The ambulance service is finding it increasingly difficult to cope with rising demand, according to a new report.
An ageing population means that pressure on the ambulance service is continuing to grow.
There are also an increasing number of mental health and alcohol-related issues, as well as fewer primary care services within the community.
But many trusts are struggling to recruit and retain staff that they desperately need to handle the situation, the National Audit Office has said.
Liz Harris, from the College of Paramedics, told Sky News that the workload faced by ambulance crews was "increasing day on day".
She added: "The type of work is increasing and there is greater demand for their expertise.
"There are also delays in hospitals that add to the pressure and stress."
Many paramedics find that their job is a juggling act, with them having to balance the treatment of those in desperate need with those who abuse the system.
For critical calls, trusts have response time targets - but the report says that many are struggling to meet them.
Some place too much emphasis on them which, in turn, means that resources are dispatched too quickly, without knowing exactly what is wrong with a patient.
In the last six years, the number of ambulance and NHS 111 transfers has increased by 2.8 million - and last year around 500,000 ambulance hours were lost due to lengthy turnarounds at A&E departments.
For some, the pressure of working in the industry has become too much.
Gemma Davison trained at university to be a paramedic, but she soon became disillusioned with the profession and has now set up her own company selling first aid kits to sports groups.
She told Sky News that when she worked as a paramedic she occasionally experienced abuse and violence from members of the public.
Ms Davison also said that some of her team became difficult towards her when she entered the profession as a graduate at a more senior level.
The National Audit Office has warned that until clinical commissioning groups see the ambulance service as an integral part of the health service, it will struggle to provide consistent value for money.
Professor Keith Willett from NHS England said: "The ambulance service is facing significant pressures, partly because too many ambulances are dispatched to simply hit targets, rather than attend those patients most in need, with 25% of dispatched blue light vehicles being stood down before they reach the scene.
"That is why we're carefully testing a change to the way in which ambulance services can respond."