Ambulance workers at South Central Ambulance Service are to be balloted on whether to take strike action.
The GMB union said a ballot will open on 24 October for ambulance staff at 11 trusts across England and Wales.
More than 15,000 members can vote on industrial action in the pay dispute, with the GMB saying any strike could take place before Christmas.
A spokesperson said workers are angry over "the Government’s imposed 4 per cent pay award, which leaves them facing yet another massive real terms pay cut".
Rachel Harrison, GMB National Officer, said: “Pay has been systematically slashed for more than ten years and we now face the worst cost of living crush in a generation.
"Meanwhile vacancies are at record highs and we have the worst A&E delays ever - and it’s not even the winter flu season yet.
“But this is about more than pay and conditions. Cuts and shortages mean GMB members feel they are unable to deliver safe standards of patient care.
“Things can’t go on like this - something has to give.”
Workers from London, East of England, East and West Midlands, North East, Yorkshire, North West, South Central, South East Coast, South West and Wales ambulance trusts will take part in the ballot, which closes on 29 November.
The Department of Health and Social Care (DHSC) urged unions to "carefully consider" any impact on patients.
A DHSC spokesperson previously said industrial action was a "matter for unions".
The spokesperson added the government valued the "hard work of NHS staff" and had given more than "one million NHS workers a pay rise of at least £1,400 this year".
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