Each Illawarra ambulance car is covered in "aggressive" chalked slogans aimed at the state government, with a desperation for change behind the messages.
Paramedic and Illawarra Shoalhaven Health Services Union delegate Tess Oxley said the chalking action began at the beginning of last month and ramped up to send a clear message ahead of the NSW election on March 25.
"We started aggressively chalking them the cars to get the government and Labor party to actually prioritise us," Mr Oxley said.
"It has definitely kept us in the conversation about what's going to be important when it comes to this election."
Slogans including "there's no way for fair pay under Perrottet" and "Perrottet delays your healthcare" have been sighted across the region, as ambulances spend more time in bed block or racing to back-to-back jobs, and rarely seeing the station in a days work.
NSW paramedics are the lowest paid in the country, according to the HSU, with a pay increase of more than $200 per week in Queensland.
Ms Oxley says low pay is driving burnt out paramedics away from the Illawarra to work interstate.
"People are doing fly in fly out work and are still making more money as opposed to working in NSW," she said.
"Our skills and knowledge have changed so dramatically over the years but our pay hasn't.
"That's a result of the NSW wage cap at 2.5 per cent. What we're saying is that cap needs to go for all government workers.
"But they also need to look at how much we have changed as professionals."
The responsibilities of paramedics has increased, Ms Oxley said, including more authority to leave patients at home and moves towards more invasive skills including decompressing chest injuries in traumas.
"When you're not being paid properly to do that, the encouragement to do that and do it well just isn't there," she said.
"And that means we're just going to transport more people to hospital which may not be the most beneficial thing for them."
Ms Oxley said while multiple new stations have been announced for the Illawarra, there have been no promises made to ensure they will ease pressures on staff shortages.
"They have not actually guaranteed that those stations will be maintained, which means if somebody is on sick leave or long service leave, those spaces won't be filled, which potentially means new stations will remain empty," Ms Oxley said.
"Even though we are getting more staff and stations in the regions, there is no commitment that they will always be run. Which is again putting pressures on the community."
With hours-long bed blocks becoming the norm, Ms Oxley hopes the message to meet paramedics' demands is heard by the state government.
"It did seem that we were having a good working relationship with (NSW Premier Dominic) Perrottet, but at the moment he has not come to the table with anything and it is very close to the election," she said.
"We're still talking with Labor and we're hoping to have an outcome for paramedics.
"(NSW Labor Leader) Chris Minns committed to professional recognition in his speech last weekend, however determining exactly what that is and making sure that is really does value paramedics is still an ongoing process."
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