Ambulance workers are on the verge of industrial action after rejecting a pay deal.
Employees at Sussex Ambulance Service NHS Trust were offered a three per cent pay rise from next month but Unison trade union members have voted not to accept the increase.
About 600 Unison members across Sussex were balloted, with 60 per cent dismissing the offer.
Unison officials say the result of the ballot symbolises widespread discontent among staff about working conditions.
There are particular concerns about what they see as unfair distribution of relief cover and staff want an evaluation of the effectiveness of standby cover which requires ambulances to be stationed at remote roadside locations in case of a nearby emergency.
At the beginning of the year, they staged a bout of industrial action to express their concerns.
The action was called off when SAST agreed to hold monthly meetings discussing the issues.
But Unison branch secretary Duncan Jones said the talks have become less frequent and proved unproductive, causing frustration among staff.
He said: "A lot of people are very unhappy and dissatisfied. What we need is for the meetings with management to be set up so we can sort this out and deal with problems.
"We do not want to take any industrial action and that would be a last resort but the result of the ballot shows the strength of people's feelings."
Mr Duncan said it was too early to know what form of industrial action would be taken if the dispute could not be resolved.
Earlier this year, staff refused to do voluntary overtime and record ambulance response times, moves which had little affect on the public.
A Sussex Ambulance spokeswoman said: "We've been notified of the results of the ballot and we will be looking to work urgently with our colleagues from the trade unions to resolve this situation."
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