It was a Wednesday morning, 0730 hours. Six men were gathered around the fire station’s dining room table; three were getting off duty and three were coming on. The shift preparing to leave — an officer, a driver/operator and a paramedic — was briefing their counterparts coming on.

The paramedic coming on duty, Tom, was one of those guys really into fitness. He had a muscular build — he’d tell you with pride his body fat was only 11% — and he was just 37 years old. He worked out every day and was the model of what weightlifting and constant attention to fitness can achieve. He also had an outgoing Type A personality. He always had to be the first and the best at everything, and he’d be quick to tell you how he’d do it.

That morning though, Tom was quiet. After the briefing he didn’t engage in friendly banter as usual, he just stayed to himself. The off-duty crew eventually filtered out of the room, leaving the on-duty staff in the dining area getting ready to eat breakfast before starting the day’s chores.

Even as the morning meal was being prepared, Tom said he wasn’t hungry. “Unusual for that eating machine,” thought the lieutenant, and asked Tom if he was feeling OK. Tom said he was fine, but the lieutenant wasn’t convinced. Tom was being uncharacteristically quiet, not eating … just not being himself.

The paramedic who had just ended his shift walked back into the room and sensed something might be amiss, too. He also asked Tom if he was feeling OK. This time Tom said he wasn’t feeling all that well and maybe they should check his blood pressure. The medic went to the apparatus bay and brought in the BP cuff.

As the cuff was being pumped up, Tom told those around him that in fact he was having chest pain and some pain down his arm. But it couldn’t be anything serious — he was just 37, for Pete’s sake, and look at him! The medic brought in the heart monitor and hooked Tom up. Then, bigeminy: For every normal beat, there was an aberrant beat from his heart. Not a good sign, especially when coupled with chest pain.

Tom started sweating profusely, complaining of increasing pain. The monitor displayed a change in cardiac rhythm to ventricular tachycardia, a potentially life-threatening arrhythmia. The crew realized they had a bad situation, and it was getting worse.

The paramedic, though, remained clinical in his approach to Tom’s increasing distress. He initiated Advanced Life Support protocols as dictated for someone experiencing cardiac-related chest pain. An IV was established. Oxygen was given by mask. Nitroglycerin, aspirin, morphine and lidocaine were administered. As the seconds ticked past, the dysrhythmia shifted to something resembling a normal rhythm. A subsequent 12-lead EKG suggested an anterolateral wall MI. Tom was having a heart attack.

The lieutenant called the battalion chief to inform him of the situation and requested an ambulance from dispatch. The ambulance arrived in only three minutes because it happened to be passing by the area. It took five minutes to load Tom into the ambulance and seven minutes to make it to the closest hospital. On the way to the hospital, Tom remained relatively stable, despite more PVCs and more pain.

As the ambulance crew and the fire crew that joined them in the back of the ambulance were in transit to the hospital, they called ahead to advise the hospital of an inbound cardiac alert patient. One bit of good news: on call in the emergency room that day was an old friend of Seminole Fire Rescue. Dr. “D” had been around seemingly forever and had treated many firefighters over the years as they arrived in his ER with traumatic injuries ranging from heat exhaustion to broken bones. Tom would be in good hands.

The ambulance arrived and Tom was transferred to a hospital bed and an immediate repeat 12-lead EKG was done. Tom was pale, sweating and in obvious pain. As the ER staff tended to Tom, the lieutenant started making phone calls, calling Tom’s family members to let them know that Tom was in the hospital. Just as the lieutenant got on the line with Tom’s wife, Tom groaned and arched his back, and his eyes rolled back. His arms tensed and his fists clenched. The monitor started to scream an alarm. V-fib! Tom had coded! Right in front of me and with his lieutenant on the phone with the wife, Tom was in cardiac arrest.

Electrode pads were already on Tom’s chest, but they were not attached to the defibrillator. I quickly moved to the unit at his feet and grabbed the cable. It took all my concentration to connect the leads. The nurse charged the device to 300 joules at Dr. D’s order. The lieutenant was trying to get Tom’s arms back down with one hand, while holding the phone to Tom’s wife with the other. “Let go of him!” I said, probably louder and more directly than I intended.

“Clear!” the nurse announced, and the unit delivered its charge. Tom relaxed and the monitor continued to scream in alarm. The display showed flat line and then … a beat … wide and slow, but a beat, then another and another. I felt for a pulse and sure enough, Tom was back!

Dr. D ordered Tom moved to the cath lab for emergency catheterization. The procedure revealed a 100% blockage of the left descending artery. A huge part of the left ventricle was starving for blood and oxygen. But the clot was able to be removed and the blood flow resumed. A dye test showed good blood flow past the blockage. Now all we could do was wait for recovery and followup diagnostic tests to tell how much damage had actually occurred.

The family arrived at the hospital, and others started to filter into the waiting room. Ambulance personnel, fire personnel, city employees and friends all came to provide support. One of our company officers was appointed as family liaison officer and was assigned to the family for the next 48 hours to make sure that anything they needed was taken care of. The union provided a catered dinner so no one had to cook. Eventually Tom moved from the cath lab to ICU, and the next day to a regular room. By late afternoon on the second full day, Tom’s cardiologist gave him the green light to go home.

I know Tom didn’t just dodge a bullet, he dodged a giant mortar shell! His excellent physical condition helped him to survive this episode. Anyone else may have been dead on Wednesday and buried later that week. But Tom can say he was dead on Wednesday and home by Friday.

Be prepared for the worst. Get fit and stay fit. The life you save may be your own.

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Michael J. Wallace is the assistant fire chief of the Seminole (Fla.) Fire Rescue Deaprtment.