A recruitment crisis could force the closure of rural ambulance stations in Northumberland and County Durham, emergency services bosses fear.
The North East Ambulance Service fears a shortage of staff willing to work unsociable hours and live in outlying areas could mean seven sites closing.
Three of the affected so-called "stand-by" stations are in County Durham, and four are in Northumberland.
One county councillor has said the move could put lives at risk.
A consultation document suggests four rural stations at Wooler, Rothbury, Bellingham and Haltwhistle in Northumberland and a further three at St John's Chapel, Middleton-in-Teesdale and Barnard Castle are at risk.
The service says it finding it hard to find staff willing to work the hours needed to provide night-time cover at the stations.
It is suggesting that centrally located community paramedics be brought in to assess 999 calls and decide whether a regular ambulance is called to take patients to hospital.
But John Shuttleworth, a Durham county councillor, who represents Weardale, said the move could cost lives.
He said: "This is more about hitting targets, massaging response times and saving money than it is about providing the best emergency service for people living in isolated rural areas.
"I really believe that lives are at stake if our ambulance stations close."
But Simon Featherstone, chief executive North East Ambulance Service said: "We are facing very real problems in these rural areas in terms of recruitment.
"We are dealing with a different generation of staff than we were 10 or 15 years ago. The stand-by arrangements that we have for them they find increasingly difficult to cope with.
"We do need to address the transport issue. We need to find a way of getting transport to the patient quickly, where we have assessed it is appropriate to do so.
"What we are asking people to do during this consultation period is to help us find solutions to these issues."
The consultation period will last until August.