He had already showered and taken the dog out for a walk by the time he realized the pain in his chest was serious enough to bother disturbing his wife, who was fast asleep.

After all, it was barely past 5 a.m. on the morning of March 18.

But by the time 81-year-old Robert T. Morgan of Edgartown wakened his wife Allouise, he was in dire medical trouble - a heart attack.

Mrs. Morgan remembers everything about that morning: the aspirin, the call to 911, the speedy arrival of police and the appearance not only of emergency medical technicians but also paramedics. If Mr. Morgan's heart attack had come just a few months sooner, there would have been no paramedic on the scene.

Put bluntly, no one would have given Mr. Morgan the medication that may have made the difference between life and death. After months in a Boston hospital and at a Cape Cod rehabilitation center, the well-known former county commissioner and state legislative liaison is up and walking.


"Without the medication, I'm not sure that we would have had a very good outcome," said Jeff Pratt, the head of the Tisbury Ambulance and one of 10 paramedics on the Vineyard.

It's a fledgling service, which started in January thanks to a concerted political effort by Island emergency medical technicians to upgrade their skills. Last year, voters in all six Vineyard towns also agreed to spend a combined $36,600 a year for the extra service. Towns also spent money to equip ambulances with heart monitors and special medications such as the one that was so helpful to Mr. Morgan.

Paramedics are trained in advanced life support and can perform two services that EMTs cannot. They can use an electrocardiogram (EKG) and they can dispense and inject drugs into an emergency patient.

"We can give them morphine for pain relief or medication to slow their heart rate down or rid fluid from their lungs," said Mr. Pratt.

Like EMTs, they can also communicate vital information to the doctors in the emergency room at the Martha's Vineyard Hospital, but now they have more data at their fingertips. And physicians can advise paramedics over the radio.

"The medics are just getting better and better," said Dr. Timothy Tsai, director of emergency services at the hospital.

Dr. Tsai said paramedics have been instrumental in several emergencies in their first six months on the job, including the Morgan heart attack.

And June was already a very busy month for EMTs and paramedics: a child run over by a car and a plane crash, among others.

But the bulk of the medical emergencies involve cardiac and respiratory cases. "We have a large elderly population here," observed John Rose, a paramedic who heads up the Oak Bluffs ambulance crew.


Time is critical, and so is cooperation.

"When you're having a heart attack, your heart is either dead or dying,"

Mr. Pratt said. "You're on the clock, and we have to play beat the clock."

The response works like a chain. It starts with a telephone call to 911. Police are often first on the scene, and they are all trained in cardiopulmonary resuscitation (CPR) and how to use defibrillators, which are carried in every squad car on the Vineyard.

This was the case with Mr. Morgan. Edgartown police arrived at his house three minutes after the call and immediately began both CPR and defibrillation.

Mrs. Morgan showered praise on Edgartown police officer Joel DeRoche, who performed the CPR. Some ribs were broken in the process, but it was a lifesaver.

"He was the hero," said Mrs. Morgan.

Then came EMTs and paramedics.

"When I knew we had a paramedic with us, I was so happy," she said. "Survivors of sudden cardiac arrest are less than 29 per cent."

According to the American Heart Association, the chance of surviving a heart attack increases from 40 to 80 per cent if a paramedic reaches a patient in less than eight minutes after a heart attack.

"The entire circle was involved," Mr. Rose said. "The entire team approach was the reason we had a successful call."

Mr. Pratt is also quick to credit the EMTs for their role. There are at least 60 EMTs on the Island. "We've always been and to this day are dependent on the volunteer EMTs. They are still the meat and potatoes, the most important part of the ambulance service on the Vineyard," he said.

Basic emergency medical technicians have received between 600 and 1,000 hours of classroom training. Intermediate EMTs undergo another 450 hours of training and are able to use equipment for intravenous access and endo-trachial intubation to improve breathing.


The highest level of pre-hospital care is paramedic, and Mr. Pratt and Mr. Rose are both pleased to see the Vineyard finally come into the fold of such medical protection. The payoff is a situation like the Morgans experienced.

When medics and EMTs wheeled Mr. Morgan out of his Pinehurst Road home, he was already breathing on his own. He was taken by a jet to Massachusetts General Hospital, where Dr. Timothy Guiney, a part time resident of West Tisbury and a renowned cardiologist, had already taken steps to reserve a room for Mr. Morgan, who is something of an Island legend for having served and chaired so many political boards and committees.

The former Army captain and World War II veteran had a rough road ahead of him. He fought off a case of blood poisoning and a bout with pneumonia before making it to the rehabilitation center in Sandwich.

"They were like miracle workers there," Mrs. Morgan said.

Mr. Morgan, who is still feeling some soreness in his chest and working on his balance as he stands up and walks, cannot remember anything about the day of his heart attack. That's probably a blessing, but he does know enough to be very grateful to everyone who helped rescue him.

"From what people told me, they moved their side of the world over to suit the Morgan family," he said. "It's so important to me that those guys and girls get noted. It was absolutely amazing to me."