They are the first port of call for members of the public in what could be their worst moments. Health correspondent Geraldine Scott looks at the pressures faced by those in the ambulance control room - and the abuse they can sometimes face.
It was described as a 'relatively quiet' afternoon in the control room for the East of England Ambulance Trust (EEAST) in Norwich, the first thing anyone arriving would have heard was a call handler, giving directions over the phone on how to perform CPR.
'One and two and three and four and one and two and three and four and... keep going, help is on the way.'
Giving the instructions was 29-year-old Charlotte Walker, a senior call handler who had worked at the service for four and a half years.
Charlotte, from Sprowston, continued to walk the person on the other end of the line through the steps until she heard an ambulance crew arrive, before seemingly unfazed moving onto the next call.
She said: 'I applied when I was looking for a new job and I've always wanted to go into a career where you feel like you're making a difference and helping people. Growing up my mum was a nurse, she was always going off to help people in the hospital so when I came across the job I thought it was something which really appealed to me.'
But although she enjoys her job, it is high pressured. And Charlotte said since having her two-year-old daughter Isla, those calls have hit her harder.
She remembered one call where a mother had discovered her 15-year-old son hanged. She said: 'There were times on that call I wanted to cry but obviously you don't, you remember to keep your emotions in.'
Other difficult calls came when those on the other end of the line became abusive.
'I think there are two types of distressing call,' Charlotte said. 'One which might be a distressing situation, so if you've got family members who are in a distressing situation, their level of emotion can be quite high, so for them you can take that step back and let them have their emotion. You can understand the situation they are in.
'Then there are other sorts of calls where we might be on a particularly busy day, calls where unfortunately we've not been able to get an ambulance to them as quickly as we'd like to. You may then have someone call and potentially be abusive, demanding where their ambulance is. And I think it's about being able to deal with that by not retaliating and raising your voice at them. We know we all get abusive callers and we know we've all had them in the past.'
For others in the control room, who do not speak with the public but instead the crews, they often hear the abuse ambulance crews get.
Dispatcher Ashley Gray, 22, said: 'On our crews personal radios they have an emergency button on the top, they can activate that button if they are in danger. I've heard one in Cambridgeshire, where he went into a breathing problems call, all sounded fairly routine. Actually he got there and the patient started threatening him with a knife so what I heard from my end was him shouting at the person to put the knife down. We're hearing that emotion, the assertiveness but also the fear in the voice of that paramedic as he's faced with this person with a knife.
'It's difficult, it's a very hard thing to listen to. They're our colleagues but they're also our friends. They're there trying to do their job and being treated like that, it's very difficult to hear.
'I just don't understand the point, why they think it's acceptable. It doesn't make sense to me at all, it's mindless.'
Dispatch team leader Charlotte Peace, from Wymondham, has worked for the service for 14 years.
She said: 'I've heard them screaming for help, cornered in a room. I remember listening to one being trapped inside a house by a group of men. He pressed his button because they cornered him and he could not get out, He was on his own. It happens more than it should do.
'The general public do still have a lot of respect for the ambulance service. But it has definitely got worse, we deal with a lot of social issues. a lot of mental health, because they don't have anyone else to call. They are the vulnerable people who have the potential to be dangerous. Our guys are just not trained to deal with that, they're not mental health nurses.'
Senior control room manager Paul Vinters said abusive callers tended to be caused by challenges of demand and expectation.
Paul, 34, said: 'When they cross that's when we get difficulty, that's when people's expectations aren't met and we have high demand so we aren't able to respond to them, some people who might normally be quite mild mannered can get quite irate.
'It's disappointing because we do get the other types of abusive callers, people who are deliberately malicious against our call handlers.
'They do their jobs to help people, everyone in the ambulance service I have met does this to help people, and so getting personal verbal abuse just for doing their jobs is not tolerated at all.
'One I dealt with recently that was for a patient calling about a relative who had fallen down some stairs. Obviously that's very stressful for them because their relative is injured and we need to be able to ascertain exactly what has happened and where we are going to in the first place. I can imagine how it would be frustrating to someone in those circumstances but becoming aggressive, violent and hostile, and using personal, derogatory, sexually-harassing slang words towards our call handlers isn't accepted.'
What help is available?
Charlotte said the extensive training prepared her for distressing calls and the team were 'really supportive'. She said there was always the opportunity to step away and take some time to recover.
Paul added: 'We do have a zero tolerance of any violence or aggression towards NHS staff and we take steps to make sure they are protected and where necessary action taken. We recognise we do an inherently stressful job and the control room should be imagined as the same as working on ambulances, it is the frontline.'
He said support available included:
• Counselling;
• Trauma risk incident management - which helps pick up signs of stress and anxiety;
• The trust tries to provide resolution and support staff if they wish to find out the outcome of a call;
• Access to Mind Bluelight, which provides mental health support for emergency services staff and volunteers.
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