Ambulance workers in Sussex are being asked if they will take industrial action over pay and conditions.
Following weeks of delays, ballot papers have been sent out to more than 600 trade union members from Unison, the Association of Professional Ambulance Personnel (APAP) and Amicus.
The unions are asking for a five per cent pay increase for all employees, including paramedics and call-handling staff.
The average ambulance worker earns £20,000 a year and a five per cent pay rise would increase their wage to £21,000.
Sussex Ambulance Service NHS Trust has awarded employees a 3.6 per cent increase with an option for staff on rotating shifts, who have been in post for at least ten years, to accept a three per cent rise in exchange for an extra day of leave.
Unions want a decrease in the working week, from 42 hours to 40, and an increase in leave.
They are also calling for cost-of-living supplements, similar to those nurses are awarded and the option for early retirement at 55.
The ballot papers ask union members if they would take industrial action, short of a strike, if no resolution was reached. The action could result in them refusing to do voluntary overtime.
The papers are due to be returned by January 27.
Unison branch secretary Colin Rhodes, based at Chichester ambulance station, said: "There is a lot of anger that our demands are not being taken seriously.
"We deserve a pay increase above the basic yearly rise."
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