The Australian Paramedics Association (APA) has weighed into the issue of bed block at Shoalhaven District Hospital.
Association vice-president Glenn Congram, himself a local paramedic with 28 years experience, knows the problem first hand.
"Definitely bed block at Shoalhaven has gotten worse," he said.
"Which is not a good statement - the Shoalhaven ranks on the list of the worst performing hospitals in the state.
"There's a number of issues involved.
"Health knows we are coming into that traditionally busier winter illness period.
"But we have winter every year and the strategy seems to be the same every year - nothing has changed in the last 20 years I've been in area to improve bed block.
"Patients are not being discharged from wards to make beds available. There simply aren't enough beds."
He said another issue was the patient transport service, which only operates between certain hours.
The Shoalhaven emergency departmentt is just no longer big enough to cope with the number of patients coming through.Australian Paramedics Association (APA) vice-president Glenn Congram
"It means paramedics are not only required to transport emergency patients but once patient transport closes and people are discharged to home or nursing homes or transferred to other hospitals to free up beds paramedics get tasked," he said.
"Paramedics understand at times there is a need to wait for everything to be ready for patients to be transferred.
"Bed block at Shoalhaven is one of the worst performing and over the years continues to be one of the worst performers in the state.
"That's down to the size of emergency department - it is just no longer big enough to cope with the number of patients coming through.
"The nursing staff at the hospital and the paramedics are very amicable and both understand each other's roles and issues, but the hospital management needs to step in and manage the problem.
"It's time government and local agencies step in and expand hospital services. The growth catchment area of Shoalhaven Hospital is absolutely phenomenal, not to mention the aging population.
"We expect waiting times to increase over the next few months and paramedics to be standing and waiting to off-load patients for longer than two hours on a regular basis over the winter period.
Hospital management needs to step in and manage the problem.Australian Paramedics Association (APA) vice-president Glenn Congram
"If it keeps going there will be no ambulances available to respond to emergency cases within a timely manner."
He said Health and local MPs should be investing money on equipment rather than closing or reducing services at smaller hospitals.
"Take Milton Hospital for instance," he said.
"There could be five or six patient transfers a night from Milton to Shoalhaven solely for the purpose of getting a CT scan to rule out a certain condition.
"Certainly the patients need the scans, but it also ties up beds and often paramedics after the transport service has finished for the day.
If it keeps going there will be no ambulances to respond to emergency cases available within a timely manner.Australian Paramedics Association (APA) vice-president Glenn Congram
"If the government actually spent some money on a CT machine for Milton [which he estimates is at least $100,000] that side of the service could be freed up.
"It takes paramedics away from Ulladulla, the new Bay and Basin station, Sussex Inlet and even Bomaderry to do the transfers between the hospitals.
"The new Bay and Basin station is virtually a transport hub."
Mr Congram said paramedic fatigue was also a big problem that could have disastrous outcomes.
"At the moment paramedics are not getting the breaks in shifts as required," he said.
"Even for simple things like having a meal break. Paramedics should have at least two half hour meals breaks in a 12 hour shift - that rarely happens. Often they are not even able to return to the station for those breaks to occur.
"Then there is overtime - at the end of a shift paramedics are often required to do overtime, pushing them well above the 12 hour shift has become common.
"Paramedics are then required to do on call after that for most stations in the Shoalhaven."
He said fatigue sets in and tests have shown that sort of condition can be almost equivalent to someone being drunk.
"It is extremely dangerous - there are no facilities for paramedics while at the hospital," he said.
"We maintain care for our patients and love doing that anyway, but we can't get patients off-loaded to respond to other calls.
"We continually receive public criticism, why we haven't arrived in a timely fashion, it's then up to frontline paramedics to explain the situation of what's going on trying to clear hospitals, or we were the first car available."
Mr Congram said there was a need for increased paramedic staffing in the Shoalhaven which was starting to happen.
There are no shortage of officers wanting to come to the area. Between Helensburgh and Ulladulla there are 38 positions advertised. There were 1100 applications.Australian Paramedics Association (APA) vice-president Glenn Congram
"We have around 90 paramedics in the Shoalhaven covering from Berry in the north to Ulladulla in the south as well as outlying villages like Kangaroo Valley, Culburra, Sussex Inlet and the Bay and Basin areas," he said.
"Ideally we need around another 36 staff in our area.
"We have identified positions that have not been filled for long periods of time.
"We have advocated for four years about the positions not being filled or on a temporary basis.
"Thankfully they now are in the process of being filled.
"There are no shortage of officers wanting to come to the area.
"Between Helensburgh and Ulladulla there are 38 positions advertised, not new positions, but people are temporarily sitting in or have not been filled for a number of years.
"There were 1100 applications."
In June last year the NSW Government committed to a record paramedic workforce boost, delivering an extra 750 paramedics and ambulance call centre staff over the next four years.
While welcoming that announcement Mr Congram said it is understood the majority of those extra officers would go into the Sydney area.
"We believe at this stage there could be an extra 12 paramedics at Dapto and the same at Bulli, which would help alleviate Shoalhaven paramedics being forced north to cover," he said.
"But at this stage neither NSW Ambulance or the Ministry of Health will advise unions or negotiate where the extra staff are going."