BBC's Ambulance paramedic on saving lives in the danger zone - WATCH
They are the highly-trained paramedics tasked with providing medical care in the toughest environments.
Terror attacks, gunmen on the loose, stabbings and any incidents involving mass casualties – when the going gets tough, chances are a hazardous area response team (HART) will be called to the scene.
Their job, which has been documented on the hit BBC One show Ambulance, is to stabilise victims before they are taken to hospital.
At times they save lives. They often work against the clock and under extreme pressure, with the threat of an armed assailant returning to a scene hanging over them.
WATCH: Paramedic speaks of his high-pressure job
They deal with perilous jobs that standard ambulance crews can’t touch, and at times they are on the scene before the police arrive.
It’s not a job for the feint-hearted, and even in a profession where blood and guts are a given, HART paramedics tend to be a special breed.
“I wanted to do this,” says Peter Bowles, a paramedic based at West Midlands Ambulance Service’s HART base in Oldbury since May 2017.
“Everyone who comes here knows that it’s high pressure. We all love the work but it is getting tougher and tougher.”
According to Peter, 30, a major reason for this is the huge increase in violent incidents they are called out to across the West Midlands, particularly involving knife crime.
West Midlands Ambulance Service (WMAS) now deals with an average of 30 shooting and stabbing incidents a week – 1,500 a year – a figure which has risen by more than 200 in each of the last two years.
The true figure is likely to be far higher, as the statistics only cover calls that contain reference to a victim being either stabbed or shot.
Other calls may refer to ‘bleeding’, for example, but turn out to involve a stabbing once paramedics are able to classify the incident at the scene.
“The level of violence has gone up massively, and what is really shocking is the number of young people, 14 and 15 year olds that are involved in knife crime,” says Peter, who has been with WMAS for four years.
“We really didn’t expect to see so many young kids as victims.
“It is becoming increasingly common to find people in their mid-teens involved, both as victims and perpetrators. The types of injuries are also worse. Usually we are looking at multiple stab wounds.
“It’s not often now that I attend an incident with just a single stab wound or a single injury, it is four, five or six stab wounds.
“As paramedics we expect to see these incidents every now and again, but not in the amount that we are seeing them these days.
“It used to be that the wounds would be superficial. Now there has been a noticeable increase in attacks with long blades and machetes, which leads to life-altering wounds, if not worse.”
HART teams were piloted in London in the wake of the 7/7 terror attacks. Each area of the country now has either one or two specialist teams, with the WMAS crew consisting of seven paramedics.
It used to be the role of the fire service to get casualties to a safe place where ambulance crews could treat them.
Now HART crews offer faster access to healthcare by treating casualties on the spot.
In his time with the HART Peter has also dealt with machete attacks and shootings, and over the last fortnight he tended to a patient that had been stabbed five times.
But it is not only the patient he needs to worry about when arriving on the scene.
When a HART team is called out to a stabbing incident – they don’t always know exactly what has happened or the extent of the injuries – a rendezvous point is set and a police escort arranged.
“We never know what dangers might be waiting for us when we get there,” Peter says. “There is always a risk that an aggressor may still be on the scene.
“The first thing we need to consider is the crew’s safety.”
Once police have decided that the scene is safe, paramedics can approach the patient to make their assessment.
This involves a quick ‘eyes on’, or a primary survey to give it its technical term, which means checking the patient’s airways, breathing and circulation.
The first thing they look for in a knife attack victim is signs of catastrophic haemorrhage, any major bleeding points that usually result from an entry wound.
If these injuries are not addressed immediately, the patient’s chances of survival are drastically reduced.
This means applying blast bandages, trauma bandages with haemostatic gauze, and other seals to attempt to stem the flow of blood.
“If we can get them to hospital where they can be treated then we have done our job,” Peter says.
The job can take its toll on paramedics, with long shifts and a regular exposure to the consequences of extreme violence making for a grim environment.
“It can be tough,” Peter says. “When you are dealing with these incidents you become task focused, on your own safety and your crew mates.
“Afterwards it is all about debriefing and understanding the actions that you took. It is huge pressure.
“It is always hard going to a traumatic incident, where somebody is walking down the street one minute, and then multiple stab wounds can be afflicted upon them.
“You are always aware that somebody’s life could be in danger.”
Peter is quick to praise the work of other WMAS crews that work on the coal face, including trauma doctors from the Medical Emergency Response Intervention Team (MERIT).
And he says the additional demand on services has led to a need for extra equipment.
“Within the last year we have put on additional equipment,” he says. “We now carry multiples of each bit of kit that we would use to treat traumatic injuries, be that catastrophic haemorrhaging or splinting.
“In the wider West Midlands Ambulance Service itself we have seen an increase in the amount of trauma equipment that is carried on ambulances.”
The increase in violent crime also means that paramedics focus more on trauma training.
With the West Midlands second only to London in terms of knife crime statistics, the workload of the HART team is unlikely to lessen any time soon.