Four months after the Newcastle Herald revealed that two of the region's most senior NSW Ambulance managers, husband and wife team Kerry and Robert Akester, resigned after being stood down, inspectors Mick O'Connor and Brian Knowles were removed from duty this month.

Both men, who declined to comment this week, were working as duty operations managers from Hamilton station.

It's understood there are several investigations underway into the operations of the bitterly divided service in the Hunter.

Numerous paramedics have spoken, on condition of anonymity, about a "deep divide" within the service.

"There seems to be two camps that have emerged and then there are the people sitting in the middle trying to stay out of it," one said.

"It's hard to know what is going on amid all the silence from the powers that be."

Another ongoing investigation is into the service's treatment of paramedic Tony Jenkins who took his own life in April 2018.

Mr Jenkins was left to drive home alone following NSW Ambulance accusations of illicit opioid use.

The state's workplace health and safety regulator is taking legal action in criminal court against NSW Ambulance over the suicide.

For months NSW Ambulance has repeatedly refused to respond to questions about the investigations or what some paramedics describe as an ongoing "toxic culture" within the service in the region.

On four separate occasions since May, a NSW Ambulance spokeswoman has dodged questions put by the Newcastle Herald about the issues.

When the Newcastle Herald first put questions in May, the spokeswoman said NSW Ambulance "does not comment on the working arrangements of individual employees".

The same response has been given on three occasions since and questions about governance, bullying and culture have been ignored.

Several paramedics said the stonewalling was doing little to boost morale.

A senior Hunter paramedic said the stony silence suggested an inability to deal with "an ongoing culture of fear", where workers were afraid to speak out.

"We want things to change and we are glad things are moving, but we are operating in a vacuum as usual," he said.

"The silence isn't helping anyone, it's leaving people walking around wondering if they'll be next. There is a lot of frustration at the lack of communication."

Another said it was "typical" that major changes were being made "at the highest levels" and workers were being "completely kept in the dark about what is going on and why".

"We're like mushrooms, they send out an email about changes in chain of command and don't explain anything," a paramedic said.

"It all comes down to rumour and gossip about what is actually going on. The level of communication is beyond poor. We're not asking for full details, we understand that is not possible, but something might be useful."

As reported in May, two Sydney barristers, based at an inner-city Newcastle hotel, interviewed more than a dozen past and present paramedics over several weeks.

NSW Ambulance's newly appointed Deputy Director of Clinical Operations, Inspector Jordan Emery, who is the most senior officer in the region, outlined plans in May to review the Hunter ambulance service and address "workplace grievances".

"It's no secret there have been significant cultural challenges in Hunter New England - that's been reflected in staff surveys and that's been reflected in people's experience," Inspector Emery said.

The Australian Paramedics Association NSW state president Chris Kastelan confirmed members had reported cultural problems in the Hunter for years.

Mr Kastelan said the association had faith that the investigations were being conducted appropriately.

"We're very happy with the way the new manager has gone in there and seems to be not only talking the talk, but walking the walk," he said.

The Akesters, formerly Hunter Zone 1 and Zone 2 managers, oversaw stations from Newcastle to Murrurundi. They were second in charge under Inspector Emery.

Mr O'Connor and Mr Knowles sit in the next level of management, along with 10 other duty operations managers.

It's understood there are four permanent duty operations managers across the region, the other eight positions are held by people acting in the roles.

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