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Designer:  Gary Kagan   Artists:    Curt CovertGary KaganEric Wilkerson

Published by: Smirk & Dagger Games. 1-4 players aged 14+  App required for total involvement.

With more and more games turning to Apps on phones and pads for player assistance, I remembered this classic game from 2017 which I reviewed way back and now think it should be once again in the gamer's eyes. 

I have taken new photos of the game for this page but the bulk of the text is as it was in 2017, edited where necessary based on more recent game sessions. 

Gary Kegan has created a near perfect family/gamer board game for 4 players and he has chosen SMIRK & DAGGER to produce and publish it. This isn't a game in the genre that people generally relate to Smirk & Dagger games, which means players who purchase/play games based on the publisher/designer rather than giving anything a chance may possibly miss out on this gem.We all know someone like that, someone who will buy a game simply because "It's a game designed by [designer's name] so it must be good" or "This [Company name] always makes good games so I have to have it, even though it costs £150.00" These are players who often never play some of the greatest [independent or mainstream] games simply because they, for whatever reason, do not like the designer or the company.

I have nearly fallen into this trap myself. In the late 80's I played a game from a mainstream company whose other games I had already admired but this time it was a new, to me, designer. The game was - in my opinion - awful and I took note of the designer's name. After this I was wary of anything with their name on it, right until I went to introduce one of my favourite games to some new friends and realised that the designer of this game was the same person who designed the "awful" game. Since then I have judged games on merit, enjoyment, playability etc, but always giving my own opinion; if I like a game I don't mind saying so. I like PARAMEDICS CLEAR a lot.

The components are two decks of cards, one with regular sized playing cards and the other being the 50% size cards. Then there are four Emergency Service Vehicles represented as Player Boards: "RESCUE 47 - 10-4"; "RESCUE 53 Responding"; "SQUAD 24  ROLLING"; and SQUAD 34 CONFIRMED" plus there are 4 sets of small round counters to represent the Medical Supplies, 4 sets of square counters for Upgrades and a 1st Player Token (an oblong tile with an Ambulance illustration). Smirk & Dagger have done a more than impressive job on the production quality. Choose a player to be 1st Player, give thme the Ambulance card and away you go, out into the wild, wild streets  where accidents happen with amazing regularity.

What you also need, which is not noted on the front of the box but is clear on the box underside, is the ability to download and use a Free App. More on this in a moment.

PARAMEDICS CLEAR is a hoot. Each player has to look after two patients at a time, most of the time, getting them the expert attention they require to survive. As the game goes from one level to the next the speed increases from crazy through to manic, with insane as the filling in that sandwich.

Each player takes one of the Player Cards and a set of both lots of counters. The round supply tokens are positioned above their illustrations on the board and the square upgrade tokens are placed to one side - you have to purchase these. The small card deck is shuffled and put in the centre of the table, leaving room for 5 off the top to form a face-up display, 5 others are placed face down to one side, these cards, called the Reserve Deck, are to be used only if necessary for the final Shift (the game is played in three progressively hectic shifts)..

The Free App takes up very little space and is quick to load and install. Once you have this on your phone or Tablet (as this is a medical themed game using a Tablet is more in nature with said theme) you can keep it there, you do not have to load/install every time you play. The App is the crux of the chaos.

Now you are ready to start playing, almost. Deal two Patient cards (from the large card deck) to each player. They look at these and then place one face up in the space on their board which says "Main Gurney" giving the other card face down to the player on their left to place in their Back-Up Gurney space - this remains face down for now. Deal five supply cards to each player, let everyone select 2 free Medical Supply tokens and place one in each of their board Medical Cabinets, and then pass the Tablet (App) to the First Player. The game begins the moment they press the Start button for the opening Shift - the clock starts ticking.

The first thing is to flip over the Patient card in the Back-Up Gurney space. Now unless one of the Patients on their display is a Red Bordered "CRITICAL" the player has to administer at least one of the required Medical Supplies to each of the cards thus sustaining the Patient's treatment for the turn. You may, if you have or can create the necessary Medical Supplies, completely sustain the Patient and drop them off at the hospital where they will get better and survive - the Hospital is the right side of your board (off board). If the Patient is "Critical" you must fully sustain them immediately or else they die and go to the Morgue (left side, off board). At the end of the game Patients in your Hospital count Positive Points and those in the Morgue score Negative Points, obviously the most successful Emergency Crew are the winners.

The game is played over 3 Shifts, designed to each go faster than the previous to represent the pressure and speed under which Paramedics have to work. The Shifts end when the Medical Supply deck is exhausted and the player who drew the last card has completed their Turn. For the first 2 Shifts it doesn't matter whether each player has had the same number of turns because the First Player token never moves and the game ends on the third Shift when the supply has expired and the turn has got back to the original First Player - then all players have had equal turns, full stop!

The mechanics of the game are simple. One, flip over the card on your Back-Up Gurney, 2, use the cards in your hand and/or the Medical Supplies in your Medical Cabinets, to sustain or save your Patients - if you do not complete the medical supply list for the patient they stay with your Vehicle under your administrations as long as you give them at least one Medical Supply that they need each turn. If you cannot give them a Medical Supply they die, even if you have sustained them for the past 2 or 3 turns and that hurts - not just the Negative points you are going to get but the fact you wasted all of those supplies and didn't save the patient.

