East Midlands Ambulance Service (EMAS) has said emergency 999 calls have reached an all-time high, with one call being made every 25 seconds.
In the last 12 months, the service answered 1.2 million 999 calls, which is 200,000 more than the previous year.
It says one of the biggest problems is the wait times to hand over sick patients from ambulances to hospital wards.
The target for handing a patient from paramedics to hospital staff is 15 minutes, but the average time for a handover in the last year was 40 minutes.
The service said it answered more than three and a half thousand calls each day in 2021/22, with the EMAS' medical director, Dr Leon Roberts, describing the pressures as ‘unbearable‘ at times.
The delays in handover times have led to 125,500 lost hours in one year - that's hours which could be spent on the road attending call-outs.
The service says preparing for added pressure this winter is their top priority.
Director of Operations at EMAS, Ben Holdaway, said "the service is not responding to patients as quickly" as it should be.
In the service's Annual General Meeting, he said: "We are dealing with it but as we said we are not responding to patient's as quickly as we would like."
"Therefore we are keen and we want to keep working with the system partners to make sure that we can respond to patients as quickly as we can."
Recognising the additional pressures winter will bring, Mr Holdaway added:
"We know we are going to have a difficult winter. We know that demand is going to go up, weather will change, pressure on the hospitals may increase through another wave of covid or flu."
"So we are really keen to use these coming weeks to put things in place that will ease the pressure on ourselves and the hospitals so that we don't see some of the long delays that we have seen in the summer."
East Midlands Ambulance bosses at the AGM said the pressures are the result of a delays and shortages across the NHS frontline.
Money to resolve the problems has been made available, and 70 new call handlers have been recruited - so the total is now 210 call handlers across the service.