A paramedic was told to turn away and leave Whitehaven for his own safety as he responded to an emergency call during the gun rampage by Derrick Bird, an inquest has heard.
Taxi driver Darren Rewcastle had just been shot dead at the town's taxi rank and two other drivers had suffered gunshot wounds when the North West Ambulance Service was alerted.
Paramedic Kevin Wright had just arrived in the town in his fast-response car when his control base rang again to tell him to "stay well back".
He parked his vehicle and was then urged to get out of the town.
As he drove away from Whitehaven, he was flagged down by two police officers in Coach Road - where taxi driver Terry Kennedy had been injured by point-blank fire from Bird.
Mr Wright treated Mr Kennedy, who had to have his right hand amputated after putting it up to his face in self-defence, and was then told by his operators that an ambulance could not be dispatched as the scene was not deemed to be "safe".
An ambulance eventually arrived 30 minutes later and Mr Wright went back to West Cumberland Hospital following information that the gunman may return to the area.
In a statement, Mr Wright said: "I was directed to attend a cardiac arrest following a reported shooting incident on Duke Street, Whitehaven town centre. I attended immediately.
"Due to the nature of the call and reference to a firearm, I requested a rendezvous point with the police. As I reached Whitehaven Library I received a further call from Control to stay well back.
"I parked up and informed Control to notify the police of my current location. I was then informed to vacate Whitehaven. It was obvious something serious was taking place."
The inquest in Workington into the deaths of Bird and his 12 victims later that an A&E doctor at West Cumberland Hospital was constantly paged during the morning about the shooting incidents.
Dr Guy Bickerton said that, when he called in to the hospital, he was told not to leave his home until it was deemed safe to do so, which was not until 90 minutes later.
He later formally declared Susan Hughes dead at around 1.15pm after she was shot in the head and chest near her home in Egremont as she returned from shopping in Whitehaven.
The body of Mrs Hughes, 57, was found in Hagget End, Orgill, with two shopping bags by her side.
At this point Bird had already claimed three victims - his twin brother, David, his solicitor Kevin Commons and Mr Rewcastle - and had just headed out of Whitehaven at speed.
Eyewitness Jeff Doran said he saw Bird with a gun sticking out of his grey Citroen Picasso taxi as he drove up out of town at speed on the Ginns to Kells Road.
Bird overtook cars despite approaching a "blind bend" in what was a dangerous manoeuvre, he said.
He lost sight of the taxi though at the T-junction at the top of the road as Bird had already left for the B5345 to St Bees and Egremont.
On that road he came across student Jacqueline Williamson who was walking her dog, the hearing was told.
She said the silver taxi was driving slowly with about a dozen vehicles behind, before it pulled up towards her.
He shouted at her but she couldn't hear what he said so she walked over as Bird leant over the passenger side, she said.
"He said 'Give me the time'. As I walked across checking my watch I noticed he was holding a gun with both hands with one on the trigger.
"He was looking directly at me. His eyes were staring, I will never ever forget that.
"I thought at first he was going to shoot the dog and then I thought he was going to shoot me.
"I gave him the time and then I thought 'this is it, he is going to shoot me."
She said at that moment her dog pulled on the lead away from the car and she walked away in the opposite direction.
She said she feared being shot in the back but eventually Bird drove on.
Shortly after at around 11am, David Bell, from Cleator Moor, and his wife and seven-year-old son drove on to Hagget End.
Mr Bell and his son witnessed a struggle between Bird and Mrs Hughes - but did not realise it at the time.
He told the inquest: "As we approached there was a taxi in the road with the door wide open. It was quiet tight to get round it
"As I looked to my left I noticed a woman and there was a man on our right and he had his arms round her neck and shoulder and she was looking at me. She had her hand stretched it out to me.
"In that split second I thought was she was the taxi driver and she was helping this person to the car .
They were both standing up at that time. It looked as if all his weight was on the lady as if she was struggling to hold him up."
He said they his wife, who was driving, negotiated around the vehicle and his son said: "Dad, are they acting because that man has got a gun and the lady is on the floor"
"I asked 'what' and he repeated it," he said
Mr Bell said he turned round but his view was obstructed. He said he did not see the gun and did not hear anything as they drove off.