On a serious note the everyday grind of these jobs leads to skill degradation. The mundane becomes second nature, of the 40 - odd jobs I've done in the past 4 days I can think of only 2 that were life threatening and 4 others that needed A&E attendance. Skills and diagnostic thought become rusty no matter how many times you go over the books. The training opportunities are there, but due to the high volume of calls every day, getting 'stood down' to participate is impossible. And yes, I have gone to training sessions on a day off, which means even less time spent with the family.