New Zealand has experienced one of its worst-ever days of 'ramping', where ambulances are forced to sit idle and treat patients on hospital ramps because emergency departments are overloaded.
Waikato had its worst day ever on Monday with almost every ambulance in the region parked for up to four hours waiting to get into the ED. Five of those ambulances had seriously ill, status two patients on board.
"At its peak we had twelve ambulances at the emergency department. As a result of that my team declared a major incident," said Dan Ohs, Hato Hone St John's deputy chief executive of ambulance operations.
Ramping is not new but it's becoming frustratingly familiar. Anything over a 30-minute wait time to clear patients from an ambulance into the emergency department is declared as 'ramping'.
Hato Hone St John said ambulances around the country were parked up on Monday waiting to get into EDs for a total of 204 hours. On a normal winter's day they'd be 'ramped' for a total of 130 hours nationally.
"In Waikato it's probably the worst day we have ever seen. We spent 60 hours sitting at Waikato Hospital, 90 additional hours across all four Auckland EDs, so it was a particularly challenging time," said Ohs.
One senior ED doctor at Waikato Hospital told Newshub that Monday was "the most overwhelmed shift I have ever worked".
He said these shifts seem to be happening more regularly, each one worse than the previous one.
He blames "poor access to primary healthcare, lack of staff, lack of beds, and bad planning given it's a Monday and typically the busiest day of the week".
In a statement, Te Whatu Ora's national headquarters said: "ED presentations fluctuate day to day and hour to hour. While acknowledging that our hospitals are always very busy, we continue to work with Hato Hone St John to understand their demands and pressures."
Te Whatu Ora Waikato confirmed a higher number of patients arrived by ambulance on Monday, 85 in total.
Spokesperson Michelle Sutherland said it "moved additional staff to support ED and increased bed capacity in the wards to accommodate those being admitted".
Te Whatu Ora insists Waikato Hospital's ED is currently fully recruited for medical staff and health care assistants in ED and nearly fully recruited for nursing staff.
"Despite the best efforts of our hospital teams, we acknowledge that ambulance teams are sometimes waiting longer than we would like to hand patients over. While patients remain safe in the care of ambulance staff, the handover delay affects their ability to be back out responding to our communities, where we all want them to be," said Sutherland.
NZ Ambulance Association spokesperson and union delegate Mark Quin worries the longer people wait in the community, care is compromised.
"The trouble is if a patient is left waiting, that delay could be time critical in terms of immediate treatment paramedics can offer. It can have less than ideal health outcomes for the patients we are supposed to be there for," said Quin.
St John said while people in the community did have to wait longer than usual for an ambulance on Monday, he doesn't believe they suffered adverse clinical outcomes - but he does want answers.
"I've been having some direct conversations today with some very senior staff at Te Whatu Ora to make sure this does not happen again for our staff and people," Ohs told Newshub.