Frank Pierce is a New York paramedic on the brink of burn-out. Haunted by ghosts from his past and unable to enjoy restful sleep, he hasn't saved anyone in months and now dreams of being fired so that he can regress into his misery. Then one night he and his partner respond to a cardiac arrest call where the victim is pronounced dead then unexpectedly responds; Frank becomes convinced that the man wants to be left to die, which deepens his paranoia, but finds a flicker of hope when he meets and connects with the victim's daughter, Mary.

Director Martin Scorsese and screenwriter Paul Schrader are individually two of the most important talents of modern American cinema, and on the two previous occasions when they have worked together the results were history-making: the brilliant Taxi Driver remains a landmark piece of 70s maverick cinema and launched both of their careers in a big way; four years later Raging Bull (which Schrader co-wrote with some time Scorsese collaborator Mardik Martin) won worldwide acclaim and topped a critics' poll for Best Film of the 80s. Hopes were insanely high for this latest work, the combination of Scorsese, Schrader and New York streets creating expectations for something that might outstrip both previous movies in its ferocious anger and unflinching brutality. So imagine the dismay when Schrader and Scorsese delivered Bringing Out the Dead. Where Travis Bickle and Jake LaMotta are driven by anger and self-interest, Frank Pierce is wrapped in a jacket of weariness and despair. Jake and Travis burned with inner fury that sometimes exploded in physical action, but Frank is on a self-obsessed downward slide and is slowly imploding. If that wasn't enough, Schrader and Scorsese refuse to push many of the standard story development buttons: though Frank's journey through his own neurosis is aided by the expected female Ray of Hope, she turns out to be as screwed-up as him, and despite the three-act structure the story rarely develops along traditional narrative lines, including the ending. In retrospect, it's not that surprising that a number of critics and many of Scorsese's traditional supporters were, frankly, pissed off. Which is a shame, because Bringing Out the Dead, though perhaps not the cinematic event its predecessors were, is still a unique and compelling work, and very much a Schrader/Scorsese film.

The film takes place over three nights, each of which sees Frank paired with a different partner, each of whom he has a history with and whose lifestyle represents a potential but ultimately self-deceptive direction for Frank himself: overweight Larry Verber treats his night work as a series of rest periods and meal stops, relentlessly cheerful Marcus has found God, and wide-eyed, manic Tom Walls is addicted to violence. All three have the outward appearance of men at one with their job and the city, but all are hiding behind a facade. Larry's night-time meals have become his whole reason for going out, and actually having to attend incidents annoys him intensely – he'd rather park at the end of a pier and sleep through his shift. Marcus appears genuinely happy, but has achieved this state through reality denial, revealed in his clearly misguided conviction that the female dispatcher wearily spilling out jobs to them is actually hot for him, and in the hilarious scene in which he convinces a group of half-stoned clubbers to pray for the life of their dead friend in order to revive him, an action actually being accomplished not by God, but by Frank and a hypodermic. Tom Walls displays an enthusiasm for his job that is almost hysterical, but he is a borderline psychotic, using his position as an authority figure to intimidate, frighten and even beat up on the very people he is charged to save. Beyond the confines of the narrative, all of this this could be read as a comment on negative aspects of modern America, with apathy, fast food, drugs, religion and violence (not to mention underfunded health care) key contributors to a potential breakdown of community life, not necessarily in themselves, but in the way they are regularly abused by those with a personal agenda.

The portrait of New York presented is as dark as anything in Taxi Driver, the streets controlled by drug dealers and infested with the dispossessed, the predatory and the dangerous; at one point Frank's ambulance has to wait for a series of drug deals to conclude before being casually, reluctantly allowed to pass. Mercy Hospital, to which Frank regularly returns, is a medical facility at breaking point, the staff unable to cope with the deluge, patients on trolleys in corridors waiting for a bed that may never be available, the reception under almost constant assault from angry relatives and potential patients, all of whom are held at bay by a lone, agitated security guard whose ultimate threat is that he will take off his sunglasses. One call to a derelict apartment block prompts an initial reluctance to enter without police backup, and when Frank and Marcus do go in they seem to ascend through layers of an inverted hell, a dark, sinister, unlit stairwell, peppered with broken drug phials. This leads them to the gloomily tattered remains of an apartment in which a young girl named Maria is about to give birth to twins, despite the fact that she has apparently never had sex, a bible story that feeds Marcus's religion but turns sour for Frank when it's the twin he delivers that dies, just like all his other recent cases. He no longer sees himself as someone who can save others – in his voice-over he describes himself simply as a 'grief mop' and feels it is enough that he simply showed up. Seemingly the only calm in this social storm is The Oasis, an apartment owned by drug dealer Cy, where clients can not only purchase a variety of mind-altering substances, but chill out or even sleep for a few hours. As seemingly the only dealer who refuses to handle the deadly and somewhat overly symbolic 'Red Death', he comes across as almost morally sound in comparison to those around him.

