First Page Critique: Inside Moves

By Mark Alpert

So far, 2017 has been a good year for the Alpert family. The big news here is that my son finished all his college applications. Also, the third book in my Young Adult trilogy is scheduled for publication in July. And I found some time over the holiday break to critique a first-page submission proffered by a brave, anonymous Kill Zone contributor. Here it is:


Inside Moves

Chapter One

The ambulance screeched around the corner—its light bar flashing and siren screaming—toward Santa Barbara General Hospital’s emergency-room entrance.

An older couple sitting on the bus-shelter bench at the corner was startled by the sounds of the vehicle, along with the knowledge of what that meant.

The man looked to be in his midseventies. He took the woman’s hand in his; she had been startled more severely than he was. “Sweetheart, since we’ve lived in Santa Barbara nearly all our lives, I’d say there’s a very good chance we might know whoever’s in that ambulance.”

But they didn’t.

Desperate to keep the man alive, EMT David Ortega kept his eye on the heart-rate monitor for any changes to Bobby Wainwright’s vital signs.

“We’re losing him!” he yelled to his partner, Tom, who pushed the accelerator of the ambulance.

David felt the ambulance lunge forward. Tom liked to drive fast when the siren and flashers cleared his path. Regaining his balance, David prepared to do CPR while speaking to Dr. Richard Kiersten through his headset. The doctor was standing by in the OR, awaiting their arrival at SBGH.

“Give him Narcan IC,” he instructed David.

David hated giving intracardiac injections because they could produce complications. Besides that, just the idea of stabbing someone in the heart with a long needle was ugly. But he did it anyway. With nothing to do but watch the monitor and the patient, David read the notes Tom had taken at the accident site.

“Bobby Wainwright. Just a few years older than me. Huh? Owner of Wainwright Erectors. Not from around here. Bet he makes a ton more than me. Accident on the job…Man, something really big fell on this dude.” Goose bumps jumped out on his arms. “No matter how much he makes, I sure don’t want to be him right now.”

At the emergency entrance, David and Tom prepared Bobby for the operating room and Dr. Kiersten. As David jumped out of the ambulance, he saw an elderly couple at a bus shelter watching him. The old lady looked scared to death. “Dear God, don’t let her suffer a heart attack before I get this guy into the OR.”

The first responders had brought Bobby to the hospital closest to the construction site where he had been injured. Right now, it didn’t appear that this hospital was close enough.


First things first: Whatever this novel turns out to be, giving it the title Inside Moves is a bad idea. That’s also the title of a 1980 film directed by Richard Donner, better known for his Superman and Lethal Weapon series (the poster for the film is pictured above). Although the movie wasn’t a huge box-office or critical hit, many film buffs (like me) still remember it, and when I saw the title of this submission, my first thought was, “Something more original, please.” Don’t get me wrong — allusions to familiar artworks can make great titles for novels, especially if the original source is the Bible (The Sun Also Rises) or William Shakespeare (Infinite Jest). But unless this submission is the first page of a novel about basketball, I advise the author to choose a different title.

(Side note: I can’t understand why so many writers – including well-known authors such as Jonathan Kellerman and Anne Rivers Siddons – have published novels titled Heartbreak Hotel. Wake up, people! Elvis owns that title. You’re merely renting it.)

Okay, on to the first sentence of the submission. I’m a big believer in “Less is more.” Every ambulance rushing toward a hospital has flashing lights and a screaming siren, so it’s redundant to mention these details. Better to change the first sentence to: “The ambulance screeched around the corner toward Santa Barbara General Hospital.” (It’s also redundant to mention the hospital’s emergency-room entrance. Where else would a rushing ambulance go?) If the author thinks this description is too spare, then he or she should add details that aren’t unnecessary. For example, maybe the ambulance rushed past a row of palm trees in front of the hospital, or nearly sideswiped a parked car. The aim here is to make the scene less generic and more interesting.

Regarding the elderly couple on the bus-shelter bench: are they going to be important to the plot? If not, why are they in the scene? Ideally, every detail in a novel’s opening scene should serve the story in some way. I suggested palm trees because they might flesh out the description of the setting (at least for people unfamiliar with Santa Barbara), and I suggested the sideswiping because it indicates either the urgency or carelessness of the ambulance driver. The opening scene in a novel is crucial – that’s where you’re going to either hook readers or lose them – so every word of those first few paragraphs should be chosen with care.

