Alert but waiting: What ER24 paramedics do in their downtime between calls

When most people think of paramedics, they picture flashing red lights, speeding ambulances and life-saving interventions. 

But between emergency callouts lies another side of the profession that the public rarely sees.

Downtime is often mistaken for inactivity, but for ER24 paramedics, it is anything but. Every quiet moment is spent preparing for the next emergency, whether that means restocking equipment, completing paperwork, learning new skills, supporting colleagues, or simply taking a moment to reset before the next call comes in.

Four ER24 paramedics from across the country share what downtime really looks like and why those quieter moments are just as important as the emergencies themselves.

More happens between calls than you might think

For Sinjin Grant-Smith, a paramedic from ER24 Midstream, downtime is an essential part of delivering quality patient care.

"Downtime isn't simply 'waiting around'. It's an important part of remaining operationally ready."

Between calls, crews inspect and restock ambulances, check medications and life-saving equipment, clean and disinfect vehicles, complete patient documentation and review recent cases to identify learning opportunities.

Mthobisi Mabaso, a paramedic from ER24 Lowveld, says the work doesn't stop just because the sirens do.

"When it's downtime, we are not off duty. We are always preparing for the next emergency."

His routine includes checking medications, testing equipment such as ECG monitors and syringe drivers, completing quality assurance and paperwork, staying hydrated and remaining mentally ready for the next dispatch.

At ER24 Hermanus, base supervisor Coleen Johnson balances operational readiness with administrative responsibilities.

"We have many administrative tasks that we need to complete after every call, including updating our Contact Centre, logging call details and completing quality control on our paperwork. There is also housekeeping, restocking and cleaning the vehicle to ensure operational readiness. Once all of that has been done, it's usually a good time to eat."

For Caryn Shaw, a paramedic from ER24 Rustenburg, downtime in a rural setting brings additional responsibilities.

Along with routine vehicle and equipment checks, Shaw and her colleagues familiarise themselves with surrounding farms, villages, mines and access routes, ensuring they're ready for emergencies that may be many kilometres away.

Every quiet moment is a chance to prepare

Preparation takes many forms, but every task contributes to providing safe, effective patient care.

Johnson uses quieter periods to research cases, consult colleagues and participate in continuing medical education.

"I try to do as much reading and researching as possible to make sure that I'm always learning."

Grant-Smith regularly revises treatment guidelines and mentally rehearses emergency scenarios because every patient presents unique challenges.

Mabaso says even simple routines help him stay prepared.

"Eating, hydrating and listening to dispatch all help prepare me mentally. You never know when you'll be needed."

Processing one emergency before the next begins

Downtime also provides an opportunity to recover emotionally before the next emergency.

"Downtime lets you process everything. You cannot carry every call alone," says Mabaso.

He credits humour, storytelling and supportive colleagues as valuable coping mechanisms after difficult callouts.

Johnson has developed her own way of honouring patients she has lost.

"I keep a beautifully scented candle at work, which I light if I have lost a patient. I spend some time thinking about them with love and light," she says. "Then I try to spend time outdoors. Time at the ocean is very healing."

Shaw says those quieter moments are essential to delivering compassionate care.

"Every patient deserves a calm, compassionate and focused medic when we arrive. Having quiet moments between calls allows us to process what has happened, debrief with our partner if needed and emotionally prepare ourselves for the next patient."

Grant-Smith believes supporting one another is just as important as maintaining clinical skills.

"Looking after each other's wellbeing is just as important as looking after our patients because resilient clinicians provide better care."

Why a parked ambulance doesn't mean the crew is off duty

Johnson says one of the biggest misconceptions is that paramedics are simply relaxing between emergencies.

"We sometimes hear comments about us 'just sitting around and drinking coffee', but those are often the moments when we're debriefing, bonding, learning, discussing cases and building trust within our teams."

Mabaso agrees.

"People see a parked ambulance and think it's a break. In reality, we're on standby to leave in under 120 seconds. Downtime doesn't mean your brain has clocked out."

Shaw says this misconception is especially common in rural emergency medical services.

"We certainly are not being idle,” she says. “We’re maintaining our ambulance, checking life-saving equipment, planning response routes, completing documentation, engaging with the communities we serve and staying ready for emergencies that could take us over an hour away from base."

Grant-Smith says much of emergency medicine happens behind the scenes.

"People only see the emergency response. They don't see everything that happens beforehand to make sure we're able to provide safe, effective care the moment someone needs us."

He adds:

"In emergency medical services, the quiet moments aren't a break from the job; they're part of the job. Every check, every conversation and every moment of preparation ensures that when someone's worst day begins, we're ready to make a difference."