Have you ever wondered, as a wailing ambulance passed you on a busy street corner, just who those people are behind the lights and sirens? Recently, three of them shared some of their experiences, and talked about what it takes to become a paramedic for the B.C. Ambulance Service.

"For a rookie, it's quite a thrill," admits 23-year-old paramedic-in-training (and my cousin) Graeme Parke. He recalls the previous night's episodes, when he transported a woman who almost gave birth in the ambulance, and a man who had a bungee-cord hook embedded in his eye. Parke talks on the way to the ambulance station at Lions Gate Hospital, where he is heading out on another 12-hour shift as part of the three-week practicum portion of his training.

"Even though I'm still a student, I'm taking an active role in the paramedic service," he says. "When I go on calls, I am the paramedic [with the same responsibility] and I'll keep that illusion." He looks the part with his well-ironed white shirt, navy pants, and polished black boots.

The B.C. Ambulance Service (BCAS), under authority of the B.C. Ministry of Health, has a prominent presence in Vancouver, which has 28 of B.C.'s 191 ambulance stations. Reached by telephone, Ministry of Health communications manager Regan Hansen estimates there are almost 1,500 predominantly full-time paramedics working in Vancouver, 70 percent of whom are men. Together, they respond to more than 300,000 calls per year in the Lower Mainland.

Parke wants to be one of these people. "I was dreaming of the job from starting out at 17 as a Vancouver lifeguard," he recalls, his 6'2" frame hunched over as we shuffle around the bench and stretcher inside an ambulance parked in the station. He shows me cabinets filled with medicines, bandages, oxygen tanks, and defibrillators. "I was 19 or 20 when I started as a ski patroller on Grouse Mountain. So I was advancing my skills along the way, as I got more and more interested in the line of work. Paramedicine is kind of the upper level, the upper echelon of pre-hospital care. I thought that was my strength as a person”¦and I was having fun, so I wanted to carry it on further."

Carrying on means getting his Primary Care Paramedic (PCP) certification through the Justice Institute of B.C. Training is offered in a full-time, four-month program or a part-time, nine-month one emphasizing hands-on experience. Classes are small and instructed by physicians, nurses, and working paramedics. There are several prerequisites for acceptance, including industrial first-aid certification and fitness requirements, as well as hefty tuition and fees totalling about $4,500. After students have completed the program and obtained a PCP certificate, they are eligible for a job as a paramedic.

The process wasn't always so complicated. "A lot of changes have happened over the past two years with the BCAS," says John Paterson, a PCP paramedic with eight years of experience, interviewed at the Sechelt Ambulance Station where he works. "It used to be you took a two-week first-aid course and were basically thrown the ambulance keys. You'd learn to work the radio along the way."

"When I started 37 years ago, the system was operated by private companies, and it was very cutthroat," retired paramedic Gerald Sullivan says from his home in the Sunshine Coast. He worked for many years as a paramedic in Vancouver and Sechelt. He believes that the basic commitment and compassion that paramedics feel toward patients hasn't changed.

The first 60 minutes following serious injury is known as the "golden hour" in emergency medicine, a vital time when correct resuscitation and transport care can have long-term consequences. This makes speed of response imperative.

"A lot of the time, our job is to stabilize the patient and transport them to the appropriate facilities, getting your patient, your partner, and yourself there safely, doing vital signs and documentation along the way," Parke explains. Although he enjoyed practising driving the ambulance on the course at the Justice Institute, he says nothing can truly simulate the experience of travelling at high speeds against the red light in the centre lane of the Lions Gate Bridge.

Paterson emphasizes that a level head is important amid all the excitement. "Blood and gore is only a small part of what we do," he points out. "It is more about being able to take control of a situation and stay calm."

As for employment prospects, newcomer Parke knows he'll have to hone his skills and build up patient contacts in a rural setting before becoming eligible for further training such as Advanced Life Support (ALS) certification. He'll also need more experience to land a full-time placement in the city, with its increased call volume and more chaotic situations.

Sullivan debates whether the opportunities and job conditions are better now than when he started his career. "The pay used to be terrible," he says. "It was like, if you were thinking of having a family, you had better start looking for a 'real job'. Now, the wages have come up and the benefits are good, but it is highly competitive, and there are not that many full-time positions in B.C." Still, he advises rookies: "If you really love the work, then you've got to go for it."

Hansen at the Ministry of Health says the starting wage for a PCP paramedic is $13.50 per hour. The average wage after five years is $17.50, with ALS paramedics earning $23.

Paramedics seem to see the job as a calling, and take the pay in stride. "The starting wage is a bit insulting, but the wages do come up quite fast and the system is slowly improving," Paterson says. "I love my job”¦not many people can say that."

"Adrenaline junkie is a bit cliché," Parke declares, "but I definitely like the unpredictability that goes along with the work. You never have the same day twice, and you are working with a variety of people in a variety of different situations. I've seen everything from little old ladies who fall down”¦to babies being born”¦and, you know, I'm probably going to see something totally different tonight."

For the rest of us, the closest we'll come to the job may be calling 911, or simply watching an ambulance speed by.