Speaking of which, I’m not crazy about the novel’s very first quote, made by the old man on the bench. It doesn’t sound like real conversation. He seems much too calm and reasonable for an elderly gent who’s just been startled by a rushing ambulance. Worse, his statement doesn’t sound truthful. Santa Barbara isn’t a small town — it’s a city of more than 90,000 people — so even if the old couple lived there for decades, they couldn’t know everyone in the city who falls seriously ill.

Yes, I’m being picky, but until the author gives readers a compelling reason to keep reading his or her novel, they won’t be tolerant of these flaws. If something in an opening scene doesn’t make sense, the typical reader is likely to close the book and look for another.

There are more flaws in the next two paragraphs. We learn the full name of one of the EMTs (David Ortega) but only the first name of his partner (Tom), which struck me as odd. We also learn the full name of the ambulance’s patient (Bob Wainwright), but that revelation comes several paragraphs before David reads this name in the notes about the accident. But these errors are niggling compared with the major problem: the scene doesn’t feel real. I’m not getting the details that would convey the urgency inside the ambulance. The scraps of dialogue (“I’m losing him!”) and description (“Goosebumps jumped out on his arms”) sound clichéd. I want to know, in gritty detail, what it feels like to stab a needle into someone’s heart. Do you have to aim to the left or right of the sternum? How do you know when you hit the organ? Is there a slight change in pressure as you push the needle through the pericardium? And what does the patient look like? Is he old or young, fat or thin? What parts of his body were mashed by the thing that fell on him? And how does David react to the gruesome injuries? Is he a consummate professional, or do fear and revulsion threaten to upend his composure?

At the end, the scene returns to the elderly couple on the bench. If they don’t know the patient, what role will they play in the book? Instead of giving me what I want – the visceral fear and alarm of the ambulance call – the author is showing me something that feels like a random distraction.

Fortunately, all these problems can be fixed. I got to know several EMTs when I worked as a newspaper reporter, and most of them seemed eager to answer questions about their work. (In particular, I remember an EMT in New Hampshire saying, “I’ve never pulled a dead body out of a seatbelt.” I think about that line every time I buckle up.) The author can get a ton of great details for this scene simply by talking to the right people.

So please don’t be discouraged! If you want some inspiration, read the opening pages of Stephen King’s End of Watch, which describes the ambulance run to the grisly parking lot where the Mercedes Killer has just plowed into a crowd of desperate people lined up before dawn at a job fair. King does a great job of conveying the horror of the EMTs as they try to save the lives of the mangled victims.

Any other thoughts, folks?

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About Mark Alpert

Contributing editor at Scientific American and author of science thrillers: Final Theory (2008), The Omega Theory (2011), Extinction (2013), The Furies (2014), The Six (2015), The Orion Plan (2016), The Siege (2016), and The Silence (2017). His latest thriller, The Coming Storm (St. Martin's Press, 2019), is a cautionary tale about climate change, genetic engineering, and Donald Trump. His website:

11 thoughts on “First Page Critique: Inside Moves

  1. Sorry to point this out, but this first page has been critiqued before on August 18 last year. It sounded familiar and I thought perhaps they had made changes since last time, but no. They must have submitted it twice. Still, good advice and more feedback couldn’t hurt.

    • Good, I am not crazy! Well, not entirely, anyway. I remembered this critique before as well. If I am not mistaken, the elderly couple was critiqued at that time as well. It doesn’t seem realistic. I think if you are going to include them, then establish their connection right at the start. Maybe have them in the ER rather than at a bus stop? Maybe to distract herself from worrying about her husband or whomever she is waiting for, she observes the other patients and sees him brought in and wonders if she knows him. Does he look familiar? Otherwise, omit them. Great points by Mark, some I didn’t catch. This is one of my favorite posts to read. I learn so much from the critiques and also from the comments.

      • It looks like there was a problem with our internal communications here at TKZ. I received this submission last month in an email, along with two other submissions scheduled for critiquing in 2017. I’ll check to see if the other submissions are also repeats. I didn’t notice that this one ran in August because I was on vacation then. Sorry for the confusion!

