When an emergency call comes in from one of South Africa's most crime-ridden neighbourhoods, ambulances do not rush straight to the scene but to a police station first to request an armed escort.
A surge in attacks on ambulance workers has led to parts of Cape Town being declared danger "red zones" but beefing up security means delayed response times in some of the poorest districts.
Robbery, theft, vandalism, violence, at times linked to criminal gangs — more than 100 attacks against paramedics and drivers were reported in the Western Cape province last year.
Patricia September and her colleague, both ambulance workers, were driving on a road bordering one of the red zones in the early morning hours when two gunshots rang out.
A brick hit the windscreen, causing her colleague to battle to control the ambulance from rolling, she recalled.
"The whole ambulance was shaking," 51-year-old September told AFP.
The stoning of vehicles is a frequent hijacking ploy and medics are not spared.
Caught in shoot-outs
Armed police protection for ambulances during night time call-outs was introduced last year but workers told AFP they still do not feel any safer.
Sometimes the police escort can even make matters worse.
More than once, September, a single mother of twins, has been caught up in shoot-outs between gang members and the police, who are targeted for their weapons.
"When they start shooting at the police, you can actually see the fear on the officers' faces," she said.
September, who has 15 years' experience under her belt, pulls the ambulance into a derelict cul-de-sac to collect a patient in one of the red zones.
The police park just ahead. But nobody leaves their vehicles.
Instead, September radios the dispatcher to instruct the patient to come to the waiting ambulance.
Only after spotting a woman moving slowly down a flight of stairs, wheezing heavily, does the team judge that it is safe to assist.
September quickly moves the ambulance to a main road nearby. The team is still deep in a red zone, but the police are now nowhere to be seen.
They leave as soon as the patient boards the ambulance.
Ambulances are targets
Another emergency worker, Papinkie Lebelo, was robbed at knife point on Christmas Eve last year, just moments after his police escort pulled away.
On his arrival, the patient had already been taken privately to hospital due to the wait for the escorted ambulance.
Lebelo was unhurt but was forced to hand over his cellphone and cash to his attacker.
"How can you attack an ambulance that is coming to help?" he asked.
In poorer neighbourhoods where crime is endemic, ambulances are targets of the same robbers that local communities face.
"By virtue of the fact that they deliver services within the community they become part of that community and are thus subjected to the same issues," said the provincial head of emergency medical services, Shaheem de Vries.
A 17-year veteran of the service, Lebelo said the attacks first began about three years ago.
But the escort system, he said, wasn't helping — only slowing down the response times. Ambulances have, at times, had to wait up to three hours before a police van is available, several ambulance staff told AFP.
Ambulances are not permitted into red zones without a police escort.
Outside the police station in Nyanga township, notorious as the murder capital of South Africa and one of 10 designated red zones around the city, AFP spoke to paramedics, who had been waiting half an hour for an escort to the scene of a multiple stabbing.
What if the patient dies while waiting? our AFP reporter asked.
The ambulance driver shrugged. "They brought this on themselves," she said.
But Martin Makasi, head of Nyanga's policing forum that acts as an intermediary between the community and police, said locals feel they are being unfairly punished for the actions of a few criminals.
"It concerns us that people will lose their lives because they are waiting for paramedics," he told AFP.
"It also boggles the minds of the community to understand why the attacks are happening."
Western Cape province lost over 3,000 work days last year to staff being off after traumatic incidents. Some employees have asked for transfers out of the city to quieter, safer towns.
Although attacks have occurred countrywide, Cape Town is the epicentre of the problem.
De Vries said his biggest challenge was retaining staff.
"Whether they are suffering from PTSD (post-traumatic stress disorder) and staying away, or because they're resigning and leaving for safer harbours," he said.
"I'm losing staff."
Even harder, he says, is attracting new applicants.
"Young school-leavers, who are looking at career choices, are now having second thoughts about whether or not they want to enter the industry at all," he added.
Six months after her attack, September is still traumatised.
"Everybody standing along the road, everybody who approaches you — you feel threatened by them," she said. "You feel so scared that it's going to happen again.