Ambulance crews have voted in favour of taking industrial action after attempts to resolve a row over pay failed.
Workers want to be paid if interrupted during meal breaks
North East Ambulance Service Trust (NEAS) staff were offered a rise of up to £1,800 to be on call during breaks.
But on Monday, union Unison rejected the offer with 80% of its paramedics and technicians voting in favour of action, including an over-time ban.
NEAS chief executive, Simon Featherstone, said he was "bitterly disappointed" by the move.
In November, the ambulance trust introduced a £20 payment as an interim measure for crews who volunteered to answer 999 calls during their meal breaks.
But Unison believes staff should be paid time and a half if they are called out during breaks or be allowed to be off duty.
Dave Armstrong, Unison regional officer, said: "The vote was to take action over a management imposed meal break policy, which is in breach of the national Agenda for Change agreement.
"It is disappointing that we have not reached agreement with North East Ambulance over meal breaks, but locally we felt that as we moved closer to a settlement, other Trusts were agreeing better deals, leaving our members at a disadvantage to other ambulance workers."
But Mr Featherstone said: "I am bitterly disappointed at the outcome of this ballot. We have made significant efforts to resolve the meal break issue locally, yet all our offers have been rejected.
"This £20 payment is voluntary and it was introduced in response to staff claims that they wanted to be aware of calls during their breaks. So we find it hard to understand why it is now being opposed."