  2. I would ask an EMT about plunging a needle into someone’s heart while in an emergency vehicle speeding down the street.

  3. Re plunging the needle…I keep seeing that scene in Pulp Fiction where Travolta has to inject Uma in the chest after she has ODed. His terror is sooooo vivid in my memory even today.

    Here it is if you’ve never seen it:

    Regarding the submission in general: I don’t know whose story this is. As Mark said, why give the crucial opening-moments point of view to bystanders? And then we whiplash into a new POV of the paramedic. Is David the protagonist? I have to assume so. Lose the old couple, make this careening ambulance scene more visceral and focused on David’s emotions, and you might have a good opening.

  4. I would agree with every one of Mark’s comments. I would also point out the jarring POV shifts don’t do the author any favors. When the POV went to the elderly couple on the bench, I thought the story would revolve around them, but then they were abandoned in yet another shift back to the inside of the ambulance. As PJ says, lose the old couple. Then read the opening of END OF WATCH.

  5. I think the core problem is that the reader is pulled away from the real action several times – the old couple on the bench and David’s self-talk about hating this or looking at that. I did this job in the distant past when we still used old stagecoaches as ambulances, I can tell you for sure that your mind doesn’t wander when a patient is in distress. The doctor wants and cardiac injection, you do it. You think about it later. (Unless the order is ridiculous, then it’s a great inciting incident)
    My advice is stay inside the ambulance with the patient. Let Tom fill in the background like: “We are two minutes out from Santa Barbara General, but they’ve just gone on a divert so we have to go to Mission Terrace. You gotta keep him going another four minutes.”
    “No problem.”
    “Go for it Super David.”

  6. It’s been a long time since I was an EMT, but Narcan is (was?) a drug used to counteract the effects of opioid overdose. And given how difficult it is to establish an regular IV in a careening ambulance, the thought of using a cardiac needle (which was not a paramedic skill back in my day) gives me the willies.

    This piece would be much more effective if the author picked a point of view and stuck with it. The EMT in the back would be so focused on the patient–particularly if the patient was crashing–that he wouldn’t see anything beyond the inside of the box. And what does “losing him” mean, and how does the EMT know. Imagine an exchange that goes something like this:

    The ancient Ford chassis had the suspension of a stage coach. David kept his knees wedged against the rails of the stretcher and his fist wrapped around the Jesus bar just to keep from getting tossed to the floor. “Easy Tom!” he yelled to the driver. “You’ve got people back here, you know.” His words probably were lost in the yelp of the siren.

    His patient, a business owner named Bob looked like crap when they picked him up, and appeared to be heading south. Color had drained from his lips and his pupil reactions were sluggish. David cast his eyes to the EKG monitor and didn’t like what he saw. He pressed the transmit button on his headset. “Ambulance Two to Santa Barbara ER.”

    “Go, Ambulance Two.” He recognized Dr. Kierston’s voice.

    “I don’t like the elevation in this guy’s S-T segment.” It meant problems with the pumping chambers of Bob’s heart.

    The idea is to take us into the character’s world, let us see, feel and smell what he does. To do that, you’ve got to do research.

    Alternatively, if you want to avoid the weeds of the paramedic’s world, write the scene from the point of view of the driver, whose world view would be much different from that of the EMT in the back, and much easier to imagine without a lot of research.

  7. The main hospital in Santa Barbara is Cottage Hospital. Maybe there’s a good reason for not naming a real place, but for the love of Central Casting, don’t use something so cliche as “Santa Barbara General Hospital.” As a reader, I immediately check out when I read something so trite, and that was in the first sentence. St. Anne’s. Miller Regional Medical Center. ANYTHING but Santa Barbara General Hospital

    Agree with the other comments, especially about the old couple. If they don’t turn out to be a pair of killers hired to assassinate Wainwright, I don’t want to be bothered with them.

  8. I’m rushed today, and late to the party, so my only question, which is a comment in disguise, is, “Who the heck is the reader supposed to root for here?”

    I want to know who the protagonist is and more about why I should root for him.

    P.S. A good story question in the opening paragraph would be nice, too.

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