Health bosses are urging the public to only call 999 in life-threatening cases as ambulance services became swamped over the weekend.
The North East Ambulance Service has experienced a high volume of calls since Saturday evening.
Demand was so high, bosses took to Twitter to urge the public to only use their services if it was a 'life-threatening case'.
They Tweeted: "We are very busy this morning. As ever please be #999wise and only call 999 if it's a life threatening emergency."
The service received 622 emergency calls between midnight on Saturday and 2pm yesterday.
A spokeswoman said the figure was unusually high but was not due to Halloween related injuries.
She said: "We are experiencing significant pressure on our services.
"To enable us to get to those patients who need us most, please only call 999 if you have a life-threatening emergency."