Daily gang-related shootings in Guatemala mean paramedics face a constant battle to save as many lives as they can, as a British paramedic discovered on a two-week working visit to the country's capital.
On Angie Dymott's second day on the job in Guatemala City, five students were shot as they walked down a street in an unprovoked gang hit.
Her new colleagues, the Bomberos Voluntarios, were mostly volunteers, trained as both firemen and paramedics.
They received a call to help move the injured into hospital, but two of the university students were already dead.
"I knew it was a violent city, but not until you're there do you realise the enormity of it - how many shootings the guys have to deal with on a day-to-day basis, in their stride," she said.
Guatemala has one of the highest annual murder rates in the world, with 52 homicides per 100,000 inhabitants. Many of the killings are blamed on gangs known as Maras. And many gangs are linked to Mexico's violent drug cartels who ship billions of dollars of cocaine through the country.
Shootings on buses in Guatemala City are a daily occurrence, as gangs demand payments from those driving through their areas and kill those who refuse to pay.
Between January and November 2010, 119 bus drivers and 51 other transport workers were murdered in the city, according to local human rights groups.
With 75% of the country living below the poverty line there is no shortage of recruits to the gangs.
The police and government are accused of widespread corruption - siphoning money from the lucrative cocaine trade.
For Angie, the shootings were a far cry from the call-outs back home in the Welsh capital Cardiff, mostly dealing with minor injuries and drunk youths. In Guatemala City, she had to wear a bulletproof vest.
She was working in a "red zone", which the bomberos would not enter unless they were wearing uniform and vest, for fear of being killed or kidnapped. Despite the danger, it was a challenge she relished.
"I think every paramedic looks for what is called a real job or a job that is interesting, a job that is exciting, a job where you can use your skills and use what you've been trained for.
"The best moments (in Guatemala), were every time that bell rang and I could race and jump in that ambulance and go on that job."
While there, Angie Dymott lived with two of the bomberos and their families.
Luis Archila, known as Archie, is a volunteer. He estimated that every day the bomberos in Guatemala are called out following 15-20 murders.
He and his family live in a guarded compound, but every time they venture out, they feel anything could happen. His wife takes off her jewellery and only takes cash when shopping.
"My parents-in-law, they were driving with my two sons and they almost get robbed," said Archie.
"They point the gun to my mother-in-law and they showed the gun to my kid and my kid, my kid started screaming, but to avoid that, that's why we live (here)."
Full-time bombero, Wilfredo Ponce lives 20 miles out of the city, in a less wealthy area, in a smaller house without high security.
At night, Angie saw groups of men wearing balaclavas and some carrying arms outside his house.
"They are the guardians of the neighbourhood," explained Wilfredo.
"From 11pm, they watch the neighbourhood, just in case anything happens. Since this system was set up, nothing serious has happened."
Angie found it hard to accept that they had to form a vigilante group to keep themselves and their families safe.
"I was quite shocked by the level of violence, and also the way people live, or have to live, or feel it's necessary to live."
The Guatemalan government has begun to negotiate with some of the gangs to try to bring the killings under control.
The Ministry of Culture invited Angie to visit a gang-controlled area called Peronia that it claimed had been made safe.
Former gang member Gustavo, who works for the ministry, managed to help negotiate a ceasefire between the Los Metales and Los Caballos gangs in the area. Before the truce, they were killing up to 10 people a day.
It is the only ceasefire to have held in Guatemala's gang-related wars.
"We come from the street," said Gustavo. "We have credibility with the gangs, they trust us. This allows us to be a bridge to help them change.
"I still feel part of the street. But the part of the street that tries to help people."
Angie loved her time in the country and has been fundraising to help the bomberos, who have limited resources.
"I cannot praise them enough, from the way they work, their attitude, their professionalism, the way they deal with the situations they have with the equipment they've got."
Wilfredo Ponce said: "Sometimes you expect people to thank you for what you do, maybe the families or something.
"But the greatest gift you can have here is to wake up alive the next day."
Toughest place to be a paramedic is on BBC Two at 2100 GMT on Sunday 13 February.