The paramedics union says the NSW healthcare system is in crisis, with patients being kept waiting for up to five hours in ambulances outside public hospitals.
The Australian Paramedics Association (NSW) says worsening 'bed block' was a symptom of poor management and resourcing, and was contributing to backlogs, paramedic fatigue and slow emergency-response times.
"Waiting in a queue outside a hospital for four, five hours at a time is an appalling waste of the specialised skills and training of our paramedic workforce," APA NSW president Chris Kastelan said on Monday.
At Wyong hospital on the Central Coast last week there were more than a dozen ambulances stacked outside and patients waiting five hours to be admitted, he said.
"It's the same from Lismore to Shoalhaven, and throughout the Sydney basin," he said.
Last week Westmead Hospital in Sydney's west had a specialised intensive care vehicle waiting for four hours - leaving the community without that level of care.
"For this to be happening all around the state - it's a clear sign of a healthcare system in crisis," Mr Kastelan said.
Inefficiencies and emergency department delays had flow-on effects across the healthcare system, he said.
In a statement, a NSW Health official said paramedics operated under a triage system in which the sickest patients are prioritised.
"NSW public hospitals are busier than ever as emergency department visits continue to increase," they said.
"At the same time, surgical teams are working hard to ensure that non-urgent elective surgery that was postponed ... in response to COVID-19 is completed as soon as possible."
Almost 90 new ambulances came online last year, and 180 extra paramedics and call centre staff were hired, they said, and the recruitment of an additional 100 paramedics is underway.
However Mr Kastelan says reform to triaging and more staff are needed.
He said while paramedics are waiting with patients, the number of queued jobs keeps building up, with staff often asked to skip meal breaks and do overtime.
"Paramedics are frustrated, exhausted, and burnt out, while patients wait longer for an ambulance and often fail to get the care they deserve," Mr Kastelan said.
"One of the quickest ways to intervene would be providing better funding and support to extended care paramedics, who have the skillset to provide specialised care within a patient's home and keep them out of hospital."
Australian Associated Press