There is a growing academic interest in the examination and exploration of work intensification in a wide range of healthcare settings. Drawing on the evidence from an empirical study in a large NHS ambulance trust in England, this article examines the challenges and differing staff perceptions of the changing scope and practice of ambulance personnel in the UK. It provides evidence on the challenges for the paramedic professionalisation agenda and managing operational demands and work intensity in emotionally challenging circumstances, with significant implications for patient safety. Research findings also highlight differing perceptions from various sub-cultural groups and lack of clarity over the core values which are reinforced by cultural and management differences and priorities. Evidence from this study has significant implications for the ambulance services for better understanding of the staff perceptions on work intensity and implications for patient safety, high sickness absence rates amidst increasing ambulance demand.