SAN ANTONIO -- A paramedic was acting according to his training when he moved on to help other victims of a car accident without checking vital signs of a woman who appeared dead but was actually alive, a San Antonio firefighters association official said Wednesday.

Mike Gardner, 35, was transferred to the San Antonio Fire Department's firefighting division and permanently restricted from working as a paramedic in San Antonio Tuesday after not checking the pulse of Erica N. Smith, 23. Smith remained in the car's wreckage with a tarp over her body for more than an hour Dec. 16 before a medical examiner discovered she was still breathing.

She died from her injuries the next day.

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Protocol calls for paramedics to check vital signs regardless of a patient's injury.

Christopher Steele, president of the San Antonio Professional Firefighters Association, said paramedics are told in training that if there is "massive visual trauma," they can move on to other victims "in the initial stages" of an emergency operation.

Steele said Gardner observed "brain matter all over the place" when assessing Smith.

"Mike Gardner performed under current practice. ... I would venture to say that I can find 200 other paramedics that can say the same thing," Steele said. "We don't want to make excuses, because he really is emotional and he's sorry, but it's difficult from my perspective to let him solely take the fall when we know this is what we're trained to do."

But Donald Gordon, medical director for San Antonio Emergency Medical Services, said training for paramedics matches written policy.

"That's false. They're told always to check the vital signs," said Gordon, who has been in charge of medical training and medical direction for the San Antonio Fire Department for 21 years. "It's standard for every patient and it is done consistently for every patient."

Gordon said paramedics take a 40-hour refresher course every year, which every other year includes "pre-hospital trauma life support." He said Gardner attended at least two of the refresher courses.

"I have written policy that says determine" vital signs, Gordon said. "They're told the same thing in class."

"We're all very sorry for this incident," City Manager Sheryl Sculley said. "Our deepest sympathy and condolences to the family and friends of Erica Smith, it was a tragic and horrific accident."

Scully said training measures would have to be changed.

"We're going to improve and upgrade our training of the paramedics as a result of this incident, and also take a look at our dispatch," she said.

Steele said Gardner would not speak about the incident because of medical privacy laws, adding that Gardner is a member of the association.

"That was his patient, so he can't say anything about the case," Steele said. "Through me he is saying he's not allowed to comment."

A message left by The Associated Press for a Michael Gardner in San Antonio at a number from an online phone book listing was not immediately returned Wednesday.

Steele said Gardner arrived on the scene of the December accident with one other paramedic. Between the two cars in the accident, in which one crossed a highway median and slammed into the car in which Smith was the front passenger, there were four victims.

"Mike Gardner comes, he looks, he sees a female and ... he saw brain matter all over the place," Steele said. "He looked, he said, 'I can't do anything for her.' There's three more people."

"In any emergency there's a buildup" of personnel, Steele added. "People have the impression that there's an emergency and there's 10 firefighters there."

While Smith was left unattended, paramedics took the other two people in the car to the hospital with serious but non-life-threatening injuries.

The driver of the other vehicle, Jenny Ann Ybarra, 28, has been charged with intoxication manslaughter, police said.

Three other paramedics who responded to the accident have been demoted and stripped of their licenses to practice emergency care in the city, officials said.