MISHAWAKA - A 38-year-old woman is having a seizure. So, the beeps go off in the fire station at 333 E. Mishawaka Ave., followed by the dispatcher's voice.
Paramedics Andy Breden and Sam Young climb into their ambulance and take off.
Luckily, a second crew is left behind to take the next call - whenever it comes.
But in a growing number of cases in Mishawaka, both crews are out, and dispatchers have to call on neighboring ambulances, like from South Bend, Clay Township and Elkhart.
"When an outside service takes the call, we have that feeling, a burden on our shoulders - you have to rush," said Battalion Chief Brian Thomas, who oversees the Emergency Medical Services in the Mishawaka Fire Department.
Calls for Mishawaka's ambulances have risen over the years. And the city has gone from relying on outside ambulances 57 times in 2006 to 210 times in 2010.
It fuels the city's desire - and plans - to meet that demand by adding a third ambulance crew on every 24-hour shift.
The city intends to add the third crew in coming weeks or months. City officials and the firefighters union are discussing how they can afford new duties within the fire department's existing staff.
Ambulance runs grew from 4,169 in 2006 to 4,486 in 2010. They make up roughly 80 percent of the fire department's total runs.
Thomas and his crews think the rise in calls may be because of a growing and aging population.
But they definitely see many calls coming from the senior living facilities and medical offices - specializing in everything from dialysis to cancer to surgery - that continue to appear on Mishawaka's landscape.
Patients may get a lift from family to a medical office, where staff find such critical issues that they call for an ambulance ride to the hospital, Thomas said.
Mishawaka's population grew from roughly 46,500 in 2000 to an estimated 50,000 or so in 2009, according to the U.S. Census Bureau.
Of those, the number of residents age 65 and older has grown from roughly 6,500 in 2000 to an estimate of nearly 7,000 in 2009, the Census reports.
Thomas said that, out of Mishawaka's 4,486 ambulance runs last year, 1,377 were for patients age 71 and older.
During the day, most of the calls come from the northern half of the city, where people work, shop and play, Thomas said. At night, most calls come from the south, where many people live.
At the extreme, crews can juggle as many as 20 calls in a 24-hour shift.
In a rare but recent case, the staff recalls, a call came in for a woman who had difficulty breathing, but all of the area ambulances were tied up, not just Mishawaka's. A crew did eventually make the call. The patient later died at the hospital. Her condition was severe enough that a quicker response likely wouldn't have saved her life, Thomas said.
When crews are constantly in and out of the station, it can delay their paperwork.
Doctors and nurses rely on the report to catch things they didn't. It can mean a difference in the treatment a patient gets, Thomas said.