A paramedic failed to check the pulse of a car-wreck victim who was presumed dead and left untreated before a medical examiner discovered she was breathing, officials said.

Erica N. Smith, 23, remained in the car's wreckage with a tarp over her body for more than an hour on Dec. 16 before she was taken to a San Antonio hospital. She died from her injuries the next day.

Paramedic Mike Gardner violated the Fire Department's operating procedures by judging Smith to be dead by looking at her and not checking her vital signs, officials said. Smith had suffered a severe head injury.

Checking for vital signs "is part of the protocol, and it's part of the protocol for a reason: To save lives," City Attorney Michael Bernard said Tuesday.

The city's policy calls for paramedics to check vital signs regardless of a patient's injury.

Fire Chief Charles Hood said "medical protocol was definitely violated in this instance. It was an error in judgment."

"I'm sorry for what the Smith family has endured, and I'm sorry for the mistake that was made on our part for the incident," Hood said.

In the days after Smith's death, Hood defended the department's response. At the time, he said paramedics had been unable to find Smith's pulse and that he didn't expect for the paramedics to be disciplined.

"We were assuming (they had checked for her pulse)," Hood said Tuesday.

Gardner, 35, has been transferred to the Fire Department's firefighting division and permanently restricted from working as a paramedic in San Antonio, officials 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.

Hood said the four paramedics were in the 21st hour of a 24-hour shift that began the previous day.

Chris Steele, head of the San Antonio Professional Firefighters' Association, said the four paramedics met with Hood on Monday and were aware of the disciplinary measures. He said the case had exhausted them to the point that they're "pretty much not emotional anymore."

City Manager Sheryl Sculley said the city would immediately implement additional training as a result of the incident.

The city's communication center also erred in its handling of the wreck, because a dispatcher miscoded the call as a non-high speed auto accident, officials said. If properly coded as a high-speed auto accident, emergency responders would have brought a ladder truck with equipment capable of removing Smith from the wreckage. The equipment wasn't dispatched until the medical examiner realized that Smith was breathing.

Smith, a senior at Texas State University, was the front passenger in a Honda Accord with two other people when their car was struck by a vehicle that crossed the Loop 410 median and slammed into the Accord head-on, police said.

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.

Smith's relatives said they're still upset with the city's handling of the incident.

"I'm very angry," said her father, Robert Smith. "It's a struggle, minute by minute."