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Paramedic Michael Carey, high on drugs and in desperate need of money, arrived at the accident scene on a highway near Modesto to find a 72-year-old woman in the car, bloody and unconscious.

Searching for identification in her purse, Carey came across the thousands Cleotilda Maria Arroyo had saved to purchase a house in Mexico - a powerful temptation for a man whose struggles with alcohol, pills and bills had left him bouncing checks, even for his state paramedic license.

Carey called for an air ambulance to fly Arroyo to the hospital and pocketed $6,100 of her cash.

With that brazen theft in June 2005, Carey joined a growing number of California paramedics, under stress with easy access to medication, who are abusing drugs and alcohol, statistics show, putting patients at risk.

In the worst cases, they are committing crimes, too: Driving drunk or high. Getting into hit-and-run accidents. Abusing patients. Stealing. Even injecting the powerful morphine they carry, replacing it with a saline solution and giving that to victims in pain.

Though the number of paramedics caught is not high, the stakes are because they treat people at their most vulnerable.

Margaret Ong, the recently retired emergency medical services manager for the Sacramento Fire Department, said cases like Carey's call for urgent action.

"We need to identify substance abusers and get them out of the system," said Ong, a former U.S. Navy nurse. "They are a danger to the public and a danger to society."

In the last two years, the state agency charged with monitoring and prosecuting substance abuse by paramedics has logged more than 65 drug and alcohol cases - up from only eight cases in 1999-2000, according to enforcement records obtained under the California Public Records Act.

The Bee's investigation included thousands of pages of California paramedic enforcement records, court and enforcement documents from other states, and dozens of interviews.

Yet official statistics represent a fraction of the cases because employers are not required to report paramedics who take medical leaves for substance abuse treatment. Others, The Bee found, are forced to resign and still more are never discovered.

The Sacramento Fire Department's months-long investigation of the theft of morphine from 43 sealed vials, for instance, ended in December with no perpetrator officially identified, though a captain retired rather than answer questions.

The 50-person state Emergency Medical Services Authority in Sacramento is struggling to keep up with the increased cases. A four-person unit there is responsible for enforcing all rules for the state's 16,000 licensed paramedics, who work for public agencies, private ambulance firms and even far-flung mining companies.

At the end of last year, 31 California paramedics were on probation for alcohol or drug problems, and another 18 with a history of substance abuse were working under provisional licenses. Yet before a recent internal shuffle at EMSA, a single state worker was responsible for overseeing such tricky cases - part-time.

Concerned about the trend, Dr. Cesar Aristeiguieta, EMSA director since 2005, recently began requiring paramedics arrested on suspicion of drug or alcohol-related offenses - even off-duty - to be evaluated by an addiction specialist. He wants to "intervene early on, try to salvage people's careers, and assure public safety."

These medical first responders - the heroes we count on to reach the scene first when we are at our most vulnerable - tend to be the last to seek help for themselves.

Former paramedic Richard Rolston recites a rescue professional's credo that turns dangerous for those with addictions - and those they rescue: "I can fix anything and everyone, including me."

Such bravado failed Rolston. During his 20-year career, he brought ambulance service to the 22,000 residents of the scenic Big Bear resort community in Southern California. He also suffered from pancreatitis and, for nearly a year, numbed his pain with at least 350 vials of morphine stolen from his fire department's safe, according to court records.

The Bee's Andrew McIntosh can be reached at (916) 321-1215 or amcintosh@sacbee.com.