An Orange County health official on Thursday sounded the alarm on the area’s emergency medical system, saying it “may collapse” due to an overwhelming increase in the number of area patients infected with COVID-19.

The county has already been experiencing record levels of hospitalizations, with capacity in intensive care units exceeding 85%.

In a memo to hospitals and ambulance providers sent Wednesday, Dr. Carl Schultz, the director of emergency medical services for the Orange County Health Care Agency, directed hospitals to activate their surge plans, set up alternative treatment areas and cancel all elective surgeries.

“The health care system in Orange County is now in crisis, resulting from an overwhelming increase in the number of COVID infected patients … ambulance EMTs are waiting hours just to transfer patients from their vehicles to emergency department,” Schultz wrote in the memo. “At the current rate of deterioration, the EMS system may collapse unless emergency directives are implemented now.”

Schultz also cited “unprecedented increases” in the amount of time in which hospitals are not able to accept new patients, and said it’s not just ICUs that are overwhelmed but general hospital floors as well.

At Orange County Global Medical Center in Santa Ana, tents were set up outside the emergency room Thursday evening to deal with the influx of COVID-19 patients.

But finding enough staff to treat all the patients has become a larger problem than finding enough beds, said Dr. Tirso del Junco Jr., chief medical officer at KPC Health, the company that runs the hospital

“Our challenge is getting the nurses,” del Junco told KTLA. “We have beds — if we can get the nursing staff and get them in the numbers that we need. I think everybody’s being challenged by that.”

Del Junco added that the hospital system has been experiencing a shortage of doctors, as well.

Orange County is not the only area in California with an emergency medical system stretched to its limits. Hospitalizations are at record levels statewide, and ICU admissions have increased by roughly 70% in just two weeks, leaving less than 1,500 of the state’s 7,800 ICU beds available.

Dr. Clayton Chau, Orange County’s health officer, discussed the situation at an afternoon news conference held after the memo was sent.

“We need to make sure that all of the hospitals are aware that there are cases of people who need emergency services that are sitting in the ambulance for more than an hour, and that we would be transferring them to the next hospital, just to make sure that everybody’s understanding and prepares,” Chau said.

Schultz said ambulances are being allowed to travel longer distances to get patients to a hospital that can accept them, and they can now depart for another hospital if they’ve been waiting outside with a patient for more than an hour.

However, he warned hospitals that an ambulance waiting to depart their hospital with the patient still inside could prompt an investigation from the state Department of Public Health.

Correction: A previous version of this story incorrectly stated the day on which Schultz’s memo was sent. This post has been updated.