Puletua has spoken out about his emergency room nightmare on behalf of other parents he saw enduring long waits at Westmead.

A senior emergency physician at Royal North Shore Hospital, Tony Joseph, described the Puletuas' experience as ''totally unacceptable''.

He said: ''What has happened in the Westmead children's ward is reflective of a broader problem across NSW where there is a lack of senior physicians in emergency departments.''

Unpublished figures obtained by Fairfax Media show NSW has the lowest proportion of senior doctors in emergency departments in the country, apart from the ACT, the state government failing over the past six months to hit reduced waiting time targets.

On the front line, in the state's 95 hospitals, that translates into times when patient demand swamps medical manpower.

After two nights and a total of nine hours in the Westmead waiting room, Puletua was forced to call on his former team doctor at the Penrith Panthers, Norm Southern.

By then, the wound had healed too much for stitches and the ragged scar inside Noah's mouth might require future plastic surgery, the family has been told.

When Puletua arrived with Noah on a week night after a trike accident at home three weeks ago, he was told there were 27 patients in front of him but, due to the two-year-old's bleeding and agitated state, the triage nurse said she would put the child on the ''injuries list'' for faster treatment.

By 10.30pm, Puletua was told it was unlikely that his son would be seen before morning and he took Noah home.

The next day a GP put plastic stirrups on the wound but they came off quickly and Puletua was back at Westmead that night. This time, there were more than 30 on the list but Noah was put on an injuries list of just three.

''I lost track of how many SpongeBob shows we watched but I changed his nappy and managed to get him off to sleep,'' he said.

''By 10.30pm, I was wondering what was going on. I waited politely and asked the nurse, to be told that the injuries list finishes at 9.30pm and we were back behind other patients on the normal list.

''I'm not a fiery person off the footy field but it was at that point that I lost it.''

Puletua was told to ''write a letter to the government''. He did write a long letter about his experience, which found its way to Fairfax Media.

He said: ''Westmead was specially built for kids but it is not a special experience for those parents I saw waiting around. The place was packed. I just wanted to speak out.''

A spokeswoman for The Sydney Children's Hospitals Network said: ''On occasion, children with less urgent health complaints may need to wait to be seen by a doctor … We trust parents understand the need to care first for children who may present with life-threatening conditions.''

The government recently increased the number of senior doctors in triage at Westmead to reduce waiting times. But hospital physicians, GPs and health experts said emergency rooms were at times ''overwhelmed'' over the past six months during a winter in which the flu bug and several viruses affecting children spiked.

Arrivals in emergency have grown nearly 8 per cent in a year to 2.3 million. At the same time, the Health Minister, Jillian Skinner, is about to cut $775 million from the state health budget over the next four years and implement $2.2 billion in efficiency savings.

Dr Joseph said that it was ''very unlikely'' the NSW government would meet the national target of treating 90 per cent of patients within four hours by December 2015.

NSW hospitals achieved 58 per cent in the latest three-month period reported, which was from April to June.

In Perth, hospitals are regularly achieving 85 per cent, he said.

''In NSW, there is a lack of senior physicians. The government needs to get serious and think about how it will meet national emergency targets,'' he said.

Richard Paoloni, an emergency physician at Concord Hospital, said: ''The number of people presenting in ER continues to grow but the number of emergency physicians has slowed and then plateaued over the past few years.

''We are falling behind other states, particularly Queensland and Victoria.''

Dr Paoloni said it was not uncommon for people to be forced to endure long waits.

''There are incidences in which numbers peak and overwhelm the number of staff present,'' he said.

According to Australian College for Emergency Medicine figures, there is a higher proportion of foreign doctors in the NSW system who require more oversight and instruction.

Paramedics still complain of ''trolley block'', the long wait for patients arriving in ambulances to be transferred to a hospital bed.

Wayne Flint of the Emergency Medical Service Protection Association, representing ambulance staff, said: ''Some days and nights emergency is an absolute nightmare with people queuing up everywhere to be seen.

''We had a spike in winter but, with Christmas coming, we're going to see the peripheral and regional hospitals under pressure from holidaymakers having accidents.''

A spokesman for Ms Skinner said: ''Local health districts are focusing on implementing new models of care that are helping to deal with an unprecedented increase in emergency department presentation''.

Labor's spokesman on health, Andrew McDonald, a paediatrician who works one day a week in hospitals in western Sydney, said the government has little hope of achieving its national emergency access target of 69 per cent of people being seen and treated within four hours.

The figures for April to June, finding 58 per cent had been treated within that timeframe, were attributed by the government to an ''unseasonal increase'' of more than 6000 patients.

Dr McDonald said it was obvious the flu bug and child viruses were coming and the government had left the state's hospitals underprepared.

''The whole system went into meltdown, unable to treat patients.''