Paramedics: Clear! Rulebook

Table of Contents

Table of Contents

• Object
• Set Up
• Playing the Game
  • Your Turn - Overview
  • Your Turn - In Detail
  • Critical Patients
• End of a Shift
• End of the Third Shift
• Scoring
• Variants

Object

Transport as many patients to the hospital as possible by treating their medical needs, within the time allowed on your turn, in order to gain points. Manage your time and resources carefully to avoid losing patients to the morgue, which subtracts points from your score. At the end of three Shifts, the player with the most points WINS!

Set Up

• Shuffle the Supply cards and the Patient cards to form their respective decks.
• Place the top five cards from the Supply Deck face up in a row to form the "Supply Row".
• Place five Supply cards face down at the side of the table to form the "Reserve Deck".
• Open the companion app / digital timer on your mobile device.

It is highly recommended that all players sit closely together, centered around the common play area.

• Each player takes an Ambulance player mat. In a 2-player game, players should use the "Rescue" mats OR the "Squad" mats, as noted at the top of the mat.
• Each player takes a set of Medical Supply tokens (2 Blood, 2 Syringe, 2 Oxygen, 4 Meds, 4 Bandage, 4 Casts) and places each type above the matching symbols on their player mat. This organizes them so you can quickly grab what you need during your Turn.
• Each player takes a set of Upgrade tokens (2 Extra Cabinets, 1 Medevac, 1 Hand Upgrade) and places them to the right side of their mat.
• Deal a five card hand to each player from the Supply Deck. You may examine your hand.
• Each player simultaneously draws two Patients from the Patient Deck, chooses one of them to place on their own Main Gurney and places the other face-down on the Back Up Gurney of the player sitting clockwise from them.
• Each player begins the game with two Medical Supply tokens of their choice; one placed into each open Medical Cabinet on their player mat. To make this choice, players should look at the Medical Needs of their face-up Patient on their Main Gurney and their hand of Supply cards. Blood, Syringes and Oxygen are more difficult to create, so they often make excellent choices. (more on creating Medical Supply tokens on page 6)
• Give the First Player token (First Responder) to the player who most recently sustained an injury - or otherwise, have someone volunteer. The token will not move during the game. Rather, the placement of this token will assure all players have had an equal number of turns.

Playing the Game

Paramedics is played over a series of three Shifts. In the first Shift, player Turns are 60 seconds long, the second Shift has 45 second Turns and the third Shift has Turns lasting only 30 seconds. The end of a Shift occurs when the cards from the Supply Deck have been exhausted. When the last card of the Supply Deck is drawn, the current player will complete their Turn before moving on to the next Shift. (Note: If the player who drew the last card needs additional cards to complete their hand, they may draw them from the 5-card Reserve Deck after Clean Up.)

The companion app is a digital timer, with a seperate timer button for each Shift (60, 45, 30 sec). Select the appropriate Shift, then activate the timer, pressing the medical symbol in the center of the screen. When activated, there is a five second period before a player's Turn begins. This period is called the "Clean Up" phase (page 7, #5). The screen will tell you to "stand by", followed by dispatch saying, "Rescue Squad, confirm and depart." Immediately after the word, "depart", a player's Turn begins and the timer begins its countdown. The screen changes to an EKG heartbeat graphic and shows the time remaining for the Turn. The current player begins their Turn by saying aloud the words at the top of their player mat. For example, "Rescue 24, 10-4".

The timer has an "Emergency Pause" button which should only be used to pause the game for rules clarifications, etc.

Your Turn - Overview

Once the timer has begun the countdown, do the following:

1. Fill your Main Gurney, if empty. (skip on 1st Turn of the game)
2. Flip over any face-down Patient cards you may have.
3. Treat Patients. In any order, you may:
   • Sustain Patients with Medical Supply tokens
   • Transport Patients to the Hospital (and immediately refill your Main Gurney)
   • Use Supply cards to create Medical Supply tokens (for placement on Patients or in Cabinets)
   • Swap Supply cards between your hand and the Supply Row in the Common area
   • Call for Assistance
   • Add Supply cards to the Upgrade area on your Ambulance player mat
   • Cash in Supply cards in your Upgrade area to pay for Upgrades
   • Call for Medevac and immediately Transport a Patient
4. Stop the Timer before it reaches "0" and shout, "CLEAR!". Press the center display to do this.
5. Immediately restart the Timer for the next player. Remember, this begins your Clean Up phase duties for the next player as well.
6. Once the next player's Turn has begun, refill your hand with Supply cards.
7. Un-tip your previously Sustained Patient cards so they are vertical, neaten your Medical Supply tokens, tidy up cards in your Hospital & Morgue and start planning your next Turn.

Your Turn - In Detail

1. Fill your Main Gurney, if empty. Your Main Gurney will be empty at the beginning of your Turn only if the Patient occupying it died on your previous Turn. To fill your Main Gurney, draw 2 Patient cards, examine them quickly to assess which you have more chance of saving (or which represents more points when saved) and place that Patient card face-up on your Main Gurney. You then choose any other player's open Back Up Gurney and place the remaining Patient card on it. If no other player has an open Back Up Gurney, discard the Patient card. (You do not place Patients on your own Back Up Gurney).