I mentioned the Medical Cabinets and the fact that you get two free Supplies, one in each, at the beginning of the game. You can buy extra Medical Cabinets (up to 2) which will not only allow you to store additional supplies but are also worth one VP each at the end of the game. To buy the upgrades you need to use supply cards of the same colour, 2 for each Cabinet, 4 for the Medevac Helicopter (also worth VPs at the game's end) and 5 for the ability to hold 6 supply cards rather than five. Patient cards have some truly amusing illustrations as well as showing (down the left side) the number and type of Medical Supplies required and the number of VPs that can be gained or lost shown brilliantly as a Heart with the ECG wavy lines or the soles of two feet with a Toe-Tag.

You can spend cards straight from your hand to buy supplies, as long as you have the supplies available and you have the correct colour of supplies required - each player board has a similar layout where the supplies cost the same number of cards but in different colours. You can also buy the upgrades with cards straight from your hand but as this is quite awkward and liable to kill your patients, or at least one of them, so there is a space where you can place cards to spend in other turns; the only problem with this Upgrade Card space is that it will only accept cards of the same colour, not that this is a problem because there are no colour restrictions on buying upgrades; you just must have the required number of cards and they all have to be the same colour. When you buy upgrades they are kept throughout the game, with the possible exception of the Medevac. You can use the Medevac Helicopter to carry a patient straight to hospital without having to first sustain it, but if you do the Helicopter (and thus the bonus VPs it is worth) are removed from your board - of course you can purchase it again the next time you have the correct number of cards


So you have flipped over the Back-up Gurney patient, used Medical Supplies to sustain both patients and you still have some cards left in your hand. If you haven't got the colour you want there might be one in the open display that you can exchange one (or more) of your cards for - the swap is one for one unless you have one og the 4 jokers in the pack in which case you can swap one of these in for any 2 cards or if there is one in the display it costs you 2 of any cards to take it; Joker cards count as one card of any colour. Or, and good luck with this if your fellow players are anything like the one's I play with, you can swap 2 cards from your hand for one that you want, if another player will take the deal.

This all sounds so easy to do, but the pressure mounts continually as the speed of the game increases and the time between patients dimishes.

At some time (hopefully many times) you are going to fully sustain the patient in your Main Gurney. This is both good and a pain because the moment you save a patient on that Gurney another one will jump onto it. Not, as you may expect the patient on your Back-Up Gurney but instead you draw 2 patient cards, select one to place on your Main Gurney and then you can place the other one face down on the Back-Up Gurney of any other player (except your own) - if no one has an empty Back-Up Gurney then the card is discarded. Of course you now have a patient on your Main Gurney who has yet to be treated, thus you need to sustain them with at least one medical supply or they immediately die - the good thing is that if a player on your Main Gurney dies you do not have to replace them until the beginning of your next turn.

One of the silly (but fun things) about the game is that when it is your turn you are supposed to shout out loud the name of your Vehicle; other times you will be shouting "CLEAR" or "TRANSPORT". etc. Shy or easily embarrassed players may wish to skip this bit, but it's all part of the fun and it adds to the pressure, chaos and panic this clearly evil-minded game presents.

Now for the part of the game which, as I said earlier, is the crux of it and yet it is the part which I suggest you do not use until you are truly as one with the game mechanics. The, previously mentioned, Tablet App, is what I am talking about. The App is a killer and after it kills you on the first Shift, it does it quicker and with more fury in the Second and then the final, Third, Shift. The first Shift begins when the Start button is pressed; your Turn lasts 60 seconds and you are supposed to finish all you need to do within those 60 seconds, in fact and actually prior to those 60 seconds expiring - extra/over time costs you dearly. The Second Shift has Turns of 45 seconds and the final Third Shift is in sections of 30 seconds.

The heat is turned up as you continue to play. Using the App/timer is hilarious and that means it's time for the other players to tell jokes, take the "P" etc so that you cannot concentrate on what you should be doing unless you are playing with nice and polite opponents - yeah right! In the 5 seconds between the end of your turn and the beginning of the next player's turn you have to tidy up the table; have you any idea how fast 5 seconds passes when you are under pressure? Thus I really say to you that as it is such an enjoyable game you really should play it without the Timer to begin with. Once you know what you are doing, having played it 4 or 5 times for example I guarantee that if you include the App the next time you play it will seem like a whole new experience, a brand new game.

We have played PARAMEDICS CLEAR numerous times since I first wrote this review and recently I have started winning because I am too conservative. I tend to use my Supply cards to continually buy Supplies whereas the winner of our games, most times out of lots, is the player who takes a risk and regularly buys the upgrades. I am so worried about killing patients off that I play to keep them alive not bothering about what their VP value is. It seems that it is advisable to let Patients die who will only lose you one or two VPs when they kick off this mortal coil. Our groups have been made up of men and women with an almost teenager (and an actual teenager) and even though the game is aimed at 1-4 players aged 14+ the younger players understood the rules and the mechanics, and in fact, the game itself.

I happily recommend PARAMEDICS CLEAR for all players who enjoy a good, decision making, fast-paced game, but do look around for the best price because I have seen it online from £25.00 to nearly £50.00.  

I have already credited the designer and publisher but there should be  a really good "hooray!" credit for the Patient Accident illustrator, Khoon Lay Gan




© Chris Baylis 2011-2021