Getting up at dawn for physical training is not something normally associated with a paramedic's work.
By Caroline Parkinson
BBC News, health reporter
But it's just part of the preparation a new breed of ambulance personnel have had to undergo.
Specialist response teams are being trained to deal with major incidents - ranging from terrorist attacks or accidents involving chemical or biological material to hundreds of people being trapped in a tube train.
The first of the crews, dubbed Hazardous Area Response Teams (HART), is already in place in London.
But the Department of Health has said each ambulance trust in England should have a similar team.
The idea has been developed over the last two-to-three years.
The 7 July bombings had a major influence on the plans. But the London Ambulance Service says it was already working on ideas for such a team because of the need for paramedics to get to the heart of an incident scene.
In the past, it has been the fire brigade's responsibility to go into the "hot zone" at the centre of an incident - whether that be a collapsed building or a chemical leak.
But paramedics now want to get to patients as soon as possible and begin treating them on the scene, meaning they need to be trained to work in dangerous and confined spaces.
The early morning training is part of that preparation. The 23 members of the London HART team were sent on a five-week residential course where they were also trained "urban search techniques", which detail how to look for people in trapped buildings, using thermal imaging cameras - and how to work in gas suits in the event of a chemical, biological or nuclear incident.
On any given day, two members of the HART team staff a rapid response car. They will be part of the normal ambulance service staffing, dealing with incidents such as heart attacks.
But their cars will be equipped with the gas suits and equipment such as specialist breathing equipment for patients so that if a major incident arises, they can be sent straight to the scene with a control vehicle manned by someone from the emergency response team.
John Pooley, head of emergency preparations at London Ambulance Service said the HART team was attending two or three incidents a day, including industrial accidents and the collapsed building in Whitechapel, east London last month.
He said: "Their remit is to bring specialist skills to all sorts of large scale incidents.
"One of the reasons it was set up was that, for many years, it had always been the role of the fire service to get casualties out in the event of a hazardous incident to a place where we could treat them.
"But we believe now that the treatment should start in the 'hot zone'."
He added: "Our staff are now equipped and trained to provide even more effective treatment to those patients who are ill or injured at the scenes of major incidents."
A spokesman for the Association of Professional Ambulance Personnel (APAP) said: "This launch reflects the responsibilities and skills that have developed within our profession over recent years to the escalating level of danger that the public face on a daily basis from chemical, biological, radiological and nuclear type incidents."
He said it was important that funding for such teams was ring-fenced, given the current demands on the ambulance service.
Health minister Rosie Winterton said HART teams would be rolled out across England.
"When there is a serious incident with many people hurt it is important that they receive good medical care quickly.
"The new HART response teams will not only deliver that much-needed medical care, but they will also free up other ambulance crews to continue dealing with regular 999 call-outs.
"This means that other patients will not receive delayed treatment when the emergency services are dealing with major incidents."