2. Flip over any face-down Patient cards you may have. Often, you will have a Patient card face down on your Back Up Gurney, given to you by another player. This is your first chance to see the Patient and their medical needs before having to quickly save them.

3. Treat Patients This is the bulk of your Turn and these actions can be taken in any order, as many times as you are able, within the confines of the time remaining. Any actions not completed before the timer runs out do not occur.

Sustain Patients with Medical Supply tokens This is the most important thing you do every Turn. Each Patient card must receive at least ONE Medical Supply token to Sustain them every Turn - or they will die.

The Medical Supplies needed are listed on each Patient card and they can be given to a patient in any order. Simply place a Medical Supply token on the Patient card, tip the card 20º to show it has been treated, and say, "SUSTAINED!" aloud.

Medical Supply tokens can be placed on Patients from storage in a Medical Cabinet - or as a result of creating new tokens through playing Supply cards (page 6). But - there are no short cuts. You must physically place all Medical Supply tokens on the Patient card or they do not count as having received them.

Transport Patients to the Hospital This is your ultimate goal for each Patient - but it requires forethought and good timing. When a Patient receives the last Medical Supply listed on their Medical Needs, they are stabilized and must be immediately Transported to the Hospital. Announce this by saying, "TRANSPORT!" and move the card from your Gurney to the right side of your player mat, which is marked "Hospital". A Patient card in the Hospital is worth the number of points shown next to the Beating Heart icon on the card. All Medical Supply tokens that were on the card are immediatley available for use again on other Patients. (Reorganizing them on your player mat is best left until your Turn is over.)

IMPORTANT! When you Transport a Patient from your MAIN GURNEY, you must immediately refill the Gurney by drawing 2 new Patient cards. Choose one to place on your Main Gurney and place the other on the open Back Up Gurney of another player (or discard it, as described earlier). Your new Patient MUST be sustained with a Medical Supply token during this Turn or they will die. So, manage the clock and your resources wisely. Note: Back Up Gurneys DO NOT need to be refilled when Transported.

Critical Patients

You can't miss these bright red cards. Unlike other Patient cards, Critical Patients cannot be Sustained from Turn to Turn. Critical patients must be given all the Medical Supply tokens they require and Transported to the Hospital - on the same Turn in which the player receives the Patient - or the Patient will die.

Critical Patients tend to be worth more points, but be careful in choosing them when filling your Main Gurney. You will have to refill it again this Turn when you send them to the Hospital. You may wish to give them to another player to deal with instead.

Use Supply cards to create Medical Supply tokens A player starts with two Medical Supply tokens, but most must be created during the player's Turn, by using Supply cards. Your Ambulance player mat has a chart showing the cost for creating any given Medical Supply. (Note: Each player's formula is unique.)

In the example, the player must play two Yellow Supply cards from their hand to make one Blood token. A Purple and Red card creates an Oxygen token. These first three types of supplies are more difficult to create. Meds only cost one Orange. The easiest to create are Bandages and Casts, as you have a choice of two colors to create the supply. A Cast costs one Purple OR one Green Supply card.

When created, a Medical Supply token may be placed immediately on a Patient card - or may be placed on any open Medical Cabinet, storing it for later use. (Reminder: 1 token per cabinet.)

Because of the fast pace of the game (and the resulting mess that can be created), avoid confusing 'played' Supply cards with any others on the table by creating a personal discard pile for Supply cards used this Turn. When your Turn is over, you can place these cards in a common discard pile for Supply cards, off to one side of the table.

Swap Supply cards between your hand and the Supply Row in the Common area Sometimes, your hand of Supply cards will not hold the colors you need to create a specific Medical Supply token. If this happens, you may do a one-for-one swap with a card from your hand with a card from the Supply Row in the common area. There is no limit on the number of cards or number of times a player may make this trade.

WILD CARDS: In the Supply Deck are 4 Wild cards. A Wild card may be used as any color card. If you hold a Wild card in your Hand, you may swap it for any two cards in the Supply row. Or if a Wild is in the Supply Row, you may swap any two cards from your Hand to pick it up.

Call for Assistance It occasionally happens that the color Supply card you need is not in your hand or available in the Supply Row for swapping. The life of your Patient hangs in the balance. You may call out to your fellow players for help. Hold up any TWO Supply cards from your hand and say, "I need a (color), STAT!" Other players may choose to trade the needed color for the two cards you offer, however, they are under no obligation to help. They would, however, end up with a larger hand on their Turn as a reward.

Add Supply cards to the Upgrade area on your Ambulance player mat Your Ambulance can be upgraded in three important ways- Extra Medical Cabinets, a 6-card Hand and the ability to Medevac Patients to the Hospital. Each upgrade is represented by a token and has a cost, as indicated on your player mat.

