Paramedic Ian Whittern admits that at the end of a 12-hour shift (which has already rolled into its 13th hour), he feels a little weary. He ought to be. Over the past two days he has dealt with the victims of road accidents, strokes and a mugging.

He has driven patients into hospitals while the computer screen on the dashboard of his rapid response car flashed the grim news that there would be no beds available once he got there; he spent a frustrating two-and-a-half hours trying to sort out food, drink, gas and electricity for an elderly person because over the weekend no other carer was available to do the work. And one patient died despite his best efforts to save him.

Like most paramedics, Whittern turns up early to check his vehicle and equipment, knowing that as soon as his shift actually starts he will be off on a job, and almost every workday overruns, sometimes by as much as two hours. His first break for a cup of tea on Saturday came at 3pm – seven hours into his duty.

“It is hard, there’s no doubt about it, and getting harder all the time,” said Whittern, who is based in Bristol and works for the South Western ambulance service (Swas). “The pressure is growing. There aren’t enough paramedics and as the NHS becomes more broken up, more fragmented, we are left to pick up the pieces. When there’s nobody else to turn to, we get the call even if we’re not the people who should be dealing with an incident.”

Facebook Twitter Pinterest From April to November last year, A&E incidents in the South Western Ambulance Service’s area were up 9% compared with 2013. Photograph: Demotix/Corbis

The focus of the health crisis over the past fortnight was A&E departments – as hospitals across England declared major incidents because of the surge in patients arriving at their doors. But the pressure on ambulance crews has been extraordinary. Across the country, crews have been working extra shifts and extra hours. The Red Cross, St John Ambulance and firefighters have tried to help reduce the burden on ambulance trusts but bosses – already having to explain why they missed response targets in November – concede the statistics for December across England will make ugly reading when they are published later this month.

Whittern, 48, who has worked for the ambulance service for 20 years, said he and his colleagues were the busiest they had ever been. “We end up doing the job community nurses or social services really should be doing – making sandwiches, brewing cups of tea for people who have nobody else.”

He is a union official but does not attack the management or the trust. “They are all doing their best but the whole NHS system is grinding to a halt. It’s no wonder that it’s a struggle to get new paramedics and many are leaving. We don’t do this job for the money but because we love to help people but it’s becoming so challenging.”

Staff are doing their best but the whole NHS system is grinding to a halt

Other paramedics say they are worn out. Neil Grigg, a paramedic and operations officer based in Devon, said the whole system was creaking. “Demand is going up year on year. My staff are still fantastic but they are tired.” A paramedic from Cornwall, who asked not to be named, admitted that he found himself sobbing in his cab a few weeks ago. “This is a stressful job. You’re dealing with life and death situations several times a day. But the real stress is not being sure you’re able to do the best job you can.”

Even before the recent rush, the service in the south west – like ambulance trusts all over – was under huge stress. In the trust’s internal performance report (pdf) for November, “real concerns” are raised over the problems caused by a staff shortage in frontline paramedics (the trust has 120 fewer paramedics than it should have) and over the number of hours lost in handovers at acute hospitals (1,273 hours were lost in November alone).

On Saturday 27 December, the service, which covers 10,000 sq miles from Gloucestershire in the north to the Isles of Scilly in the far south west, dealt with 3,200 incidents – 883 more than the same Saturday in 2013 and 1,000 more than it was set up to cope with.

Also raised in the report are response times to Red 1 and Red 2 incidents – the most serious categories. Ambulance services in England are required to reach 75% of Red 1 incidents within eight minutes. Overall the trust managed 74.67% – better than the national average. But in some areas the figure was much worse – in Wiltshire just 59%, South Gloucestershire 62% and Cornwall 68%.

The pressure on the system undoubtedly means some injured people are suffering. Just over two weeks ago, 88-year-old Ruby Elsworth got up from the dinner table at the Wiltshire dementia unit she lives in and slipped, spilling a cup of tea over herself as she fell. Staff suspected – correctly – that she had suffered a broken hip. “She was wet, confused and in pain,” said her nephew, Steve Grimmett.

Facebook Twitter Pinterest During exit interviews, many paramedics have told managers they would not stay even if better wages were available. Photograph: Dan Kitwood/Getty

Staff called for help at 1.40pm. “It was 3.40pm before the paramedics got there,” Grimmett said. “All that time she was lying on the floor. Nobody could move her, all they could give her was some paracetamol. When they got there the paramedics were apologetic. It’s not their fault. It’s the system that’s wrong. How can we profess to be a civilised, first world country when we leave a very elderly lady with dementia lying like that for so long?”

On the same day, 70 miles north, Janet Walsh, 66, was on her moped near Cheltenham when she clipped a kerb and hit the road hard, injuring her leg and shoulder. A passerby called 999 and then alerted her husband, Christopher, 69. To his surprise, when he arrived she was still lying in the road. “There were six or seven people looking after her. They had put a coat over her but she was in agony and crying,” he said. “Janet was going into shock.” Mr Walsh said it took the ambulance an hour and 10 minutes to arrive.

In that case, the Swas argues that based on the information it had, its response was the right one, though it accepts elements of the call could have been handled better. As for the other cases, it apologises and points to the extraordinary strain it is under to explain the delays.

