Hunter New England Health (HNEH) says Newcastle's John Hunter Hospital (JHH) was no busier than normal at the weekend, but paramedics and Emergency Department staff tell a different story.

Australian Paramedics Association state president Chris Kastelan said staff were at such skeletal levels that paramedics who had just finished their shift were asked to go on-call, others have spent hours 'ramped' at the hospital waiting for a bed and some asked to cancel annual leave.

"That's a response strategy that's out-of-date by 15 to 20 years, we don't have on-call in metro built-up areas because it's unsafe for the paramedic and it's not ideal to have one person turning up to a case that needs two sets of hands," he said.

"It's worrisome from our end because really significant crisis management strategies are really now becoming a daily occurrence.

"It's a governance situation where we have a lot of money spent on these areas but they're continually failing, failing more regularly and for longer times."

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In the most life-threatening cases, the average response time in Newcastle was 9.1 minutes in the October to December quarter - still within the 10 minute target.

But Mr Kastelan said relying on a workforce that's done 24 to 30 hours work in two days has its own issues.

"Ultimately that has to be a last resort, because paramedics are attending cases tired and fatigued," he said.

"A workforce put up to those stresses is going to crack at some point without the enhancement of more resources."

A NSW Ambulance spokesman said it uses on-call rosters to ensure there's enough capacity to respond to emergencies.

"On-call is offered in line with the NSW Ambulance fatigue policy, to ensure staff are provided the opportunity to rest and recover, before and at the conclusion of their shift," he said.

The hospital has strategies to manage a high influx of patients, including opening surge beds, rostering an additional waiting room nurse and a patient experience officer who updates on wait times.

But, NSW Nurses and Midwives Association John Hunter branch secretary Rachel Hughes said when there simply aren't enough beds - there's nowhere for patients to go.

"Our members are telling me there was a bed block, and that's why there were so many ambulances out there, they can't offload patients if there's nowhere to put them," she said.

"It just slows everything down and limits access to paramedics because they can't go and get the next one.

"Everyone is exhausted, we have been saying this for ages, everyone is burnt out, people keep coming back to work and doing overtime because they don't want to leave colleagues short and patients unsafe."

Ms Hughes said on-call shifts have become an issue particularly in maternity and gynaecology, where what was supposed to be an 'as-needed' solution has become an expectation.

"I spoke to a midwife the other day who's done three overtime shifts this week, when you work full-time already that's ridiculous," she said.

"People do it because they don't want patients to be unsafe or their fellow staff to be unsafe - so they do it - and the hospital relies on the staff feeling guilty and doing it anyway."

She said staffing issues needed to be addressed by making the nursing profession more attractive with mandated staff-to-patient ratios and better pay.

The hospital's general manager Leanne Johnson said the number of patients that presented to ED were consistent with other weekends.

"As one of the largest trauma centres in NSW, JHH is well equipped to treat a significant number of complex cases while not compromising patient care, and this past weekend was no different," she said.

"Like all other hospitals, JHH has been under significant pressures with staff furloughed due to the COVID-19 pandemic, however the ED continues to be staffed appropriately."

Maitland Hospital faces similar issues, as staff told the Herald 'freakishly busy' days have become commonplace - putting a strain on paramedics, patients and ED.

Wallsend MP Sonia Hornery said the state government needs to step up and provide more resources.

"This is not the first time this has occurred and the problem is a shortage of available staff and resources," she said.

"They are ignoring the issue and trying to play it down, we want to praise the staff and their hard work but that's all they're getting, is a thank you, it's not about a pay rise or increasing staff which is their major concern."

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