Got the same problem in the US, too. If someone calls for an ambulance and there is one available, failing to respond is considered negligence, for which the ambulance company and the even the crew on duty at the time can be sued in civil court, possibly even charged in criminal court. But once you start treating a patient, you can't leave them until you pass care to someone of equal or greater training. This leads to such ridiculous situations wherein a paramedic treats a person with a cut and can't leave them until they are handed off to the ED, even if a "code 500" (ie, a full cardiac arrest) is waiting in the queue. But, that's the law! Most ambulance companies try to have at least one paramedic on duty at all times but not all jurisdictions have them available, or available all the time. A basic crew (a BLS - "Basic Life-Saving" crew) is two EMT-Bs (B for "Basic"). An ALS crew ("Advanced Life-Saving") has an EMT-B (or an EMT-I, "I" for "Intermediate") and a paramedic (an "EMT-P"). Most US states have these gradations but some have their own (for example, New York still has the "EMT-CC" designation, "CC" for "Critical Care", graded just below an EMT-P). we are getting closer to having a uniform training-standard and grading system spanning across all 50 states and probably will soon; there is for example now a national test for the EMT-B that allows a person to be one in any of the states without having to re-test if he moves to a new state. Anyway, there used to be doctors included on ambulances back when the whole thing started but after awhile the medical establishment in the US concluded it was better to train people to keep a victim alive long enough to get them to a hospital where the doctors can have all their equipment and other support staff available. Generally this seems to work out well but of course there are exceptions. It's the template-approach to emergency situations-- this works 99% of the time and given the costs, opportunity and otherwise, associated with having MDs on ambulances versus not, we went with the less-expensive option. Cost is a real big factor. MDs in the US, esp. trauma MDs, make a lot of money. If 99% of the time a paramedic is fine for saving a person's life, and that para makes $15/hr., it's a lot cheaper to field the para than the MD. On top of that, the opportunity cost of placing an MD in an ambulance where he can only treat one patient at a time is very high. In an ED, a trauma MD can treat as many patients as will fit in the place (of course within reason, but it's going to be more than one patient). So finally, the "fast-transport" model was adopted over the "in situ" model. It just happens to really suck for those who fall into the 1% category.