A 47-year-old man has died while waiting more than 40 minutes for an ambulance in Adelaide.
The man, who was suffering chest pain, called triple-0 at 5:19pm on Monday, after pulling over on Anzac Highway at Plympton.
However, according to the state's Ambulance Employees Association, 35 minutes later, bystanders noticed the man was unresponsive and began giving him CPR.
The union said the case was upgraded to a priority one, and the first paramedic arrived at 6:01pm, 42 minutes after the initial triple-0 call.
However, the patient was unable to be resuscitated.
An SA Ambulance Service (SAAS) spokeswoman said they experienced high demand of triple-0 calls on Monday afternoon.
"SAAS offers its deepest condolences to the family of the gentleman who sadly passed away in Plympton yesterday," she said.
"Demand for ambulance services was incredibly high and we acknowledge that hospitals were also under significant pressure. Delays are not acceptable and while our staff did everything they could, the outcome was a tragic one."
At the time of the case, the union said, the SAAS had declared an "Opstat White", with 20 urgent cases left uncovered across the metropolitan area.
The union's Leah Watkins said the man had "fallen victim" to the "crisis" the SA Health system was in.
"He's not the only person that this has happened to — there were, I think, five people who passed away waiting for an ambulance in the two weeks, over a two-week period in March and so this is by no means an isolated event," she said.
"The health system was left to decay to a point that it was irrecoverable.
"I can tell you that if that was one of my family members I'd be f***ing furious and I'd be doing everything in my power to make sure that someone was held accountable for it."
Ms Watkins said the union has long warned the risk was "foreseeable".
"We've got to be able to do more than what we are now, because we can't have this situation where people are dying waiting for an ambulance," she said.
Ms Watkins said that, at the time an ambulance was called, 19 other priority two cases — which should receive an ambulance within 16 minutes — were also waiting.
"It's an incredible risk and — if that game of risk is played day in, day out — it is only a matter of time before it happens," she said.
While Ms Watkins could not say if the man would have survived if an ambulance had arrived sooner, she said his best chance of survival was for the ambulance to arrive quickly so paramedics could provide lifesaving intervention.
The union said ambulance crews had been ramped for three hours at the Royal Adelaide Hospital and for six hours at the Flinders Medical Centre.
Good Samaritans tried to help
Craig McArdle was one of the bystanders who tried to revive the man by using a defibrillator from a nearby pub.
"Three of us removed [the man] from the vehicle, put him on the floor and then start CPR," he said.
"It was upsetting to know he actually rang the ambulance himself and had to wait a length of time.
"Fortunately he had the idea to pull over...and leave the doors open."
He said bystanders tried their best to keep the man alive until paramedics arrived.
Joshua Hamdorf, who worked near the incident, also performed CPR to help the man.
"Basically, I commenced CPR and did that for a bit, and I think minutes later the first paramedic arrived and then administered drugs and I was still doing CPR till the next paramedic arrived," he said.
"He was very unwell at the time and he needed medical treatment and he didn't receive that in time, but I knew that the paramedics were doing all they could, they were at the Flinders Medical Centre from what I heard when they were talking, they were ramped for a while," he said.
Witness Chady Hamra was working across the road when he saw the man going into cardiac arrest.
"We couldn't really see what was happening … we could see people standing around someone," Mr Hamra said.
"I think something needs to be done about it, someone's life just got taken.
"It's pretty tragic to wait that long, and it's not far [ambulance units] from here.
"We're not out in the country, we are in the city … you'd expect within five or ten minutes if that.
"It was terrible, my wife was in tears when we heard."
Premier says death is 'beyond tragic'
South Australian Premier Peter Malinauskas said the circumstances of the case were "beyond tragic", and that an investigation would be conducted.
"A man, a relatively young man, has tragically lost their life under circumstances that might have been preventable," Mr Malinauskas said.
"I think every South Australian knows that my government has made it clear that addressing ambulance ramping, which has consequences in terms of ambulance response times, is a priority of ours which is why literally as we speak, we are dramatically ramping up the resources within the ambulance service so they don't spend their time ramped and spend their time responding to call-outs as quickly as possible.
"We saw over the course of the last four years ambulance response times collapse. In no small part, that was a function of ramping, which is why we've got a policy to reduce ramping."
SAAS will employ 350 new staff in coming years and so far 28 paramedics have hit the road.
