Paramedics say they are sleeping in their cars, living in tents and caravans, or staying in pubs because of a severe housing shortage across regional and rural NSW.
The Australian Paramedics Association of NSW says many rural officers cannot find rentals amid the housing squeeze, which has been intensified by disasters and an influx of people moving to the regions.
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Union vice-president Scott Beaton, who is a paramedic in Gilgandra, north of Dubbo, said the living conditions were desperate, especially as rural staff cover 24-hour on-call shifts.
"If they happen to do a lot of jobs through the night, they need to be able to sleep, which is quite difficult in a tent in the heat," Mr Beaton said.
"It's just not a pleasant experience. If it's a 24-hour station, it's exceptionally tiring."
The union said its members could not find housing in towns and cities including Tamworth, West Wyalong, Tottenham, Collarenebri, Kangaroo Valley and Griffith and several regions on the north and south coasts.
Mr Beaton said the state government should consider permanently leasing houses for frontline staff and charging workers rent.
"If you can't find somewhere to live, then moving to a smaller community is not going to be attractive at all," he said.
A NSW Ambulance spokeswoman said staff housing was provided in some parts of the state, and the organisation was reviewing accommodation where these issues were being reported.
Several national and state rural health inquiries have heard quality housing is a critical part of luring workers to the bush and often helps them settle into a community for the long term.
In June, the NSW government announced $174 million to build more than 270 new homes for frontline staff in regional areas.
It is also trialling a "welcome experience" program in eight regions to connect key workers with locals, who will share their knowledge and networks.
Griffith Mayor Doug Curran said housing was the major issue discussed at the Regional Capitals Australia meeting in Canberra on Wednesday, which included rural councils from most states.
"It's dire, no matter who you're talking to," Mr Curran told AAP.
"It's one of the biggest problems we have, all of us, not just for paramedics, but for police and skilled and unskilled labourers."
Griffith is one of the regions included in the government's welcome program and Mr Curran hopes it will help.
But the housing shortage is a long-term problem, worsened by COVID-19 population and workforce changes, he said.
"We can't find a builder to save ourselves, materials are impossible to find.
"It's a perfect storm; people want to come to our area, we want them here, but we can't find accommodation."
Tamworth Mayor Russell Webb said the housing market was tight in the northern NSW city and vacancy rates were very low.
"It can be very expensive. It's very concerning, for paramedics, doctors and workers from every industry," he said.
One paramedic reported living in a caravan park for three months in Cowra, in central west NSW.
Mayor Bill West encouraged frontline staff to work with locals and councils to find housing options.
Regional Health Minister Bronnie Taylor was contacted for comment.
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