The North East Ambulance Service says it is operating under extreme pressure, because of the high number of calls it is receiving.
The operating level has been raised to Level 4, the highest possible measure.
The volume of calls is taking its toll on response times, and the handover of patients at A and E.
While calls to the ambulance service peaked on New Year's Eve, the pressure is still on.
There continues to be a pressure for us. We've taken 30 percent more calls from 23rd of December until the 31st of December than what we would expect. We do plan for this obviously, we put plans in place but they are only forecasts. Activity this year has been far greater than we've ever experienced in previous years. The high volume of calls is because of all types of illnesses, a 153 percent increase in coughs, colds, hoarse voice and breathing difficulties. Quite clearly for the elderly it becomes a big issue and that's reflected in the volume of 999 calls. An ambulance is necessary if someone is unconscious, has chest pain or severe blood loss. But for some people, GPs or pharmacists are more appropriate and if you call 111 we can direct you to alternative services which would avoid the impact on the 999 service.
In some circumstances, the service is even asking patients to see whether they have "alternative transport options" - such as a lift from a family member.The trust said it had faced unprecedented demand between Christmas and New Year.
Between 23 December and January 1, it answered more than 40,000 NHS 111 calls and more than 16,000 999 calls - compared to around 28,000 NHS 111 calls and 15,000 999 calls in the same period last year.
The trust said it had even asked workers in urgent care centres whether they can provide additional support.