Paramedics who treated survivors of the 7/7 bombings complained that some people died because they lacked equipment to move them, an inquest heard today.
Emergency medics also reported being hampered by problems with their radios, a shortage of pain relief, confusion about their roles, and delays in deploying them to scenes of the four blasts.
Firefighters clashed angrily with the first paramedic to arrive at Aldgate Tube station, where seven people were killed, after he refused to take seriously injured victims to hospital.
Andrew Cumner said he was "incident officer" and had to stay at the scene and assess how many more ambulances were needed.
The fire crews responded with "hostility and panic", with one telling Mr Cumner, "give me the f****** keys and I will drive the f****** ambulance", the inquest for the 52 people who died in the attacks on London on July 7 2005 heard.
A long list of complaints by paramedics involved in the emergency response was drawn up at a debriefing session at Millwall Football Club in south London at the end of the day, the hearing was told.
Minutes from the meeting show these included "communications very difficult to get through", "not enough pain relief in packs" and "five different people telling you five different things".
Tom Lynch, who in 2005 was in charge of London Ambulance Service's bicycle medics, highlighted the fact that motorcycle response units (MRUs) and cycle response units (CRUs) did not carry stretchers.
The minutes noted: "MRUs - CRUs - no equipment for moving people out, some people died because of that. Tom Lynch suggested the use of stretcher bags for MRUs and CRUs."
Paramedics based in Camden, north London, complained that they were left to watch the events of July 7 unfold on television before being sent to help survivors.
The memo records that they said: "We felt we were badly deployed - we waited a long time before being deployed."
There were also concerns that old oxygen cylinders sent to one bomb scene could not be used, apparently because no one had the key needed to turn them on.
A separate debriefing for paramedics at Waterloo ambulance station on July 27 raised similar problems.
Minutes of the session noted: "communication difficulties: having one radio channel for multiple incidents created some confusion" and "many crews were held back until it was clear that their assistance was required".
The memo went on: "Lack of familiarity with the ESVs (emergency support vehicles). Drivers struggled to open doors and were unsure what equipment was carried or where it was stored."
Mr Cumner recalled that there were problems opening the doors of an emergency support vehicle at Aldgate but added: "I'm not sure how long it actually delayed matters."
Suicide bomber Shehzad Tanweer detonated his device on an eastbound Circle Line train at Aldgate at about 8.50am on July 7.
Mr Cumner, who in 2005 had 22 years experience as a paramedic with London Ambulance Service, and his colleague Andrea Ray arrived about 20 minutes later.
Recalling the scene, he told the inquest: "As I left the vehicle, I could see a number of people outside the station who indeed did look like they were covered in soot.
"Some of these people were standing, some were sitting and some were lying down."
Fire crews told him he needed to take wounded survivors - including Emma Brown, who had severe shrapnel wounds to her stomach - to hospital for treatment.
Mr Cumner wrote in debrief notes after the incident: "Firefighters insisting that we take a number of casualties at the station entrance.
"I declined, explaining that we were the first ambulance on and could not convey any patients but had to evaluate the situation, and I had to take on the role of incident officer until relieved.
"This was met by some hostility and panic from the firefighters, with comments such as 'give me the f-ing keys and I will drive the f-ing ambulance'."
Mr Cumner added in brackets the comment, "not helpful".
He told the hearing that the clash with fire crews only delayed him by about 30 seconds.
Sean Clarke, the first senior firefighter to arrive at Aldgate, said there was a misunderstanding about the role of the first paramedics on the scene.
He said: "We are always taught about the golden hour, how to get people out of a situation and get them care as quickly as possible within the first hour.
"And, naively perhaps, we think that the ambulance service are there to do that, to ferry them off and get them away from the situation."