Ambulance crews have voted to back taking strike action if bosses do not ensure staff get rest breaks.
Ambulance staff are entitled to a 40-minute rest break in a 12-hour shift but have said they are often asked to work though.
GMB union members voted with 93% backing strike action in a consultative ballot.
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Talks are due to take place this week and the union has said if rest breaks are not secured then a formal vote on taking action will be held.
Karen Leonard, GMB Scotland organiser in the ambulance service, said: “The failure to ensure crews are properly rested has been an increasing cause of concern for years.
“Crews were once told it was because of Covid, now turnaround times at hospitals are being blamed. Enough is enough.
“The strength of feeling and deepening frustration of staff is reflected in the result of this ballot.
“For many reasons, not least the welfare of crews and the safety of patients, proper breaks must be an essential and secure part of every shift.
“Breaks are not a luxury but a necessity and it is beyond time for managers to understand that and ensure crews are properly rested when asked to drive under blue-lights, diagnose patients and administer drugs.”
The union said a two month trial, where ambulance dispatchers were told crews on a break should only be disturbed to attend the most serious call-outs or if no other ambulance is available for 25 minutes, failed to ensure proper breaks.
A Scottish Ambulance Service spokesperson said: "We recognise the pressure facing our staff as a result of wider NHS demand and delays in handovers at hospitals.
"We know that, on occasion, ambulance crews like many other NHS staff are not able to take breaks in optimum conditions, which is why we are working in partnership with trade union colleagues to update the current rest break policy and procedures to ensure we enable staff to take breaks in a timely manner.
"As part of our Demand and Capacity programme, we have recruited an additional 458 staff to increase capacity and ease pressures on our staff.
"We’ve also adopted guidance from the Health and Safety Executive (HSE) in relation to fatigue scoring to reduce the risks associated with fatigue.”
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