I would like to thank the Prime Minister who paid tribute to Thursday's "heroic response" by the police, London's hospitals and the London Ambulance Service.

As a paramedic, I am extremely proud of my colleagues in London who showed, once again, great skill and competence in dealing dutifully with this hideous attack.

The Prime Minister should also consider the fact that we, the very people who embrace unquestionably the responsibility for picking up the pieces at times such as this, are in a position where, very shortly, we will be "de-skilled" by the very process intended to reward us for the abilities for which he praises us.

I am talking about the "agenda for change". We have been warned there is no money to pay us what was initially promised.

Please don't let our only reward be the removal of our skills from the public simply because the only pay scale our services can afford to put us in will not allow us to practise what we do.

Every day, we work in difficult circumstances on - thank God - a far smaller scale.

We treat patients having heart attacks at home and we are skilled in procedures which very few in the health services will carry out unsupervised, let alone on a dark, wet night at the road side.

We hold the hands of the dying, give others hope when it seems there is none, we deliver children and help them breathe their first breath. We tell wives their husbands have died, we work at Christmas, seldom seeing in the New Year at home and often missing milestones in our families' lives.

We touch people's lives in many ways when they are at their lowest and feel privileged and humbled to do so.

Last Thursday was extraordinary in its scale and ferocity but consider that, today, the very people who served London last week and their colleagues across the country will be back at work, facing an uncertain future.

Rest assured though, when called upon to do what is asked and expected of them, they will do so quietly and largely unnoticed by most.

-Stuart Rutland, Hove Ambulance Station, Sussex Ambulance Service