Unions and ambulance leaders are to restart negotiations over meal breaks amid claims that patients are suffering under current arrangements.
Since June, North East Ambulance Service paramedics have received unpaid and undisturbed meal breaks.
They said as a result there have been a number of incidents where crews nearest an emergency have not been contacted but crews have come from further away.
Unions said staff want to be paid for meal breaks and being on standby.
One paramedic, who asked not to be named, told the BBC: "It makes us feel frustrated, angry and I suppose you could say it's very upsetting for the crews who want to be able to treat those patients but they are unable to carry out their job.
"And they know that people are suffering during the periods that they are unavailable."
The issue of meal breaks rose as part of negotiations on a national NHS Pay Structure called Agenda for Change.
It was the cause of industrial action last year when it emerged staff would no longer be paid for meal breaks even though they were on standby.
The matter went to arbitration which ruled in the staff's favour but this was then overtaken by a national agreement that there should be unpaid and undisturbed meal breaks.
On Tuesday night, North East Ambulance Service chief executive Simon Featherstone met with staff and negotiations are due to start again.
Joel Byers, from Unison, said staff morale had been hit.
He said: "We want to be treated like other emergency services. We are unique within the health service.
"We are either an emergency service and are available 24/7 or not and are available 22/7, you can't have it both ways."
The union believes it would cost £1.5m a year to pay staff for meal breaks.
Mr Featherstone said they were complying with the undisturbed meal breaks, which had been signed up to nationally by Unison and management.
He said 45 new staff were being trained to minimise the impact and ideally he would like to change the situation.
He said: "I don't have the resources to pay the staff exactly what they want."