The paramedic It all starts with a phone call, says Pat Hanafin, chairman of the Assocation of Ambulance Personnel (AAP). Someone on the road has been in a crash, or comes across a crash, and they've called 999, and they're in a total panic.

"The control centre tries to get as much information as possible from the caller, but they're obviously highly emotional, with maybe someone dead at the scene, and blood everywhere, " he says. "As soon as they've got the information, they press a button, and the phone rings here in the station, and out we go."

The combination of a distraught caller and bad Irish signposting often means that paramedics have trouble finding the scene. "Every minute, every second is vital, " he says. "But this time can be wasted. Then you land at the scene, and what has been reported as a minor crash turns out to be a serious accident with spinal injuries."

The paramedics don't leap out of the ambulance. They must first assess the danger. Leakages, gases, flames . . . crew have been killed in the past.

"You have to keep your cool. You'll see the worst, and you have to be prepared for that. A 20-tonne lorry on top of a car, people who have been decapitated, amputated arms and legs. And people are shouting and screaming at you to help, and there's blood everywhere, and there's no team or boss to tell you what to do. You have to make vital decisions, and if you panic, the whole situation is lost, " says Hanafin.

In his 22 years as a paramedic, Hanafin has watched the injuries intensify, as the speed of cars increases. He's also seen a marked change in the "bullet point" . . .

the time when most phone calls come flooding in.

"It used to be that accidents happened at 1am, and we'd be finished by 2am, " he said. "Now the main bullet point is between 2am and 5am. I think that points to one of the biggest factors in road accidents that few people talk about . . . fatigue. It's a major cause of accidents, in my experience, dozing off at the wheel."

With everything done that can be done, the paramedics go back to the office. They can, if they want, use a counselling service to relieve some of the trauma.

"One big accident is worse than working a 12-hour day, you're so exhausted, " says Hanafin.

"You have to try to let it go, but some things stay with you. I once saw three lads who had driven over a cliff, and their heads were destroyed. You'll think about that, and always ask yourself if you could have done more."

The garda No matter how bad the crash, how horrific the injuries, the investigation of the accident is not the hardest part, according to a detective sergeant from Munster. "Nothing is harder than telling the parents, or son or daughter that their loved one is dead, " he says. "You get some training in Templemore, but nothing can really prepare you. It's one of the worst jobs you can do, and any garda will say the same."

Before going to the house, the gardai try to get as much support as possible. "We look for neighbours, or the priest or the doctor to come with us to give the family support. Then you drive up, in the middle of the night, and knock on the door. The yellow light comes on in the hall, and the people inside see the blue shine from the car and us in our yellow jackets, and they know it's the guards. When they open the door, they always look terrified."

The gardai are trained to break the news gently, but quickly. Never give false hope. "Then we stay as long as we can, " says the detective. "They always ask how, and why. A lot of people collapse. Others get pure hysterical. They're in total shock."

One case has always stayed with him. A 12-year-old boy was killed in a car crash.

"I can't forget about it, " he says. "It's just every person's nightmare, telling parents that their young lad is not coming home.

I still call to those parents, every three weeks or so. And they're still devastated.

They always will be. If people could come with us, and see the faces of the families when we break the news, they'd stop the speeding. They'd have to stop."

The family For the Quinn family in Buncrana, Co Donegal, no garda came knocking on the door. Just one year ago, Patrick Quinn was driving his taxi when he came across a car crash. He saw five people were dead.

He didn't know that one of them was his son, Darren.

"I saw the firemen and the ambulance crew and then I found out Darren was in the car, " he says. "Looking at it, I couldn't help but think the worst. But when they told me that he and his four friends had been killed, I couldn't believe it. We stood there for about four hours as they cut each body out. It's something that never leaves me."

For the five Buncrana families who lost their children that night, the pain only gets worse. "A year later, we're as torn up as ever, " says Quinn. "And I can't see it getting any easier. You get up in the morning and see his photo looking at you, go out to the town and meet people who still shake your hand. I see young lads going out at night and know he should be with them. A lot of the time, we have trouble believing he's really gone."

Before he died, Darren had been living in the US. He only returned home for the funeral of his friend Shane, who had been killed in another road accident. "He didn't even want to go out that night, because he was feeling sick, " says Quinn. "The wrong place at the wrong time. It's Sunday evenings we miss him the most. He'd go out with the boys on Sunday afternoons and I'd pick him up at 10pm and bring him home. He was always good crack to have around."

Quinn says that he feels for the families in Monaghan who lost five young men in a car crash last weekend. "No matter how the accident happens, the mothers and fathers have to go through the same thing, " he says.

"So many young lads are gone now. There's no end to the hurt."

The coroner It's speed or drink or both that brings so many people to a coroner's court, according to former Mayo coroner, Dr Michael Loftus.

"For the younger lads, a lot of the time they've had just one or two drinks, but that has been enough to let their inhibitions go, and they put down the foot and they speed, " he says. "Other cases, it's all drink. I once had an elderly couple in their 60s, and they were 200 yards from their home when they crashed. Their alcohol levels were as high as you could get. Then there was the man in his 40s who crashed into a wall, and his car went on fire. His body was burnt to the car. That was the worst I ever saw. And alcohol was involved again."

Loftus believes it is our drinking culture that's killing us, and that we're letting it happen. "Young men are drunk and crash, and the media reports that they had been 'out socialising' that night, " he says. "Not out drinking, but 'socialising'. We should be highlighting the drink, not tip-toeing around it."

The doctor When the funerals are over, car-crash survivors must find a way to live again. For Dr Aine Carroll, a consultant in the National Rehabilitation Hospital, her job is to make the future as easy as possible.

"No matter how bad the injury, we have to stay positive, " she says. "We want to get the patient functioning again, to as much of an extent as possible for them. The problem is, so many young men come in to us thinking they're going to be restored to full health, the way they were before. I regularly have to break the news that this isn't ever going to happen, and that is difficult.

"There are so many tragic cases. I'm human, and there are certain times when I'm very deeply affected. For example, there was a young lady here, the same age as me with three small children. And it just made me stop. You have to try not to be affected, obviously. But some cases never leave you."