Nine patients died last year because of adverse incidents involving the South Australian Ambulance Service.
SA Health Minister Stephen Wade says a review of the adverse events is "incredibly concerning" after it found there was a lack of response by ambulance staff in some cases to abnormal observations and clinical risks.
The review found some officers had failed to understand the risks posed to patients in their care with the nine deaths reported to the state coroner for investigation.
It found there were 12 adverse incidents last year, though that number could rise to as high as 20 with some cases still being assessed.
The figure compares to seven incidents in 2017, 16 in 2016 and 28 in 2015.
Ambulance service chief David Place says while there was a spike in the number of adverse events in the last three months of 2018, ambulance officers responded to 300,000 patients over the 12-month period.
"Our paramedics are put under a great deal of pressure and that pressure has in some cases impacted on the care they provide," he told reporters on Monday.
"We can't let that happen, we have to put our patients first."
Mr Wade said the review found that the ramping of ambulances outside hospitals had not caused any of the adverse events.
But he said it highlighted how ramping affected the decision-making of ambulance crews, making them less inclined to transport patients to hospital than they should be.
"Ramping not only has a direct impact in terms of delaying care and tying up ambulance resources, the report highlights its indirect impacts such as undermining the clinical management of patients."
Mr Wade said the government had accepted all 14 of the review's recommendations including the development of a new strategy across the ambulance service to deliver high quality and safe care.
It has also recommended patient or family interviews be conducted during investigations of serious incidents.
