac emergency can be stabilized by these people.

WOMAN (ON RADIO): I am getting asystole, Medic 4.

GREG BARRON: That shocks the heart and establishes a beat for it.

JOHN COLONNA: Hopefully, yes.

GREG BARRON: Oh, my God.

JOHN COLONNA: Sometimes the things you're doing for people just don't seem to help them.

PHIL STROBEL: We aren't made here on Earth to live forever. I wonder, what the hell? It just isn't working out this time.

GREG BARRON: So you do what you can, and you leave it at that?

PHIL STROBEL: That's right.

[UPBEAT MUSIC]