Union members at Shropshire and West Midlands Ambulance Service have voted overwhelmingly in favour of taking industrial action.
The public service union Unison balloted its members in a dispute over a new pay deal.
Unison claim the Department of Health has lowered agreed pay scales.
Seventy two per cent of eligible members voted, with 93% approving of industrial action - and three quarters voted to go out on strike.
Union leaders met bosses from the ambulance service on Tuesday and are still hoping to strike a deal.
An ambulance service spokesman said they would meet again on 6 January and there would be no industrial action before then.