An emergency call handler said it feels like their fault when they tell crying people they'll wait hours for an ambulance.
Janice Taylor, 40, worked at a sexual assault centre before becoming an emergency medical advisor (EMA) with the North West Ambulance Service (NWAS) because she "wanted to help more people". Now the number of calls they receive is "extraordinary", she told the ECHO on a picket outside Estuary Point in Speke, home to NWAS's emergency operations centre.
She said: "We're doing three times what we did when I started, and it was hard when I started. Now every day is hard. You feel bad. We're not saving people. You know it's not your fault, but you feel like it is. The delays are bad, and it affects your mental health when people are crying down the phone saying, 'My mum's been on the floor for three hours'. You feel awful for it, and you take those ones home. It does affect your mental health."
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The Unison union steward faces abuse from callers, but this is mostly aimed at the government, which callers describe as "a joke". Janice said: "I can understand the frustrations. They're not being abusive to you as a person. They recognise it's an emergency and they're frustrated. I get it, I'd be frustrated too."
EMAs feel the public don't understand just how much pressure they're under when handling their calls. Lewis, 28, said they "do get to the sickest patients as quick as possible, and we will stay on the line with people", but some callers are requesting an ambulance for conditions like toothache. They have to process the calls no matter what the complaint.
He told the ECHO: "They don't know that the call you might have just taken, or the call after, is someone you're giving life-saving treatment to, and the next person is calling because they've got splints and they want an ambulance, or toothache. These are things people are ringing 999 for."
Hearing about patients facing long waits for ambulance - sometimes up to 18 hours - takes its toll on the people handling callers' frustration over the phone. Keira, 22, said: "Obviously it has a different impact on us than frontline staff who are face-to-face with patients, but we're the first point of contact.
"Coming in and hearing those things happen to people, and we can't reach out to them, we can't do anything other than organise the help. And that's what we do, as much as we can. People are really, really stressed and the pressure is massive in there, massive, and there's not enough people for what the job needs."
All ambulance services in England, including NWAS, failed to meet response time targets for category one and two calls in December. An NWAS spokesperson described it as "the second busiest month of the year in terms of calls", saying the service is "under extreme pressure".
In the North West, ambulances took an average of nine minutes and 58 seconds to respond to category one calls for life-threatening conditions like cardiac arrest. The target is seven minutes. On average, NWAS took 58 minutes longer than the target of 18 minutes to respond to category two calls, which includes serious conditions like strokes.
A spokesperson for the ambulance service said: "Our staff work hard every day to ensure everyone who needs an ambulance gets one, and we continue to perform better than other parts of the country. While patients suffering from life-threatening conditions do receive the next available ambulance, some patients are waiting longer than we would like.
"Improvements to our call centres mean we are now offering health advice to more patients over the phone without the need to send an ambulance. Consequently, well under 50% of our patients actually go to the hospital. We also continue working with NHS partners to ease handover delays.
"We are grateful to patients for considering alternatives for non-urgent health concerns, including NHS 111 online, GP or local pharmacy, which helps us keep our ambulances available for emergencies."
Janice and her colleagues are among the up to 20,000 paramedics, emergency call handlers and technicians who're on strike today. It's the third day members of the GMB and Unison trade unions have walked out in a dispute over a 5% pay rise offered to - and rejected by - NHS workers on the Agenda for Change contract, which includes nurses and cleaners.
Emergency medical advisors answering calls and coordinating ambulances earn between £21,730 and £26,282, according to the government's National Career's Service. That's just over £10 an hour at the lower end of the scale. Janice said: "We're undervalued, understaffed, underpaid, overworked. We are not appreciated.
"We're on £10 an hour - what do those people in government make, for what? We're saving lives, we're giving life-saving interventions, delivering babies over the phone, ambulances delivering babies when they get there, CPR, dealing with blood loss, all those things. What do they actually do that is beneficial? Why do they get paid more than us for doing nothing?"
She added: "There are three people on my team that I know of who go to foodbanks. That's just not on. People shouldn't be going to foodbanks anyway, but these are people who are sacrificing their own mental, financial and physical wellbeing to help others. We need to take this seriously."
Support remains high among the public, who the government says the strikes put at risk. More than 50% of people back nurses and paramedics in their disputes, according to the latest Opinium poll for the Observer.
Ambulance workers who are members of Unite are striking again today, with GMB members at NWAS walking out tomorrow. They will be joined by GMB members at seven other ambulance services in England on four more days of industrial action next month. The union announced these five days, plus one in the West Midlands, after talks with the government failed to produce a new pay offer on Wednesday.
Rachel Harrison, its national secretary, said: "Ministers have made things worse by demonising the ambulance workers who provided life and limb cover on strike days - playing political games with their scaremongering. The only way to solve this dispute is a proper pay offer. But it seems the cold, dead hands of Number 10 and 11 Downing Street are stopping this from happening."
After two separate strike days at 44 NHS trusts before Christmas, nurses walked out for a 24-hour period at 55 trusts on Wednesday and Thursday last week. Whiston and Arrowe Park hospitals saw picket lines for the first time in this dispute, the first national strike in the Royal College of Nursing's nearly 107-year history.
Their biggest walk-out is yet to come, with even more trusts affected - including hospitals in Liverpool, Wirral, Knowsley and St Helens - on February 6 and 7. Unions representing ambulance workers are co-ordinating a same-day strike for February 6.
More than 45,000 junior doctors could join them the following month if members of the British Medical Association (BMA) vote in favour of industrial action over a 2% pay rise. For NHS staff on strike, or soon to walk out, the dispute is very much about patient safety, working conditions and the state of the NHS.
Jan Buoey, a paramedic and GMB representative, said: "Patients are waiting excessive amounts of times for ambulances. We're under-resourced, we haven't got enough staff, we haven't got enough ambulances to respond to the calls.
"The NHS is almost getting driven into the ground. We want to be able to respond to our patients in a timely manner, to be able to treat them and get them to definitive care, the hospital, and get them the necessary care they need."
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