Toronto's emergency medical workers say they're understaffed. The city disagrees. To prove their point, some paramedics have taken their names off the voluntary overtime call sheet: If the city's short on personnel, they aren't available.

Acting of their own volition, dozens of paramedics started taking their names off the list last week. There's no time frame so far on when they'll sign up again. In 2011, the city spent $6.7-million on paramedic staff overtime, up from $2-million in 1999. It's hoping to shave that down to about $6-million this year.

Emergency medical services argue the city's system is strained to the breaking point: Demand for urgent care, and the complexity of delivering it, has grown far more than the growth in personnel or capacity. Between 2002 and 2010, emergency transport volumes increased by more than 20 per cent; paramedic staffing levels by 1.2 per cent.

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But the city is strapped for cash. Toronto is projected to save just over $1-million this year by holding off on new paramedic hires. This will leave 36 positions vacant toward the end of 2012. By December, that translates to 6.5 fewer ambulances on the street over a 24-hour period.

City staff have predicted this will slow response times, which will continue a trend in recent years. A budget briefing note from January, 2011 warned that a "deterioration in response times is largely the result of an increasing workload of emergency patient volumes and a static staffing level."

The industry standard for responding to critical calls is 8.59 minutes. Toronto EMS hit that target 63 per cent of the time last year, down from 86 per cent in 1997. Deferring hiring and taking ambulances off the road is projected to reduce that rate to 60 per cent.

The city hopes to improve response times by re-jigging its allocation of EMS staff so people are where and when they're most needed.

Mayor Rob Ford, who during his election campaign said he supported making EMS an essential service, told reporters Tuesday paramedics shouldn't take themselves off the voluntary overtime list.

"I don't think that's right. I don't think that's right at all," he said. "They've got a job to do. They should do it and take it from there."

With a report from Kelly Grant