Warning: This article contains language and content some readers may find distressing
Katie* is one of three female paramedics who have shared their experiences of being "hounded" for sexual favours in return for passing training, getting a promotion or simply keeping their jobs.
Although these remarks were often dismissed as "jokes" or "banter", Katie says, occasionally it shifted into a "monumental" abuse of power.
"Handjobs. blowj*bs. They were obsessed with blowj*bs," she says.
These women approached Sky News after our initial investigation earlier this year revealed how misogyny, harassment and sexual abuse is "rife" in the ambulance service. This included the case of a former paramedic who tried to take her own life after being sexually assaulted in the back of an ambulance.
In response to our more recent findings, the NHS's national guardian Dr Jayne Chidgey-Clark, who protects its whistleblowers in England, has said she's "not confident" women in the ambulance service are safe. Requests for sexual favours need to be taken "incredibly seriously", she added.
"It's a matter of worker safety and wellbeing that also, ultimately, impacts patient safety."
Sarah*, 40s, paramedic
From my bum being slapped to glue being left on the women's toilet seats - the jokes and sexual advances were constant. Male colleagues would even walk around the crew room with their penis sticking through the zip of their trousers and their pockets turned out. They'd swing it and sing Nelly The Elephant.
Once I made a mistake with a patient, and a colleague tried to blackmail me into having sex with him. It was horrendous. When I told him no, he said, "watch your back, because I could rape you".
From my earliest days in the job, I was told to laugh it off. I'm ashamed to say that's how I've taught my students and other women to respond. Maybe if I'd told them to speak up, things wouldn't be so bad.
I don't know how you change this culture. When posters saying "We Do Not Tolerate Sexual Harassment" were put on the doors in the ladies toilets, a man crossed out the "Not" and drew a penis next to a woman's mouth.
No one is taking harassment seriously. That's why I plan to quit, which breaks my heart. I love being a paramedic.
Katie*, 40s, former paramedic
As a student, men would ask for handjobs or blowj*bs in return for signing off on my work to show I'd put in the training hours needed to progress in my course. They were obsessed with blowj*bs. They might have seen it as "banter", but it was my career at stake.
Once, I went into a manager's office, in front of other senior workers, and asked for a new suction unit for the ambulance. He said I could have it "if I gave him some suction". Then he told me to sit on his lap, and asked the others if they'd like to join us in a threesome. I just remember standing there and everyone laughing.
As a woman, it was a horrible atmosphere to work in which allowed real predators to operate openly. A senior colleague asked if I "wanted to get raped" by taking the bus after I refused his offer of a lift home. There was also another boss who repeatedly asked me out, and when I refused, he tried to get me fired.
Janet*, former emergency care assistant, early 50s
When I joined the ambulance service in the noughties there were few women, and virtually none in leadership positions. The misogyny and harassment was blatant, whereas today I think it's more insidious.
There's no doubt in my mind that sexual favours were seen as a route to advancement for women back then. I applied for paramedic training, but was told on a night out that the way to secure my space on the course was to sleep with a manager. They even gave me a choice of managers I could sleep with.
I was horrified. So, I refused, and never made it as a paramedic. But I've heard of several women who slept with bosses and it was really damaging for them, impacting their mental health or marriages.
To this day, whenever a woman gets a promotion, people will semi-jokingly ask: "Who did she sleep with to get that?" A few years ago, it all became too much, and I finally quit the job I'd loved for two decades.
This isn't the first time the issue of "sexual favours" has been highlighted in England's ambulance trusts. In the past decade, independent investigations into two trusts have heard similar allegations.
For the first time this year, the NHS Staff Survey asked workers about their experiences of sexual harassment. It revealed ambulance staff were by far the most likely to be victims of this behaviour - with nearly one in 10 saying they suffered harassment or some form of abuse from their co-workers.
Last year, a report from the organisation which supports NHS whistleblowers heard "harrowing examples" of "sexual boundaries" being breached between students and management. While, in some trusts, sexual assault and harassment were seen as "part of the culture".
Steve Russell, chief delivery officer for NHS England, described these new allegations as "completely unacceptable", and stressed that action, including dismissal of staff, would be taken against anyone found "responsible for sexual abuse or harassment".
He told Sky News that all ambulance trusts have signed up to the Sexual Safety Charter which "is rolling out better reporting mechanisms, training and support for staff".
NHS England will continue to "implement the recommendations of the ambulance culture review including on sexual safety", he added.
But he also acknowledged there was still "much more to do" to ensure staff feel confident raising issues and come to work "in an environment where they are treated with dignity and respect".
In the next few months, the NHS will publish new national guidance to reduce sexual misconduct and ensure allegations are reported and investigated.
A Department of Health and Social Care spokesperson said: "Sexual abuse or harassment in the NHS is completely unacceptable and needs to be properly investigated and punished.
"This government is determined to create a culture where whistleblowers are free to speak up."
Katie, Sarah and Janet are all hopeful things can improve - but that change will come too late for them. Once Sarah follows the others out of the ambulance service, all three women will have left the jobs they loved, because of a toxic culture that they say was allowed to fester for decades.
Health and Care Professions Council chief executive Bernie O'Reilly said: "We are deeply concerned by today's reports of truly disturbing and reprehensible behaviour within the paramedic profession. These are not the first allegations of this type within ambulance services.
"We commend the brave victims who have taken the decision to speak out about their experiences, but it should not have happened in the first place."
Do you have a story you would like to share? Email sky.today@sky.uk or Whatsapp 07583000853
*names have been changed
Illustrations by Rebecca Hendin
