Violent crime is sucking millions of dollars from Auckland's health sector every year and injuring around 20 people a day, leaving stretched ambulance and hospital staff to mop up the aftermath while receiving a daily barrage of abuse.
Assault-related injuries in the city have racked up almost $13m for ACC already this year. St John staff say they are responding to roughly one firearms incident every fortnight.
One emergency department nurse said there have been more than 200 assault-related injuries treated at the hospital where she works so far this year. Last year there were 420.
Victims are struggling to make ends meet – even going bankrupt - while recovering from serious injuries and surgeries that have forced them out of work for months, or a year.
A "notable" increase in the last six to 12 months of random attacks, drunken brawls and firearms incidents victimising anyone from children to the elderly is putting a "huge" strain on St John staff and resources, Waitakere Territory Manager Andrew Everiss told the Herald.
"It can be anything from domestic-related incidents, to brawls in the street, to violent crime...involving gangs.
"We see an increase in Auckland CBD outside bars. Members of the public that are just out there for a good night to socialise with their friends are getting caught up in these incidents."
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Rising firearms incidents are significantly tying up St John and hospital resources.
"Firearms injuries usually … tie up staff longer, either trying to stabilise the patient or get the patient to ED," said St John shift manger Steve Walker.
"A person who has been hit with a projectile normally requires urgent theatre."
Staff working a Saturday night can expect to be "extremely tired" after a 12-hour shift, Walker said.
West and South Auckland are hotspots for violent crime, especially on weekend nights, and drugs and alcohol are fuelling the violence.
The increase is taking St John staff from Aucklanders who need primary medical care, Everiss said, and causing them to be subject to a "constant barrage of verbal abuse and assaults".
More than 3000 ambulance staff reported being verbally or physically abused last year either by the patient, members of the public or even the patient's family, he said.
Delays at emergency departments across all three Auckland hospitals have left St John staff waiting up to two hours before offloading their patients. On some Saturday nights four to five ambulances can be parked at one hospital at once.
Hospital staff have reported being stressed, burnt out and scared when treating violent patients often under the influence of drugs or alcohol.
"They are trying to break down the door...they are hitting out at us and the security officers. There are other patients in close proximity within the ED so it becomes a very difficult situation," said one nurse the Herald has agreed not to name.
"It becomes quite scary to even approach them."
Patients are presenting with gunshot and stab wounds, facial and serious head injuries that take away resources from other patients.
Another nurse, who wishes to remain anonymous, said people who have been assaulted are presenting "pretty much every night" at the hospital emergency department she works at.
"One night we had three people that were attacked by this one person and it was a completely random act of violence.
"A lot of these people come in ...and do not know who has attacked them."
She said she is constantly verbally abused and in one case a woman tried to kick her head, but she feels she has to "brush it off".
"You have to de-escalate and get security on board...you have to pull on your big girl panties and go to the next [patient].
"The pressure to just keep on going is what makes us feel burnt out...there's more people at the door, more people coming in."
Both nurses have noticed a significant increase in patients presenting with assault-related injuries in the last year.
"Alcohol has a massive part to play in this," said one nurse.
"There needs to be more restrictions on alcohol. When people get that social lubricant in them they are more inclined to get aggressive and that can trigger arguments which can lead to assaults."
ACC is footing an ever-increasing bill as victims recover from their injuries.
There was a 13 per cent rise in new claims for assault-related injuries lodged in Auckland between 2016 and 2019.
The annual costs for active assault-related claims rose roughly $2m each year in the same period, from $16.7m in 2016 to $24.3m in 2019.
This year 3688 new assault-related claims have been made so far in Auckland.
Almost 2000 of those have been for soft tissue injuries, followed by lacerations, fractures and concussions.
Victims are also suffering from the cost of treatment.
An Auckland father has had to liquidate his business after he was attacked by a stranger while waiting for a taxi home from his birthday celebrations at the Viaduct.
He had no medical insurance and his weekly income has more than quartered while his injuries prevent him from working.
The psychological damage can be ongoing too.
Newmarket physiotherapist Mark Quinn said patients recovering from violent crime can be "too scared to be touched".
"Their confidence is shattered and they often find it really hard to get out and go to work with all these triggers around."
The recovery process can take longer as patients deal with trauma, Quinn said. Then there can be physical reminders.
"If there is scarring or a permanent disability, there's that constant reminder of what happened.
"If there's a big scar and they see that scar on a daily basis... it's hard to ignore."