The files also reveal an increasing trend of verbal violence towards ambulance officers from people, some of whom wield guns, knifes, broken bottles and bats. Incidents against ambulance officers. "I don't know what to say ... it's pretty sad and alarming," Ray Creen, chief executive of the Ambulance Service of NSW, said. "It beggars belief that a person could in any way attack a paramedic whose sole intention is to provide emergency medical aid to a patient in need." While Mr Creen acknowledged anti-social behaviour towards ambulance workers had soared, he said the shocking statistics also reflected the fact that paramedics were no longer prepared to tolerate "senseless" acts of violence against them.

"I don't think we really know the level of assaults, but what we do know is our zero tolerance approach, with the support of police, has produced a culture of improved reporting." In December 2013, the service launched a moving anti-violence campaign aimed at raising community awareness and stamping out violence towards paramedics. The If you Hurt A Paramedic Campaign reminded the public that without their uniforms, paramedics were everyday people, such as someone's mother, daughter, brother - or even grandfather. The initiative also delivered a strong message of deterrence, highlighting amendments to the Health Services Act that had introduced a five-year maximum prison term for people caught violently obstructing or hindering paramedics. But four years on from those legislative reforms, the maximum term has never been imposed by the courts. Of the 174 assaults referred to NSW Police last year, 127 involved physical attacks on paramedics. In some cases staff had feared for their lives, with 26 forced off the job because of related injuries. The statistics also show there were 59 assaults on female workers. In March last year Kiama-based paramedic Rebecca Snelson got a swollen jaw, a black eye and bruising across her shoulders, back and hips after an ice-addicted patient - who had previously assaulted a female nurse - cornered her in the back of an ambulance.

The frenzied attack ended only when a colleague, standing outside, heard her terrified screams. The offender received a minimum jail term of 12 months. "I have been on the job 20 years ... I do think violence is escalating," Ms Snelson said. In December, a 14-year-old girl was among four people charged after emergency service workers were pelted with rocks and verbal abuse as they attempted to reach a teenager who was hit by a train at Taree, on the NSW mid-north coast. The 18-year-old patient, whose legs were severed above the knee, died in hospital three days later. While evidence shows that alcohol and drugs played a part in almost 40 per cent of all assaults last year and a further 32 per cent of offenders were suffering mental health issues, 28 per cent had nothing affecting or aggravating their behaviour. "It astounds me ... they just decided to verbally or physically abuse one fo our paramedics," Mr Creen said.

Gary Wilson, secretary of the Australian Paramedics Association, said the "overwhelming feedback" from members was that attacks were increasing. "It's flown under the radar because we just get on with the job. But it's got to the point now where it's become too commonplace to accept - even under the guise of working in a hazardous environment. Something has to change." twitter: @eamonnduff EMERGENCY SITUATION 174: Total number of assaults on paramedics referred to NSW police last year, compared to 142 in 2013 and 107 in 2012

127: Those that included physical violence 68: Offenders who were drug or alcohol-affected 56: The number of attackers suffering mental health issues 35: Attacks by non-patients 26: Assaults that occurred with police on scene

87: Police charges laid.