Facebook Twitter Pinterest Too often emergency services are seen as a first, rather than a last, resort, says Andrew George, Liberal Democrat MP for West Cornwall. Photograph: David Levene for the Guardian

There are other examples. In Bristol, the family of a great-grandmother said she lay on her living room floor for seven hours after falling. She weighs 19 stone (266 lbs), so sourcing the right equipment and crews proved difficult. In Verwood, Dorset, an 86-year-old woman lay on a pavement for 90 minutes after tripping and hitting her head.

Also in Dorset, parish councillor Susanne Parkin, 73, from Corfe Mullen, failed to get an ambulance at all on the night she woke up with excruciating head pain. “I realised there was something seriously wrong,” she said. “I woke my husband up and asked him to phone an ambulance.” The couple described her symptoms but the operator at the 111 service – run by Swas in the county – did not judge it necessary to send an ambulance.

The next morning, Parkin’s husband, Michael, found her lying unconscious on the floor. A nurse from the local GP practice visited and told him to drive his wife straight to hospital, where she was diagnosed as having a brain aneurysm. Her family were told she had a slim chance of survival. Happily she has recovered. “I was very lucky,” she said. “I think there’s something wrong with the system.”

Ken Wenman, chief executive of the ambulance trust and a registered paramedic, admits there is a problem. “But we’re doing the best we can with the resources we’ve got,” he said.

Last week, A&E departments across England were declaring major incidents. Ambulances loaded with patients were sometimes waiting for hours outside hospitals because there were no beds. A car park at Swindon’s Great Western hospital – Swas’s patch – briefly took on the appearance of a field hospital when the ambulance service pitched a tent to provide a extra space for patients and equipment.

Swas set its “Reap” indicator of how the service was operating at level 5 – “critical” – one level short of 6: “potential service failure”. Wenman and his team turned to volunteers and the private sector for help. If there had been five times the number of people available, they would have been able to use them.

Wenman said it was getting more difficult to hire and retain staff. “Nationally, there’s a shortage. There are insufficient numbers coming out of university. Paramedics are finding other positions in the NHS.” Positions that are better paid than a paramedic (who might start on about £22,000) that do not always require weekend and night working.

Positions that are better paid than a paramedic may not always require weekend and night working. Photograph: Christopher Thomond for the Guardian

During exit interviews, staff tell managers they would not stay even if better wages were available. “The majority of those who are leaving are saying the work is becoming more and more difficult. It’s busier. They often do 12-hour shifts. There’s very little respite in that 12-hour shift, they rarely get meal breaks, they get a lot of overruns. It’s becoming a very stressful and tiring job. We’ve asked staff if we paid them more would they stay and it’s not the money. I think staff are very tired, they’ve seen an increase in workload year on year and that’s not been matched by an increase in ambulance resources.”

Wenman points out – fairly – that the problems Swas faces are replicated across the country and it does better than some trusts. But what changes are needed? According to Wenman, more resources, cleverer ways of giving staff variety in their job – for example by winning contracts for other medical services so that paramedics can be given time away from the stresses of the road - and more flexibility over targets.

He argues that the government ought to take into account what happens when a paramedic gets to a scene – not just how quickly they get there. “If we arrive in seven minutes and 59 seconds and the patient dies, that’s called a success; if we arrive in eight minutes and one second and the patient lives, that’s called a failure.”

The unprecedented level of activity has outstretched available frontline resources,

Christmas and the new year may have been exceptionally busy but details in Swas’s November performance report suggest a more worrying story: the past few months were not just a blip.

From April to November last year, A&E incidents in Swas’s area were up 9% compared with 2013. It would usually expect to face 2,450 incidents on a Saturday – but on Saturdays in November, it was tackling 2,600. “The unprecedented level of activity has outstretched available frontline resources,” the report said.

Whittern and his colleagues blame a range of problems from the 111 phone service (the concern is that because most staff are not medically qualified but follow an algorithm, they tend to play safe and send an ambulance out to a patient when it is not needed – though Parkin would disagree with the thesis) to the pressure control rooms are under as they try to help meet government response targets. Then there is the huge problem of other professionals – GPs, social workers and so on – not being readily available on weekends and evenings: the reason Whittern ended up organising food and power for one patient at the weekend.

Paramedics attend to an injured person. Photograph: PA

Andrew George, the Liberal Democrat MP for West Cornwall, has asked health ministers to ensure that Swas receives the help it needs. He, too, blames poor integration and lack of capacity in NHS and GPs’ out-of-hours services, in mental health teams and social services departments. And perhaps the 111 phone service – though in Cornwall, where the service is also run by the ambulance trust, only 3.6% of callers are referred to emergency departments, compared with the national average of 5.7%.

George said that emergency services are too often seen as a first, rather than a last resort: “This must be looked at when we have the luxury of more reflective time, otherwise problems will reoccur, not only at every future Christmas and Easter, but at other times.”

One of Whittern’s colleagues has another theory. “It’s all about common sense. People don’t have as much as they used to. They want someone else to pick the pieces up, rather than taking responsibility for themselves.”