Director for the Grampians region, Terry Marshall's comments come as new data shows a 20 per cent spike in urgent call outs in Horsham.

Paramedics responded to 299 code one calls for assistance across Horsham Rural City between July 1 and September 30 - up from 249 in the same three months of 2018. It responded to 83.6 per cent of these calls in less than 15 minutes.

He said the flu season explained much of this increase.

"It started off in the Wimmera, then moved into other busier cities. Many people not only called us, but they had to go to hospital to be looked at - so it really did put a lot of pressure on the health system," he said.

"2017 was a really difficult year (for the flu), too.

"We also track flow through the hospital. If you have a lot of people who self-represent and then the ambulance arrives, that can slow us down. The hospitals make incredible efforts to free our resources up so we can respond to more emergencies, so we're in a very close relationship.

"The other problem that affects response time is distance - there is only so far an ambulance can travel in 15 minutes and if an accident happens 35 kilometres away, the ambulance is going to take 25 minutes to get there."

Mr Marshall said he was seeing his paramedics being exposed to high levels of occupational violence.

"I've never seen it as bad as it is," he said.

"We're doing a lot of education with our paramedics on how to de-escalate scenes, but we just have situations where people just lash out and do things that are unacceptable.

"Paramedics are coming out to do the best they can to help people, so don't give them a hard time. The last job they went to could have been an horrific car accident, so just be kind to them and work with them."

Mr Marshall said paramedics worked to provide "best care", which could sometimes involve looking after a patient's pets and calling relatives among other jobs. He said it was important people listened to the call-taker after requesting an ambulance.

"They are highly-trained in getting the right information from you, so we can work out exactly what we need to send you and the time frame," he said.

"Even after they have the information, they will continue to send you instructions. It's also helpful - particularly at night - to turn the lights on so it's easy for us to identify the property."

Mr Marshall said there were sufficient vehicles and paramedics to meet the region's demands.

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