"There are a number of accidents that have stuck with me"

St John intensive care paramedic Roger Blume knows not to let his emotions play any part in treating patients at the scene of car crashes.

He says even if paramedics knew the person they were trying to save they couldn't let it affect the job at hand.

"It is what it is, you can't change it.

Jonathan Cameron St John paramedics work at the scene of a double fatality involving three motorbikes and a van on State Highway 3 near Normanby in December 2012.

"Certainly I've seen more patients that I know in Taranaki in five years than I saw in Auckland in 16 years.

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"It doesn't change what you do, if it did change what we do, by providing a better service, that means we are letting all those other patients down.

ANDY JACKSON/Fairfax NZ St John intensive care paramedic Roger Blume.

"It's not very pleasant but it is what it is, this accident we didn't cause, whether we were on shift or not it was going to happen and there's a group of emergency services personnel who are going to respond to it and you try not to take it home."

The 44-year-old who began his career in Auckland in 1996 as a life support ambulance officer, qualified as a paramedic in 2000 and as an intensive care paramedic in 2002 before moving back to Taranaki in 2011.

He says traumatic brain injuries could be life changing and potentially a fate worse than death.

ANDY JACKSON/FAIRFAX NZ Emergency services work at the scene of a fatal crash involving a car and truck at the corner of Mountain Road and Te Arei Road, near Lepperton.

"Sometimes I'm not sure that we have done them any favours at all."

Blume says the first task was to establish the number of patients, severity of injuries and who needed treatment first, what resources were available and the suitable hospital destinations for patients.

"There's a lot to take in and decisions to be made - who we want out first and how quickly we want them out."

Andy Jackson St John paramedics treat a motorcyclist after a crash with a car at the corner of Magnolia Drive & Wallath Road in New Plymouth.

However, there were always unknowns including if a patient was taking prescribed medication that could react with other drugs they could be given and internal injuries or bleeding which could only be confirmed and controlled in hospital.

"Essentially, in good faith, based on the information we can see we need to ascertain the sickest and in the absence of CT imaging you are never going to get it one hundred per cent right, you work with what you have got at the time and it changes and sometimes we get it wrong and we make that change and re-prioritise and other times we get it right."

A horrific crash that killed two motorcyclists and seriously injured five other people near Normanby in December 2012 was one of the worst scenes Blume said he had ever worked at.

"It is one that sticks in my mind but there is a large number from my early days working in south Auckland.

"That kind of scene where you have got a large number of critically unwell people, you have got a lot of emotive people and you have got a lot of resources that you have to manage from all three services.

"The numbers were close to exceeding our capacity and there's a lot more to decide of who goes where and how than a simple single one vehicle accident with one occupant."

He says when working in those high pressure situations the key was to stay focused on the task at hand.

"It's rationalising that horrible things happen to people and we're in a role where we experience horrible things that happen to people and we need to separate our personal lives from our work lives.

"I guess fortunately the vast majority are relatively benign with minor to moderate injuries and critically injured or fatal accidents aren't the norm, but they are never very pleasant."

Blume says paramedics often have no idea what they'll find when at a scene so tried to arrive with no preconceived ideas.

"It depends on the informant and whether it's first hand or third hand, some of the more remote ones are often via a trucking radio telephone to a dispatcher who calls 111 really having no picture or being able to describe what they see and others we have far more of an idea of what we are going to.

"Then we need to account for everyone and in a vehicle when you have got unconscious patients who can't talk to us we need to search the scene to make sure people aren't down the bank or in the bushes having been ejected from the vehicle."

Blume encouraged drivers to obey the rules when behind the wheel this holiday period.

"I think life is full of choices but the decisions that they make, they probably have no understanding when it goes wrong of the impact it has on others and the life changing injuries people get from relatively benign moderate crashes."