Talks to resolve a long-running dispute over payment for North East ambulance staff during meal breaks have stalled.
Unison members have rejected an offer of £35 for every meal break interrupted by a 999 call-out.
Currently North East Ambulance Service crews who are on breaks are not called out to attend emergencies - even if they are the closest to an incident.
Unison said it was keen to resolve the row and had urged members to accept the offer.
It was rejected by more than 70% of those balloted.
Ambulance trust chief executive, Simon Featherstone, said: "I am very disappointed at this result.
'Patient care'
"We thought that having reached an agreement with local Unison officers that we finally had a mutually acceptable solution.
"Our priority remains patient care and we will continue to deploy the extra staff we recruited this time last year to provide additional coverage during meal breaks.
"It is also important to remember that crews should have proper breaks during what are busy, 12-hour shifts in the interests of delivering safe patient care and their own health and safety."
The breakdown in talks means ambulance crews in Northumberland, Tyne and Wear and County Durham will continue to have unpaid and uninterrupted meal breaks.
Crews on Teesside have already come to a separate agreement.
Paul Summers, Unison regional officer said the union was "committed to reaching an agreement nationally".
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