Johannesburg
Young paramedics starting out always thirst for action, and by action they mean trauma: physical injury resulting from a force applied to the body, be it blunt (as in hit by a car) or penetrating (as in getting shot). Paramedics in developed nations hankering for experience see much less serious trauma than those starting out twenty years ago – seatbelts, airbags and speed limits have made sure of that. Even crime is down. But there's still plenty of trauma to be found elsewhere in the world. All a paramedic keen to practice the management of major trauma needs to do is visit Johannesburg Photograph: Benjamin Gilmour
There is plenty of bloodshed in the colony of Lazaro Cardenas. And because many Mexicans only call ambulances when someone is lying dead on the road, it is not uncommon to deal with more dead patients than live ones. The story of how these people came to be dead often remains a mystery. This man did not make it home after going out to 'pay a debt' sometime before daybreak Photograph: Benjamin Gilmour
Australia
Providing ambulance services to a country as large as Australia involves posting paramedics to remote outback towns, some hundreds of kilometres from hospitals and doctors. It is not uncommon for the local paramedic to be the first, and sometimes the only, medical practitioner people living in these communities rely on – a daunting situation for a young paramedic Photograph: Benjamin Gilmour
Lahore
A new Punjabi ambulance service in Pakistan, Rescue 1122, employs only the most committed of medics: those willing to engage in mouth-to-mouth resuscitation in an era where a bag-and-mask for artificial respiration is commonplace. According to employees of Rescue 1122, a true medic should never be disgusted by their patient, nor put up any physical barriers, even those intended to prevent the spread of disease. The level of self-sacrifice by paramedics is so extreme that some will not eat or drink on shift in order to experience something of the pain and discomfort felt by their patients Photograph: Benjamin Gilmour
Lahore
When Rescue 1122 began In 2004, I helped train the first class of Pakistani paramedics, beginning with a lecture on childbirth. It quickly became apparent why my hosts had passed this lecture on to me. All two-hundred students were male, most of them unmarried and with very little experience of 'the mysteries of women folk', as one chap put it Photograph: Benjamin Gilmour
Karachi
The city of Karachi has suffered a terrifying crime wave in recent years, along with suicide bombings and some of the worst industrial accidents Pakistan has ever seen. These Edhi Foundation drivers are waiting for an emergency at a lonely intersection in Karachi. While riding along with these two medics I overheard one boast to the other how many patients he once managed to fit into his ambulance. Fourteen, and not one less, he said Photograph: Benjamin Gilmour
Skopje
In the Macedonian capital, Skopje, doctors and nurses working on ambulances have little time for the oxygen cylinders, heart monitors and other cumbersome items of equipment normally carried to emergencies. They know what is really needed, or at least what the Macedonian patient calls for: Valium. The doctor carries a little black bag with her stethoscope and purse in it, the nurse follows with a briefcase mainly full of Valium ampoules. The vast majority of emergency calls in Macedonia are for cases of anxiety and stress Photograph: Benjamin Gilmour
Honolulu
Being a paramedic in Hawaii was a laid-back job before health and social services were overwhelmed. Nowadays roughly one-in-three emergency calls are to sick, intoxicated or mentally-ill people with nowhere to live. Many claim they were originally from mainland USA and were offered free one-way tickets to Hawaii by cities wanting to move them out. Although no US state has officially admitted to doing this, there are now estimated to be more than 6000 homeless people on Oahu, prompting the Hawaiian government to consider giving away one-way tickets out Photograph: Benjamin Gilmour
Venice
Before ambulance boat crews respond to emergencies in Venice they first meet under a giant map of the city and plot their route – taking a wrong turn in Venice can mean the difference between life and death. Boats entering canals which are too shallow will run aground, other canals are too narrow to pass. And if there is an ultra-high tide, ambulance boats may only be able to sail under a handful of major bridges. This forces crews to abandon their vessels and walk to the emergency on foot through the city's maze-like alleys. A paramedic's advice – don't have a heart attack in Venice at high tide Photograph: Benjamin Gilmour
