TORONTO -- On a good day, it's a stressful job. During a pandemic, it's even more so. For the men and women of Toronto Paramedic Services, it's been an exhausting 14 months.

According to paramedic Claude Muir, "this year has been unprecedented in terms of the volume of patients we've been dealing with."

For Alan Williams, a paramedic who works in Scarborough, the majority of calls he sees these days are related to COVID-19.

"We're having people who are significantly sick, poor oxygen saturation, struggling to breathe, multiple symptoms and definitely needing paramedic help," Williams told CTV News Toronto.

That help comes at the hands of more than 1400 paramedics and 150 dispatchers who are employed by Toronto Paramedic Services — people whose jobs have changed dramatically during the COVID-19 pandemic.

From pre-screening patients, to constantly wearing extra PPE, steps have been put in place to keep paramedics safe.

"You can't let your guard down," Gord McEachen, chief and general manager of Toronto Paramedic Services told CTV News Toronto, "It doesn't matter what size of incident you're responding to, you've got to follow the procedures and you've got to look after your partner and yourself, as well as the patient."

Even the job itself has changed. Paramedics are now tasked with helping with the vaccination effort in clinics across Toronto. They're also no longer just bringing patients to hospitals in the city, they're moving them out as well.

"We've been doing critical care for a long time prior to this," critical-care paramedic Jeff Engel told CTV News Toronto, "We would often bring critically ill or injured patients into the city for definitive care, but with COVID-19, and really with the third wave, we've added to what we do with actually taking patients out of Toronto and moving them farther away."

The logistics behind that aren't simple. Engel recalls a shift where he was told that “50 critical care patients [were] waiting to be moved that day — and just to put that into perspective, in Toronto, when we're starting the day we have three critical care vehicles​​."

With more kilometres being put on those vehicles, it means more work for the automotive technicians who keep the ambulances running — like Mario DeRosa, who tells CTV News Toronto "they're coming in [for servicing] a little more frequently now because they're doing more mileage."

McEachen admits his members are tired and that the stress of the past year is taking its toll.

"People are still very sick in the community. The virus is still in the community, so we always have to remember that. Now we're at pre-COVID-19 activity levels, so our levels now — our response and the number of calls we're doing — are similar to 2019 and 2019 was one of our busiest years ever," McEachen said.

Many other paramedics agree.

"Burnout is a real thing," said paramedic Mark Ellis, "we can feel it within ourselves.”

And Ellis says it's not just limited to the paramedics, "Within the nursing staff, the doctors, everyone is definitely burnt out or trying to mitigate the burnout. But we're staying positive and we're working together as a team, whether it's my partner and I, whether it's the service, whether it's the nursing staff, the doctors staff, everyone's in this together."

To help deal with the workload, the service is looking to hire between 150 and 200 new paramedics.

In the meantime, McEachen admits he has sleepless nights, worried about what will happen in the coming months, worried it will be busier than ever.

"We're going forward now into a summer that will start to slowly reopen and I'm very nervous. I'm a little bit worried about the amount of calls that we're going to do as the community begins to open up,” McEachen explained.

But McEachen says he has faith in his staff and their ability to help the people of Toronto, saying "it is not an easy job, it is not an easy profession, and they continue to respond and they don't question why. I'm so proud of them and I can't thank them enough."​