Authorities are continuing to urge patients to keep emergency departments for emergencies, with over half of all presentations during the period classified as semi-urgent and non-urgent.
Between October and December 2022, there were 346,748 ambulance responses, more than in any quarter since the Bureau of Health Information (BHI) began keeping records in 2010.
During the same period, there were 790,309 emergency department presentations, up 1.8 per cent compared with the final quarter of 2019.
Staff in NSW emergency department's encountered a record number of the highest two category triage patients, with 6175 and 113,435 respectively.
NSW Health Deputy Secretary Adjunct Professor Matthew Daly noted almost half, or 370,000 of all emergency department patients, were of the less serious variety, placing additional stress on the system working hard to bounce back from the pandemic.
"We urge the community to please support our hardworking frontline staff by saving our emergency departments and ambulances for saving lives," Mr Daly said.
"Our emergency departments will always prioritise critically ill and seriously unwell patients first, which unfortunately can result in less urgent cases waiting longer."
For patients presenting at EDs, 66.4 per cent of all patients started their treatment on time and 78 per cent of patients had their care transferred from paramedics to ED staff within 30 minutes.
Waiting lists for elective surgery remained longer than pre-pandemic, with 99,300 patients listed at the end of December 2022 compared with 88,044 at the end of 2019.
"We remain focused on addressing the minority of people on the list whose surgeries are overdue, particularly those in the non-urgent category who were most impacted by the temporary suspensions during the pandemic response," Prof Daly said.
BHI Chief Executive, Dr Diane Watson said demand for ambulance and emergency departments had been steadily increasing since long before the arrival of COVID-19.
Paramedics in NSW are on the worst pay scale in the country, prompting many to move interstate where housing is cheaper and wages are higher, according to Health Services Union NSW Secretary, Gerard Hayes.
"While they're committed to helping the public they also have to feed their families," he said.
"It's no surprise that our remaining workforce is stretched to the bone and fatigued to breaking point."
With NSW spending a record $33 billion on health, Mr Hayes said the state needed to take a good look at how the money was being spent through a royal commission.
"We need a thorough examination of how our health dollar is being spent, with judicial oversight and powers to compel witnesses and discover documents," he said.
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