“Sharp scratch here, Dorothy.” She gave the warning more out of habit than any expectation of a reply. The vein blew the instant the cannula pierced it, and she swore beneath her breath, pressing gauze over the rapidly spreading bruise. “It’s always the ones who bloody need it,” she said, ripping tape with her teeth whilst contemplating her next target.

Two courses of antibiotics hadn’t touched Dorothy’s urinary tract infection, and the carers at her residential home had taken a few hours to realise that her violent shivers were due to a high temperature and that the extra blankets they’d piled on her weren’t actually helping. She was septic, her blood pressure low, her pulse and respiratory rate sky-high. She needed time-critical transfer to A&E for IV antibiotics, blood cultures, and fluid resuscitation. Instead, with ambulances queuing in hospital corridors and a stack of 999 calls still waiting for vehicles, Jem was managing alone with a single tank of oxygen and IV saline that she couldn’t find a vein for.

For the most part, Jem didn’t mind shifts on the rapid response vehicle. The single-manned cars had been introduced to hit government targets designed to get the sickest patients an ambulance within seven minutes. They stopped the clock and ensured essential aid could be rendered, but they couldn’t transport a critically ill patient to the hospital. Jem usually enjoyed the challenge of solo working, and with no regular mate on her line, the RRV could be a welcome break from an ever-changing parade of newbies and numpties. On nights like this, however, when the service was operating at DEFCON 6, the RRV became a nightmare, trapping her on scene for hours without backup, no matter how unstable the patient. At least there were no relatives breathing down her neck this time, just three well-meaning but harried staff members who had a full house of demented residents demanding their attention and who had been only too happy to entrust one of them to her care.

“Sorry about this, love.” She swabbed a fresh patch of Dorothy’s arm and downgraded the size of her cannula, guided by the logic that any access was better than no access. It was a sound theory, and relief made her feel giddy as she flushed the line and taped it into place. “There we go. All done.”

Using the door and a coat hanger as a drip stand, she set the saline running wide open and hit the voice button on her radio for the third time.

“Do I have an ETA on a crew?”

“That’s a negative, Jem.” Ryan, her usual dispatcher, sounded as despondent as she felt. “We still have thirty-four calls in the stack.”

“Not your fault, pal. Just do your best, eh?”

A tentative knock interrupted his reply. She hurried to the door, grabbing the IV to prevent it pulling loose.