North East Ambulance Service has declared a critical incident for the second time in nine days due to "unprecedented" pressure following the Christmas break.
The incident was declared due to significant delays for more than 100 patients waiting for an ambulance, as well as a reduction in ambulance crew availability to respond because of delays in handing over patients at the region's hospitals.
Critical incident status means that the service cannot provide usual critical services and patients may face harm.
It comes after the majority of ambulance services in England declared critical incidents last week ahead of strikes and the Christmas period.
Shane Woodhouse, strategic commander at North East Ambulance Service, said: "This is the second time in nine days that we have declared a critical incident due to the unprecedented pressure we are seeing across the health system.
"Declaring a critical incident alerts our health system partners to provide support where they can and means we can focus our resources on those patients most in need.
"The public should only call 999 in a life-threatening emergency. For all other patients, we are urging them to use www.111.nhs.uk, speak to their GP or pharmacist.
"We will be advising some patients to make their own way to hospital when it is safe to do so.
"We know patients will be experiencing longer waits for an ambulance – please only call back if your condition worsens or to cancel if it is no longer required.
"We are experiencing greater numbers of calls to 111 right now and ask that callers please consider 111 online first and don’t call 999 unless your condition is life threatening."
This article contains information from PA Media.