New health figures show patients in the Heathcote area are among those waiting longer for an ambulance to arrive, but paramedics say they are already being pushed to the brink as hospital emergency departments get busier.
The latest Bureau of Health Information (BHI) Quarterly report shows that the grouped Sutherland-Menai-Heathcote region recorded an ambulance arrival time within 15 minutes for P1 emergencies - the highest priority call - of 52 per cent.
It was the second lowest percentage across Sydney, following Rouse Hill, and was slightly lower than the same quarter last year (53.4 per cent).
There were also more P1 emergencies than the same quarter last year (14.9 per cent higher).
Most ambulances for P1 callouts in the Sutherland-Menai-Heathcote area arrived within 30 minutes (96.2 per cent).
There were also more overall ambulance responses (a total of 2975 for that area), which is 13.1 per cent higher that the same quarter in 2018.
Within Cronulla-Miranda-Caringbah, ambulance activity was also up (5.4 per cent higher). But ambulance arrivals for P1 emergencies was better, at 78.3 per cent.
There were more callouts overall at Hurstville and Kogarah-Rockdale, since the same quarter last year.
"This was a very busy quarter for our ambulance services," BHI chief executive Diane Watson said.
"While we did see increases in response times for the broader emergency category, the median response time for life-threatening cases remained stable at seven and a half minutes."
Australian Paramedics Association NSW member and paramedic, Liu Bianchi, says the figures are troubling, because staff are already "100 on task".
"We're not even into winter and this is a January to March report," she said. "Our concern is that not only our paramedics are working more that ever before, but they are travelling greater distances to get to their patients.
"What comes with that is an increased risk of having fatigue, probability of accidents, and a greater risk of taking longer to get to patients. We are always on the go."
Last year the government introduced 'superstations' - a central hub to expand the number of ambulance vehicles. One at Caringbah supports existing stations. But Ms Bianchi says they can also create problems.
"We're not only drawing paramedics to a centralised location, they're staying at hospitals longer due to waiting times," she said.
"For them to go out to the periphery like Heathcote, Menai, Bundeena and Engadine, it's of course going to take longer. There are lots of older populations living around that area and they're the most vulnerable people in winter. If someone goes into cardiac arrest, how are we going to get there on time? For people who aren't living near those super stations, this impacts on a system that's already stretched. There's only so much we can do."
The NSW government's record $1 billion 2018-19 NSW Ambulance budget includes a commitment to provide an additional 700 paramedics and 50 Triple Zero control centre staff over the next four years. Ms Bianchi says this is "wonderful" but is only a "catch up".
Hospitals across the state also recorded increased activity in emergency departments.
At Sutherland Hospital, the figure was 7.5 per cent higher than last year. At St George, it was 4.6 per cent higher.
At the same time, the timeliness of care provided was down across key measures, NSW Health stated.
Across the state, about seven in 10 patients (71.9 per cent) were treated within clinically recommended timeframes and about the same spent four hours of less in emergency.
At Sutherland Hospital, most presentations were semi-urgent. At St George, most were for urgent presentations.
"Emergency departments across the state experienced high demand during the quarter, particularly from patients triaged as emergency or urgent," Dr Watson said.
"At NSW level, the timeliness of care provided to patients has declined from last year."
The early start to the flu season is also making its impact felt.
"While many people will remember the 2017 winter, our worst flu season on record, we saw thousands more patients this quarter, and these figures do not even show the full winter months," NSW Health Deputy Secretary Susan Pearce said.
She said despite the challenges posed by the record rise in patients, hospital performances across the state maintained a high standard.
"While there is always room for improvement, it was pleasing to see that some of our hospitals improved their performance despite large increases in presentations and very unwell patients," she said.
"These results are a testament to the efforts of our doctors, nurses and paramedics, but NSW Health continues to urge people to get their flu shots to protect them during the cold days ahead."
