There are times when all the hours of training pay off, when the brain and the hands work perfectly in concert on a specific task, as they were taught — even if you've never done it before in real life.

So it was Sunday for St. Paul firefighter and medic Jeremy Coy and his teammates, who brought a homeless man who had collapsed back to life by cutting a hole in his throat — right there on the sidewalk — so he could breathe.

"We all just kind of helped each other out," said Coy, a firefighter for eight years.

It was shortly before 5 p.m. Sunday when the 55-year-old man collapsed outside the Dorothy Day Center in downtown St. Paul. Police officer Nicole Obrestad was working off-duty at the center when she was alerted. The man was not breathing.

Obrestad called paramedics and was joined by two other officers, Edward Dion and Michael DeTomaso, who began CPR. They also tried the Heimlich and used a defibrillator. Nothing worked.

Coy and Jon Hall, the crew of Medic 8, along with a paramedic trainee, Dorwen Bishop, were returning to their downtown station when they heard the call. Within minutes, they were on the scene.

Joined by the crew of Engine 8, the team continued CPR — even using an automatic CPR machine. Still, the man was not breathing. He had no heartbeat. The firefighters tried clearing his throat, but food and other material blocking his airway was lodged too deep.

At that point, it was decided to create a surgical airway. Called a cricothyrotomy, it requires an incision into the trachea so a breathing tube can be inserted. As Tomo Klepp, a member of Engine 8, held the man's head, Coy used a scalpel to make the incision. Klepp then used a Sklar hook to hold open the trachea while a breathing tube was inserted.

Three minutes after the tube was inserted, the man was breathing again and his heart was beating. He was transported to Regions Hospital.

Coy, who is also a medic for St. Paul's SWAT team, had never done the procedure before — at least not on a live person.

"Only on rubber necks and cadavers," he said.

Capt. Ken Adams, coordinator of Emergency Medical Services for the fire department, said the procedure is rarely done — only once every seven or eight years in St. Paul, he said. Some paramedics will never need to do it. "The docs said it was one of the cleanest and best they had ever seen," Adams said.

"It takes a lot of courage, skill and pinpoint control to make a surgical airway," said Dr. R.J. Frascone, EMS medical director for the St. Paul Fire Department. "It went well. I am extremely proud of those guys."