Ricky Badway was always smiling, laughing and cracking jokes. He was easygoing with simple tastes: golf, the New York Giants, the Yankees and U2. He worked at a car wash near his hometown of Phillipsburg, N.J., and was thinking about going to plumbing school. He was a big guy -- over 6 feet tall, around 200 pounds -- and, besides the occasional anxiety attack, healthy.

A few Saturdays ago, Ricky was lounging around his girlfriend's Roxborough townhouse when his heart short-circuited and went into sudden cardiac arrest. He collapsed to the floor, stopped breathing and turned blue. His girlfriend immediately dialed 911 and began performing CPR. Ricky desperately needed paramedics to restart his heart and get to the hospital. Under recommended state and federal guidelines, an ambulance should have been on the scene within eight minutes. But due to an overwhelmed and understaffed Philadelphia Emergency Medical Services, Ricky Badway waited 22 minutes. And then, he died.

The Fire Department refused to comment about the death, saying only that the incident is under investigation. And while a final autopsy report is still pending, paramedics interviewed for this story describe Ricky as the latest casualty of Philadelphia's severely distressed EMS system. In a recent cover story ["Emergency Breakdown," Mike Newall, May 12, 2005], paramedics detailed how mismanagement and a lack of resources were resulting in longer response times. They warned that the city was playing Russian Roulette with taxpayers' lives. Because of the meager number of ambulances dedicated to ever-rising medical emergency calls -- after 12 a.m., there are only 27 ambulances to cover Philadelphia -- the city routinely runs out of available ambulances, sometimes on a daily basis. All of Roxborough and Manayunk were left unattended at the time of Ricky's death. The ambulance that did respond sped nine miles to get there.

"People have no idea how badly broken the system is," says paramedic Lou Rosmini, a nine-year vet. "The stuff happens all the time but no one hears about it."

The city's numbers support Rosmini's claim. The survival rate of saveable cardiac-arrest victims -- otherwise healthy individuals, who, like perhaps Ricky did, suffer a sudden heart arrhythmia -- is considered to be the gold standard of measuring an EMS system's efficiency. Cities with the proper amount of resources dedicated to EMS save 40 to 45 percent of these individuals; Philadelphia saves only 4 percent.

"Borderline negligence," says Lori Moore, a national EMS consultant and assistant to the president of the Washington, D.C.-based International Association of Fire Fighters, who says that a city with Philadelphia's population and call volume should have 70 full-time ambulances.

The paramedics' complaints were highlighted in May when Danny Rumph, a standout guard at Western Kentucky University and a Mt. Airy native, collapsed after a pickup basketball game at the Mallery Recreation Center. He died while waiting 30 minutes for an ambulance to arrive.

The city promised to add eight new ambulances sometime this past summer, but it never happened.

"It's just like in New Orleans, where they knew the levees would break," says a 911 dispatcher who requested anonymity. "And they did nothing but just stand around wishing, praying and hoping against hope that it wouldn't happen. Now, another poor kid has the bad timing of having a heart attack when there's no ambulances available. It's a shame, but the truth is, the city will sweep it under the rug and nothing will change."

Paramedics recently sent every member of City Council a fax notifying them of the dire state of the EMS system. They say that not a single councilperson responded.

Fire Department officials contend that the new ambulances are tied up in ongoing legal battles concerning firehouse closings. But in the wake of Ricky's death, the department last week downgraded two ambulances from advanced life-care service (ALS) to basic life-care service (BLS), which means they'll no longer be staffed by paramedics but by lesser-trained EMT firemen. The department plans on further downgrades in upcoming months. They argue the BLS ambulances will free paramedics responding to some of the non-emergency calls that routinely tie up ambulances.

Paramedics scoff at the notion that downgrading service will lessen the strain on the system, arguing that BLS ambulances would be beneficial only if they came as additions to the existing number of ambulances. Already, say paramedics, ALS squads are being called to respond to some of the same calls as BLS ambulances since the EMT's can offer only the most basic treatment.

"All they are doing is eating up resources even more," says Rosmini, "and putting more people at risk."

Ricky and his girlfriend Erin Whitaker were supposed to be in Atlantic City on Oct. 22, enjoying the second evening of a weekend getaway. But having no luck at the card tables, they cut their trip short. They spent Saturday relaxing at Erin's house, watching television and eating Chinese takeout. It was a lazy night, rainy and downcast.

By 1 a.m., the five ambulances in, or near, Roxborough were either out of service or on emergency runs in other parts of the city.

"Dispatchers were desperately scrambling to get a squad back toward Roxborough," says one Fire Department Communications Center employee. "But it was too busy and there just weren't enough ambulances."

A few minutes before 1 a.m., Erin went up to her third-floor bedroom to brush her teeth. Ricky stayed behind in the kitchen to wash dishes. When he came upstairs, he was clutching his chest. "My heart feels funny," he said.

Thinking he may be having an anxiety attack, Erin told him to lie down, but Ricky collapsed. He managed to get up but collapsed again. He shut his eyes and turned blue. His heart needed a shock from a defibrillator. According to the American Heart Association, Ricky needed to receive the shock within four to six minutes for a good chance at survival.

Erin dialed 911. According to Fire Department sources, the police emergency communication center received the call at 1 a.m. By 1:02, a first responder fire engine was on its way. As the call taker walked Erin through CPR, dispatchers scurried to find the closest available ambulance. By 1:08, Medic Squad 22, which was coming out of Einstein Hospital, nearly nine miles away, picked up the call.

The first responder fire truck, Engine 12, arrived on the scene at 1:09. Firemen administered a shock to Ricky's heart, but he had no pulse; his brain was receiving no oxygen. According to MCP Hahnemann University EMS instructor Peter Cunnius, a cardiac-arrest patient who goes 10 minutes with no oxygen to the brain has a 1 percent chance of survival. At this point, says Cunnius, Ricky needed paramedics trained to intubate him with a breathing tube and administer drugs to chemically kick-start the heart. But the ambulance was still 13 minutes away.

Ricky's ambulance finally arrived at 1:22 a.m. Ricky's heart was struggling to beat on its own but too much time had passed with the heart and brain not receiving oxygen. His heart muscles had deteriorated beyond repair. Paramedics worked frantically but were unable to get a pulse.

Sometime after 2 a.m., emergency room doctors at Roxborough Hospital declared Ricky dead.

"I don't know if he could have been saved," says one paramedic. "But had medics been able to get there earlier they could have given a damn good chance. He was a young, strong kid, fighting to survive."

As they await the autopsy results, the family hasn't decided whether they'll pursue legal action against the city.

"Right now, I'm more angry with God that He took Rick away from me," says Erin. "But if it turns out the paramedics could have saved him, I'm going to be extremely, extremely angry."