During your Turn, if you have extra time and Supply cards, you can start saving for future Upgrades by placing Supply cards of a single color on the spot marked "Upgrade Cards". Only one color Supply card can be stored here at a time (& may include Wilds). Though, you can always discard the cards from this space - or pay for an Upgrade and then switch to a different color. Once placed, you cannot use the Supply cards for other needs, like saving a Patient. You may hold the cards here and add to their number over Turns, until you wish to spend them on Upgrades.

Cash in Supply cards in your Upgrade area to pay for Upgrades On your Turn, you can pay for Upgrades using the cards you have stored. This may be done at any time, including after just placing Supply cards onto the Upgrade area. When you pay for an Upgrade, discard the appropriate number of cards from the Upgrade area and place the token of the Upgrade you paid for onto your player mat. You can make Upgrades in any order.

UPGRADES:

• Extra Cabinets (Cost 2): Each cabinet allows a player to store one more Medical Supply token. In addition, this Upgrade is worth one point towards victory.
• 6-Card Hand (Cost 5): After paying for this Upgrade, the next time the player would draw Supply cards, they draw 6, instead of 5. This is a significant advantage.
• Medevac (Cost 4): Potentially the most important Upgrade, the Medevac can be used to move any one Patient to the Hospital immediately, without the need of completing their medical needs. If paid for and unused at the end of the game, it is worth 2 points towards your victory. When used, remove the token from the mat. THIS UPGRADE CAN BE PAID FOR AND USED AGAIN & AGAIN.

Call for Medevac and immediately Transport a Patient As mentioned above, this Upgrade can save a life, when all else fails, so always look to see if the potential to complete this Upgrade exists when you are in a bind. When activated, say "MEDEVAC!" aloud, as you Transport your Patient to the Hospital. (Remove token until paid for again.)

4. Stop the Timer before it reaches "0" and shout, "CLEAR!" Failure to stop the timer and shout, "CLEAR!", before time expires requires the player to choose ONE of their Patients to send to the Morgue - EVEN if they had been Sustained during the Turn. If this happens, the Gurney does not refill until the beginning of the next Turn. (If you let the timer run out because you are unable to save one of your patients, you only lose one.)

5. Immediately restart the Timer for the next player, and perform CLEAN UP. Keep the pressure on the next player by starting that timer right away. It is the responsibility of the player who just ended their Turn to straighten up for the next player. CLEAN UP must be completed before the timer begins the actual countdown - a five second window. The player must neaten the Supply Row in the Common area, add cards if any of the 5 are missing or discarding cards of their choice if over 5. Collect and consolidate discards and otherwise neaten the play area. The active player can choose to move the timer closer to themselves if they wish.

6. (once the next player begins their Turn) Redraw Supply cards up to your current hand size up to 5 cards, or Upgraded 6-card Hand. Do not discard any remaning cards before redrawing.

7. Ready Patient cards by tipping them back up, neaten your Medical Supply tokens, neaten piles for your Hospital & Morgue and plan your next Turn.

End of a Shift

When the Supply Deck is depleted, the Shift will end after the current player finishes their Turn. Shuffle all discarded Supply cards as well as those remaining in the Reserve Deck and the Supply Row. Place five Supply cards aside as the new Reserve deck, deal all players enough cards to fill their hands and turn five cards face up to form the new Supply Row. On the timer, push the button for the following Shift to adjust the countdown clock. When ready, begin the next player's Turn.

End of the Third Shift

All players get an equal number of Turns. Shuffle the Supply Deck and allow play to continue until the player with the First Responder token is reached. (They do NOT get another Turn.) This ends the game.

Scoring

Any Patients still on Gurneys are discarded and do not count for scoring purposes.

• Players total the Heartbeat numbers on all Patient cards in their Hospital.
• Then, players subtract from that total the Toetag number on all Patient cards in their Morgue.
• Add any bonus points from your Upgrades.

The highest score WINS!

Tie breakers:

1. The highest count of Patients saved, minus the number of Patients lost
2. The most Critical Patients saved
3. The fewest Critical Patients lost
4. Share the honor of being a damn fine Paramedic!

Variants

• Custom Game Length: Play for 1, 2, or 3 Shifts. Custom Difficulty: Choose any combo of 60, 45 or 30 second Turns.
• Handicap: Experienced players may have an edge, so shorten the length of their Turns. Perhaps a 45, 45, 30. Or if they are really good, 30, 30, 30. Try distracting them. Misread their remaining time. Refuse them Supply card assistance. Deplete the Supply of colors they need. You know... remind them this is a Smirk & Dagger game. ;)
• Team Play: 4 players form two teams, sitting diagonally from one another. One team takes the Squads, the other takes the Rescues. Once per Turn, team members may swap a card from their hand for a color they need on their partner's Upgrade. Take the card from their Upgrade and place one from your hand face down in its place. Face down cards still count as the color your Team mate was collecting. BUT at least one card must remain face up of that color in order to swap. Scoring is based on cumulative Team scores.
• Solo Play: Play one shift, choosing a 60, 45 or 30 second Turn. Rate your score. 0-18: Rookie / 19-25: EMT Basic / 26-32 EMT Intermediate / 33-39 EMT Paramedic / 40+ Paramedic Specialist