Glad I found your blog; liked it so much I added it to the sidebar on mine. Anyway, I just started at a volunteer amb. co. in upstate New York and already I have seen a little bit of what you are talking about. I have a lot to learn: culture, protocol, and of course, practice. But in the short time I have been there, I have already seen that even here in the States the burden on EMS is going up. The number of calls in our area is very high and vol. companies are understaffed throughout the area, even with many standing up three crews at all times (or trying to anyway), even when paying paramedics and senior sub-paramedic grade personnel hourly wages. Our area is also considered well-covered if you can believe it; other parts of the state don't have a paramedic-level provider within 100 miles of them, and an ED anywhere near? Nearest is three hours away for some communities. And we don't even have nationalized healthcare in the US so people are calling for EMS help even though they know they are going to carry the burden for the cost, or some part of it, with their private health insurance carrier (if they have one, which many do not) footing the rest. Our aging population is without a doubt a major factor. It seems like 4 of 5 people an ambulance is dispatched to is elderly. No surprise there, but if you consider that in the US (and UK, and Germany, and Spain, and Italy, etc., etc.) the pop'n continues to get older on average, there is a tilt factor-- fewer younger people to act as EMS workers with more and more elderly people in need of EMS workers to save them from some condition. You could say the same thing about other related fields, of course: hospital workers, nursing home workers, any number of other professions as well. Here in the U.S. our "Boomer" generation is just beginning to enter the part of their lives where they are going to need or demand substantially more healthcare/EMS resources. If we are already overstretched now, what will it be like in five years? In ten? Dare I even think 20 or 30? On top of that, legal liability issues as well as pay issues, politics, stress from multiple sources and of multiple kinds, training demands, crazy hours and all the rest put the pressure downward on both recruitment and retention. More to consider: all over the place, public funding for healthcare institutions is actually being reduced; currently just here in NY state, for example, our governor wants to cut $40 million from the state budget for healthcare, and he probably will succeed. On top of all this, we (i.e., we in the U.S.) are in a long, protracted war in the middle east that arguably hasn't even begun to get serious (a few thousand casualties is nothing compared to what it could or will be if it continues, which I am 99.99% sure it will). All those wounded, physically and psychologically, will need a large number of healthcare resources, and on top of that, eventually civilian healthcare workers will get tapped to handle military casualties. [Most Americans don't know this, but the legal apparatus for a drafting particular types of specialists and workers, including healthcare workers at all levels of skill and training, is already in place; a general draft need not be enacted by Congress. The president merely has to sign the paperwork to activate this system.] So, just WTF is the civilized world going to do about this issue? It can't do nothing, but it seems unwilling to do anything. I dunno what it will all add up to, but eventually, "the system" has got to break down. There is no escaping cause and effect.