"One of the groups of people I find who end up waiting a really, really long time are old people who have fallen over and they just lie on the ground for hours. It's such a shame. They can't get themselves up and it's just horrific knowing that they've been there for ages."
Even if they do get to patients quickly, she says they can face long wait times at hospitals because there aren't enough beds available in emergency departments.
"Hospitals, they're doing everything that they can. They're always, always, always busy and it's even worse now with Covid and flu.
"[But] I do not blame them in any way shape or form. It is what it is at the moment."
Before Covid struck, Sarah could "relatively regularly" could get a nap in during her 12-hour overnight shift.
Now, she said, that doesn't happen.
The 15 minutes Sarah has to get organised before she officially starts her shift could be the calmest minutes of her day.
It involves a brief handover, a chance to check everything is in order inside the truck and to pick up any general station duties that need to be done.
Then the real work begins.
Her crew's pager will go off with details of their first job and they hit the road, not knowing if they'll get a break until up to seven hours later.
"If we haven't had a designated break within those seven hours, we have a forced half-hour stand-down period," she explained. "But it can happen where we've only had one break after the seven hours so we may miss our second break.
"That can happen regularly. In a four-shift period [working four days in a row], I've had sometimes only one or two of my breaks on time."
Facing the growing wave of virus-related illnesses, paramedics are busier than ever and, although it varies, Sarah said on many shifts they're now doing more than eight jobs, whereas prior to Covid they were doing around four to six jobs each shift.
The Auckland-based paramedic, who asked not to be identified, told the Herald burnout had become a "massive thing" among her colleagues as their workload increased.
"There's always something happening," she said.
"That is a big reason why people do leave and do move, and you definitely feel burnout, I've definitely experienced it."
This led her to being snappy with people, having less patience at jobs and struggling to stay as calm as she needs to when dealing with patients and their families.
When cases were initially spiking earlier this year, St John reported a 31 per cent rise in average workload in Auckland.
"It has always been busy, it's just obviously a lot different now and starting winter and everything, it always go up anyway because kids get croup or you're more susceptible to the flu, common colds or that sort of stuff."
Adding Covid-19 to the mix is not ideal, she said.
"It is frustrating going to people who have waited hours. I feel for them [but] there's nothing you can do."
The squeeze on ambulance services in general was evidenced last month when a Wellington man was found dead in his doorway six hours after calling an ambulance and complaining of chest pains.
His death was referred to the Coroner due to the hours-long wait for the Wellington Free Ambulance workers to arrive.
Although calls to ambulance providers have increased, Sarah said many callers don't need hospitalisation and they often are encouraged to go to a medical centre or do a video appointment with their GP.
She told the Herald people should consider whether calling an ambulance is essential or whether they can be driven by someone else.
She said ambulances may not be the only option and despite common belief, being driven by one doesn't guarantee the patient will be seen sooner once at the hospital.
"It's always [the] sickest who are seen first.
"We can wait a really long time at hospitals now with beds not being available in ED so we're just backlogging and that does take time.
"[But] it is a case-by-case basis as to what is appropriate to go in the car versus what is appropriate to wait and hopefully get an ambulance quickly."
Besides Covid, and the usual ills and chills, Sarah told the Herald's In the Loop podcast there has been an increase in mental health-associated callouts.
"Initially it was quite frightening when Covid was first a thing because it was literally the blind leading the blind. When you first start in a like a full-time role, you have people you can lean on because they're more experienced, they've got years under their belt, whereas with this Covid setting everyone was super fresh so you didn't know and it was quite stressful."
Sarah said there was no short-term fix for what they're going through, but increasing staffing numbers and adding vehicles would make a large difference.
As well as this, she said another hospital would be "fantastic", but that was not going to get built in a day.
Although Sarah said they have good mental support on the job, some staff are not coping and have either left entirely or moved to different parts of the service.
"For me personally, I'm really struggling with night shifts, I feel like I'm getting way too old for night shifts even though I've only been in it for four years."
Each shift is 12 hours long, and start times vary so some nights she'll start at 6pm and others as late as 10pm. Each crew member working four days on, four days off.
Despite this, she still wants to stay in the industry, but not sure if working on board an ambulance full-time will be her future.
"It does take a toll and there's obviously all the kind of physical health impacts that can happen with shift work, like you get those 3am munchies essentially and you just want to go to a petrol station and get some chocolate. It's not good for your body to be up at that hour regularly."
Sarah admits that during 2020 work was a bit of a struggle, but now she takes it in her stride and is really enjoying her job.
"It's not a life-long career for me but I want to stay in the industry one way or another long-term.
"I'll move away from front-line and maybe drop down to part-time or casual so I can still do the job that I love without things like burnout."
St John EOC Welfare & National Operations Manager Hauora Māori, Dan Spearing, said
in addition to an increase in their underlying workload, they are experiencing a resurgence of Covid-19 infection and reinfection.
"As well as a greater than usual impact of influenza, and other respiratory illnesses. Winter bugs have also impacted our people and their whānau – resulting in an increased number of staff to be away sick."
He said they anticipated these challenges, and have stood up an emergency operations centre to monitor workload, staffing levels, maximise resourcing, and ensure the wellbeing of their people is prioritised.
In response to feedback and in collaboration with the unions, Spearing said they put in place a range of new initiatives to increase the number of ambulance officers who can respond to demand.
"While also recognising the significant contribution our people are making during this time."
He acknowledged workload could be "consistent" in certain areas but they have processes in place to ensure people are allocated their breaks, if crews are working for an extended period of time.
Spearing told the Herald that St John's new four-year funding contract to run the emergency ambulance service, would also help to address most of their service sustainability needs.
"We really want to acknowledge our ambulance officers for their ongoing commitment and thank them for their hard mahi."
*Sarah's name has been changed to protect her identity