All of which sounds seriously depressing stuff, but balancing this is a very nice line in black humour, some splendid character detail and Scorsese's sometimes dynamic technical handling. Occasionally he overplays his hand – UB40's 'Red Red Wine' playing over shots of blood running from a shooting seems a tad obvious, and the ghost of Rose, the girl Frank once failed to save, makes a few too many appearances – but when he hits gold the results are electrifying, as in the supercharged sequence in which the Frank and Walls, both fired up, propel themselves furiously into the night to the sounds of The Clash's 'Janie Jones'. Essential to this are Robert Richardson's glowing, almost hallucinatory night-time photography and Thelma Schoonmaker's sometimes dazzling editing, which itself has become as much a part of Scorsese's style as the direction itself.

Performances throughout are first rate. Nicholas Cage is close to his Leaving Las Vegas best as Pierce, coming across as an authentically tortured soul, his face and body language expressing a genuine weariness with the world, his eyes sometimes pleading for salvation – even his manic moments, such as his anger at the would-be suicide who fails to do the job properly, have a desperation about them. Patricia Arquette is appropriately downcast as Mary, but the real drive come from three key supporting roles. John Goodman is almost stereotypically cast as Larry, his bulk and casual attitude making it easy to believe he feeds and sleeps his way through shifts, but as ever he is a delight to watch and invests the role with humanity, an element seen at its best in an almost throwaway moment during Frank's flashback to Rose's death, a time we can presume when Larry still really cared, the very real concern on his face as they fight to save their patient being that of a committed professional. Those who know Ving Rhames primarily for his role as slow-talking gangster Marcellus Wallace in Pulp Fiction will have trouble even recognising him here as the cheerfully religious Marcus – the transformation in both look and character demonstrates all too well the actor's range. And while Tom Sizemore may also be in danger of being typecast as the half-crazed Tom Walls, the wide-eyed energy with which he plays the role makes it hard to imagine anyone else working half as well. His borderline madness is at once both amusing and frightening.

Bringing Out the Dead is an underrated, too often overlooked film from two of the most consistently fascinating talents working in modern US cinema, and a welcome change from the shouty, obvious, CGI-driven action dramas that have become the dominant Hollywood norm. It also offers a view of modern, street-level urban America that is refreshingly critical, as befits the two once angry young men behind it, who maybe older and wiser, but appear to be no less cynical.

Touchstone's region 2 disk is about the film and nothing else, and the lack of extras is in some way compensated for by the picture and sound quality. Shot almost entirely at night (the daytime scenes, such as they are, take place in a gray murkiness that reflects Frank's melancholy), but processed in a way that produces a pronounced glow to deliberately overexposed white highlights, this could prove a major challenge for DVD, but the transfer here is first rate – the contrast range, shadow detail and colour rendition are all excellent, and there is no sign of edge enhancement or intrusive artefacting. Reviews of the region 1 disk suggest that the region 2 has the edge here. The picture is 2.35:1 and anamorphically enhanced for widescreen TVs.

The 5.1 sound mix has an impressive breadth and clarity, the music that is so essential to the film – whether it be Elmer Bernstein's moody score or the various rock numbers that accompany Frank on his missions into the night – playing particularly well. Distant city sounds linger nicely in the background in all scenes outside the ambulances, sometimes hauntingly so. Surprisingly, the rear speakers are very low key, as is the subwoofer – though fine for the most part, the sequence in the night club almost demands that both be used aggressively.

The menus are static, barely designed at all and are bare bones functional.

As mentioned in the previous section, this is almost as far from the term 'special edition' as you can get, and the DVD cover spine has that curved 'wide screen' banner that used to translate, with the aid of those glasses from They Live, as 'no extras'. Here there is one, the standard electronic press kit running just under 11 minutes. Made up from interviews with principal cast members, Scorsese and Joe Connelly, the real-life paramedic on whose book the film was based, it does give a few snippets of info into the reasons for creating the book and film, but also has a lot of back-slapping typical of this sort of featurette and overall is of little value.

Though a seemingly increasing number of critics (online and otherwise) are prepared to stand up for the movie, it remains in general an unfairly maligned work, in part because it lacks the in-your-face drama and explicit violence of many of the director's previous urban films. Bringing Out the Dead requires a more patient viewer, and despite its setting is altogether more European than American in its sensibilities, an instant barrier for a sizeable proportion of its potential US audience. It won't have students standing in front of mirrors with fake guns reciting "Are you talking to me?" at their own reflection, but that's no bad thing, and taken on its own merits rather than as a comparative work, this is an intelligent, emotive piece of cinema that deserves a wider audience. Extras are virtually non-existent, and maybe one day someone like Criterion will do something about that, but the picture quality is first rate and the sound generally impressive, which for fans of the film will be enough for now.