Emergency 911 calls have soared across Oahu, exhausting paramedics and emergency medical technicians, and adding to the strain on a health care system that’s already buckling amid the rapid rise in COVID-19 cases.

“It’s almost unmanageable,” said Sunny Fitzgerald, a paramedic stationed in Makiki. During her noon-to-midnight shift, she may respond to 12 to 17 calls, a workload she called overwhelming and brutal.

In August, about 400 calls for ambulances were coming in per day, compared to an average of 250 calls per day in past years, according to data provided by the Honolulu Emergency Services Department. Oahu has just 21 ambulance units staffed by about 250 paramedics and EMTs.

The number of call locations coded as related to COVID-19 jumped from 40 to 60 per month to a record of 332 in August.

Fitzgerald said the surge in COVID-19 cases adds a level of fear to the job as front-line emergency workers worry about contracting the virus and bringing it home to their family.

“The thing with COVID is you can’t see it,” she said. “A lot of the other things that we’ve dealt with before, like blood and vomit, we can see it, we can clean it, we can make sure it’s not on us. But COVID, you can’t see it, so it’s that fear of the unknown.”

While available vaccines have proven highly effective at preventing someone from getting seriously ill from COVID-19 or dying, vaccinated people can still have “breakthrough” infections or unknowingly transmit the virus. That can be particularly stressful for medical workers with children under the age of 12 who still aren’t eligible for the vaccine.

Fitzgerald is urging residents to call 911 only if it’s truly an emergency and to wear a mask around EMS workers when they arrive.

The COVID-19 calls are adding enormous stress to the system, said Jim Ireland, director of the Honolulu Emergency Services Department. Paramedics are having to intubate some people before they get to a hospital; others are in cardiac arrest before they even reach them.

“Not all of them are saved,” he said.

The EMS crews also are facing bottlenecks once they arrive at hospitals, where emergency departments and intensive care units are overflowing. While previously the wait time to drop off a patient was negligible, paramedics and EMTs can now wait 20 minutes with the patient, according to Ireland.

Every day, he said, more calls come in at once than there are ambulances, requiring dispatchers to triage the calls to determine which ones can wait.

“Most EMTs and paramedics are called to this. They love what they do,” Ireland said. “But everyone has their limit.”

He urged people to get vaccinated against COVID-19. About one-third of 911 calls related to COVID-19 this past month were from West Oahu in the area stretching from Waipahu to Makaha, where just 35% to 45% of the population is fully vaccinated, according to state data.

By comparison, about 64% of residents statewide are fully vaccinated.

While Hawaii’s hospitals have been able to bring in hundreds of nurses and respiratory technicians from the mainland to help with the COVID-19 surge on a temporary basis, there is no relief in sight for EMS workers.

“The mainland is seeing the same problems; they are surging in certain cities. There are fires in California, the big hurricane in Louisiana,” Ireland said. “So there really aren’t any paramedic strike teams to bring in because they are busy all across the country.”

Meanwhile, state and county officials are urging residents to act responsibly over this Labor Day weekend to mitigate the pressure on the health care system. Gov. David Ige and county mayors have warned that law enforcement officers will be out in force and issue citations if people are violating gathering restrictions.

Under an emergency order issued by Ige, gatherings are limited to no more than 10 people indoors and 25 people outdoors, including parks, beaches, trails and campgrounds.

If COVID-19 case counts and hospitalizations aren’t reined in soon, hospital officials worry they may have to begin rationing critical care. Hospitals across the state have already started canceling elective procedures and surgeries that can be delayed amid limits on ICU beds, staff and oxygen supplies.

But coronavirus case counts so far haven’t shown any sign of declining and models suggest they could continue to climb through this month. On Saturday, the state Department of Health reported one new coronavirus-related death and 888 new confirmed and probable infections statewide, bringing the state’s totals since the start of the pandemic to 614 fatalities and 66,778 cases.

Saturday’s count included 562 new cases on Oahu, 141 on Maui, 128 on Hawaii island, 39 on Kauai, four on Molokai, one on Lanai and 13 Hawaii residents diagnosed outside the state.