The number of Rotorua residents calling 111 for an ambulance dipped slightly last year, bucking the national trend.
But local crews are still flat out responding to back-to-back jobs, a St John operations director says.
St John received 6165 emergency 111 calls in Rotorua in the year to June 30 - six fewer than the previous year.
That's at odds with the increasing national workload which prompted the organisation to announce last month that it was bumping up its callout fee to cover burgeoning costs.
Bay of Plenty district operations manager Jeremy Gooders said the drop in calls in Rotorua was "minute".
Crews were "very busy" around the clock, with many squeezing 12 back-to-back jobs into a 12-hour shift.
Emergency 111 calls in Rotorua peaked during winter, he said. "Our busiest months are July and August . . . as elderly people and people with chronic conditions become more unwell."
St John's workload had increased "steadily" over a number of years, especially in the number of calls for less serious situations. This was partly thanks to people getting on to medical problems early.
"I think people are better educated in the community now, so they're calling us earlier rather than waiting until they are in a serious condition."
Sometimes calls weren't an emergency, but because members of the public weren't "medical experts", it was better to err on the side of caution, he said.
"We're far happier to see them at an earlier stage, than at a late, life-threatening stage."
Nationally, St John received 380,785 emergency calls in the year to June - 14,276 more than the previous year.
From April 1, patient charges rose by $4 or $13 - depending on the region - to a single rate of $88. Rotorua residents had previously been paying $84 so faced the smaller increase.
The flat rate charge for those not covered by public health services also jumped, from $769 to $800. St John operations director Michael Brooke said the organisation was increasing its part charge in response to increasing demand for its services.
"People tell us they are comfortable to pay a part charge, given the high quality of the service and treatment they receive, and when they understand that the part charge goes towards funding frontline ambulance staff."
The subsidised charge covers patients who need an ambulance because of a medical emergency.
People who have suffered an accident don't need to pay anything as long as the callout is within the first 24 hours of the injury and meets ACC criteria.
St John has 1043 paid staff and 2951 volunteers and treat more than 415,000 people every year. It costs $1 million to run one ambulance for a year.
Today is the start of the St John Annual Appeal week. You can donate at stjohnappeal.org.nz or by calling 080 ST JOHN (785 646).