In an emergency, we expect ambulances to be available when they’re needed. Today’s BBC investigation revealing seriously ill patients waiting more than an hour for an ambulance is yet another item on the yearly list of “winter pressures” leading to excessive waiting times.

As a working paramedic, I can offer some insight into the day-to-day reality of a system that’s constantly under pressure. Rest assured, your ambulance crew is not sitting watching reruns of Homes under the Hammer while your relative waits in pain. Most likely they went out on a job within minutes of their shift starting, and they won’t get back until 12 hours later. Whenever they deliver a patient to hospital or discharge them at home, there will be another job waiting. Calls to ambulance services have risen by an average of 5.2% each year since 2011. The flow never stops.

Demand almost always outstrips supply: there are more calls coming in than crews available to send out. In an ideal world, dispatchers would have some ambulances free, ready to send out to the emergency that’s yet to come in. The reality is a control room frequently playing catch-up, watching the incidents spread across the map like digital chickenpox and juggling a backlog of calls against the resources that will hopefully become available soon. Managing call volume and response is a kind of geo-mathematical puzzle – only with slightly higher stakes than the average game of sudoku.

The biggest drain on the ambulance service is the routine dispatch of emergency resources to non-emergencies. Government documents state that only about one in 10 of all 999 ambulance calls involves a time-critical medical emergency. Some people call 999 when they can’t get a GP appointment; others are sent our way by 111. Some people treat us as a “free” taxi service, a mobile checkup facility, or even a means of jumping the queue at A&E. In the week before Christmas, in over six 12-hour shifts, I can’t remember a single patient being ill enough to require a blue-light journey to hospital, and about half of my patients were left at home.

The official message is that you can’t second guess a patient; if someone reports chest pain, we respond as if they’re having a heart attack until we can prove otherwise. But what about the sick and vulnerable patients who get sidelined in the meantime? Just before Christmas, my crewmate and I were sent, consecutively, to two healthy young people with cough and cold symptoms; they had called 111 and triggered high-category responses based on the phone assessment. We gave them some advice and referred them to walk-in-centres – and were then sent to a man with dementia who’d fallen and hit his head, and had been lying on a hard floor for several hours.

With the growth in urgent care cases presenting via 999, the emergency call triage system is in need of reform. Telephone triage has many challenges: time constraints, panicked callers, misunderstandings, language barriers, and the fact the call-taker can’t see the patient. However, ambulance services need to understand why so many non-emergencies resemble emergencies at the call stage. Aside from giving call-takers more time, and involving clinicians in more calls pre-dispatch, one way of improving the system would be to audit telephone interactions against on-scene assessments and patients’ final diagnoses, to improve the accuracy and sensitivity of the initial triage algorithm. Initiatives such as the National Ambulance Data Set should facilitate such modification.

Delays at hospital present another challenge, and no one is more frustrated than the ambulance crews themselves. “Avoidable conveyances” – patients taken to A&E who might be better managed elsewhere – are a contributor to delays, but as the Carter review points out, often crews “don’t have … access to the right alternative health services, and taking the patient to A&E is the only option”. Work to increase alternatives to A&E is ongoing, but making referrals can still be arduous, especially out of hours. While working in the clinical area of the control room, I tried to refer an elderly lady to a community team. She required a routine medical intervention after a distressing hospital admission and her family were reluctant for her to be taken back to A&E. Ninety minutes, multiple phone calls to different teams and an emailed document later, I had made the referral but was unable to guarantee a visit, so had to advise a repeat 999 call if the wait proved too long.

Likewise, delays can be caused by a bottleneck further down the hospital’s admission – or even discharge – process. These are areas where an increase in investment, for example in social care packages that facilitate the discharge of medically well patients, or the provision of accessible alternatives to A&E, would surely lead to efficiency savings elsewhere in the system.

No one would ask a humble paramedic how to improve ambulance response, but perhaps listening to those on the ground would help make changes that just might save lives.

• Jake Jones is the pseudonym of an NHS paramedic who has worked on the frontline of the ambulance service for over a decade, and the author of Can You Hear Me? A Paramedic’s Encounters with Life and Death