A continuing rise in coronavirus cases across New South Wales has led the state's ambulance service to reach crisis levels four times in the past fortnight.
Ambulance NSW Commissioner Dominic Morgan told the media today: "We haven't known it this busy in our history".
Reaching the highest emergency response level — called status three — means workforce surge plans are enacted and off-road managers and educators are deployed to help.
Health Services Union secretary Gerard Hayes said status three was seldom declared but the system wasn't coping due to the lack of staff.
"Now it is happening on a reasonably regular basis... and this just means the supply and demand for paramedics is not equal," he said.
Mr Morgan said the fourth COVID wave was a major factor behind the demand.
He also said that without any restrictions, people were out and about more so there was increased triple-0 calls for incidents such as car crashes, assaults and falls.
However, when asked if more staff needed to be employed, he pointed to the 1,300 paramedics that joined the service in the past two years.
"There's not been a thing that I’ve asked the government for in the last two and a half years that hasn't been delivered," he said.
He said staff isolation was the service's biggest hurdle, with 4,669 health workers furloughed yesterday compared to 1,600 at the beginning of March.
On top of this, triple-0 calls are now consistently higher than what the service would experience on a normal New Year's Eve.
Mr Morgan urged people to "save triple-0 for saving lives" as too many were still using the service to simply ask questions that could be answered elsewhere.
The extremely high demand is not due to subside any time soon, with modelling indicating an upwards trend in COVID cases for the next two weeks, Mr Morgan said.
In the 24 hours to 4pm yesterday, NSW recorded 13 more COVID-19 deaths and 20,389 cases.
NSW Health said there were now 1,302 people with COVID-19 in hospital, with 47 of them in intensive care.
About 60 per cent of cases in NSW are among people aged under 40 but cases among people 60 and over are flattening.
Investigation into two deaths during peak period
Meanwhile, NSW Ambulance is carrying out a review of the circumstances surrounding two deaths in March at a time when triple-0 calls were soaring.
The NSW Ambulance service has expressed its condolences to the families of both patients.
"On 11 March, NSW Ambulance received a triple-0 call to a Sydney address. The patient was declared deceased by paramedics on arrival at the scene," a spokesman said.
"On 19 March, NSW Ambulance received a call to transfer a patient from the St George Private Hospital to St George Hospital Emergency Department. Sadly, the patient passed away from their medical condition at the hospital.
In a written statement, the ambulance service said March had been another challenging month.
"Triple Zero (000) call volume increased by about 27,000 compared to the previous month, similar to case numbers during the peak of the Omicron BA1 wave."
NSW Opposition Health Spokesman Ryan Park said paramedics were facing difficult situations every day.
"COVID-19 has certainly made it worse," he said.
"We know that our ambulance system was under strain before COVID, but COVID has really tipped it over the edge with the increasing number of people calling for help."
Mr Park said with cooler weather on the way, hospitals and paramedics would see even greater demand in coming weeks.
"We are likely to have another strain of COVID, we are likely to have a difficult flu season — that is certainly what medical experts are concerned about," he said.
"And that is why the New South Wales government needs to make sure we have adequate paramedics to deal with that."
NSW Health Minister Brad Hazzard has been contacted for comment.
