I've not read it all yet. But one comment stood out. Efficiency can only go so far. Then it's like trying holding sand in a your hand the harder you squeeze the more it pours out. (it said something like that anyway)
Our local ambulance service is having a major recruitment drive. They're also training ambulance techs to be paramedics for the first time in years.
God know they need to. I've been out with ambulance crews before and they've said they're the only available ambulance in the county at some points in the shift (and it's a big county). And I'm talking for extended periods of time, not the odd ten mins.
I've also known a colleague ring and ask if an ambulance could be on standby outside a high risk homebirth (home birth against advice) and ambulance control said there were no ambulances in the county.