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The ambulance sector has welcomed a parliamentary inquiry into the service it provides but says patients will be at risk until changes are implemented.
An inquiry into ambulance services by the health select committee says cities should have ambulances with two crew on board within three years and all large towns over 15,000 people within four years.
The MPs said single crew callouts should stop, but it would take time for more staff to be put in place.
The Order of St John, which is the largest ambulance service provider covering 86 percent of the population, estimated it would require $53 million more a year to double-crew all its callouts.
Health Minister David Cunliffe said the report seemed to be well reasoned and would be given "very serious consideration" by the Government.
It had a policy of moving towards double crewing ambulances as priorities allowed.
"It's not an inexpensive step ... it is definitely an additional resource and the health budget is pretty stretched," Mr Cunliffe said.
In a press release later, Mr Cunliffe said to implement the recommendations would mean a "rethink of health spending authorities".
More money had been put into ambulance services and further work was being done on a national ambulance strategy.
St John chief executive Jaimes Wood said he was delighted with the report.
"The St John position has always been that emergency ambulances should be fully crewed wherever possible," Mr Wood said.
Eighty-two per cent of St John ambulance responses were double crewed and to increase this would have significant funding implications.
National Distribution Union ambulance co-ordinator Craig Page said the Government had been warned about the dangers posed by the current level of service.
"The best way to deliver effective and consistent ambulance services is through one well resourced national ambulance service provider," Mr Page said.
"Professionals told the committee of our concerns with a lack of regulation, multiple service providers, under-funding, poor quality assurance, inadequate network coverage and single crewing in rural centres. As long as these issues are glossed over patients remain at risk."
The inquiry followed calls by the Ambulance Association that coverage was inadequate, ad hoc and a large number of single crew callouts was putting people at risk.
There have been reports of families of people suffering from heart attacks or witnesses at scenes of accidents being asked to drive ambulances to hospital while a paramedic helps the patient.
MPs recommended the three and four-year targets be taken up by the Government.
"We realise that the nature of the workforce will mean that there is a mixture of paid and volunteer officers achieving this goals."
The report called for clinical standards to be applied to ambulance services and paramedics to become registered medical practitioners under health laws.
MPs said funding to ambulance services through the Ministry of Health and ACC was complicated and confusing.
For instance, all callouts created costs, but ambulance services were only paid if a live person was transported to hospital for treatment after a traffic accident.
Some have called for a single national ambulance service, but the MPs stopped short of recommending that, saying there should be greater co-operation and collaboration.
MPs said streamlining funding and setting up a national standards body would go some way to achieving this.