Underpaid, understaffed and underappreciated - that's how paramedics describe New Zealand's "dysfunctional" ambulance service.

A former St John paramedic who moved to South Australia last year says it was difficult to leave his family behind, but the move was a financial no-brainer.

"Australia's worlds ahead of New Zealand when it comes to paramedicine," says the former St John employee, who asked to remain anonymous.

"It's kind of amazing that for the same job, in New Zealand we're on 42 hours a week and here in Australia it's 37 hours, you knock off about five hours a week and add about a 33 per cent pay rise on top of that."

He says he was not planning to come back.

"I would need to see some pretty significant changes. Every month that goes by... other than missing family or friends, returning to the service has very little benefit or interest to me," he says.

"I have no intention of returning back to the [New Zealand] service in the state that it's in."

First Union national ambulance coordinator Faye McCann says paramedics were finding it difficult to stay in New Zealand.

"Some ambulance officers aren't even paid a living wage, so [it's] not really seeming like it's a viable career for New Zealanders to remain in the ambulance service," she says.

"They're often having to do overtime to make sure they can keep their heads above water."

Many graduating paramedics went straight to Australia and never looked back, she says.

"It's not just our members who are moving to Australia, we know of paramedics who have trained in New Zealand who don't even go to St John or Wellington Free in the first place.

"They're just straight overseas where they can get better recognition for the skills they've just earned," Faye says.

"It's certainly more tempting to go overseas, get recognised for your qualifications and really be appreciated for the role that you're doing."

Union members have been on strike for several weeks as they push for better pay, but were still responding to emergencies.

Rotorua EMT Joe Huxford was on strike and says the city's ambulance service was critically understaffed.

"We've got five ambulances during the day, and at night we have only two," he says.

"To be honest with you it's not the St John I joined. I've been with them for six years now, I'm an EMT and I'm on the pathway to become a paramedic... but at the moment finance has been put before patient care. Senior management should be really ashamed of this."

Joe says patients who called 111 at night would be left waiting for an ambulance, or not get one at all.

"We apologise... we come and we can see it's been a long time [they've waited]. We're just honest and say: look, there's only two ambulances," he says.

Faye says it was unsustainable for St John to keep operating as a charity.

"The ambulance service needs to be fully funded, it doesn't make sense for it to be a charity when New Zealanders depend so much on it," she says.

"New Zealanders deserve an ambulance service they can absolutely depend on, and for that it needs to be funded properly."

Recruits arriving from overseas - St John

Hato Hone St John general manager for ambulance operations Stu Cockburn says the service had a low turnover rate and that recent recruitment campaigns were successful.

"Over the past 12 months, our successful recruitment campaigns have brought in experienced paramedics from around the world, including the United Kingdom and Australia," he says.

Casey Costello Photo: RNZ / Angus Dreaver.

"We remain focused on the current collective bargaining process and are hopeful of reaching an agreement."

Associate Minister of Health Casey Costello backed Stu's claim.

"I've been told that St John and Wellington Free Ambulance have no problems recruiting paramedics in New Zealand and St John's vacancy rate is the lowest it has been in a long time," she says.

"Since 2022 the contract with Hato Hone St John has supported over 300 additional front line and communication centre staff to be recruited."

St John did not respond to the claims that it put financial considerations ahead of patient care.