Members of the GMB union from 11 trusts in England and Wales are being balloted in the coming weeks.

NHS workers in other unions, including nurses, are also being asked if they want to strike over pay.

Ambulance workers from the following trusts will be balloted:

• East of England Ambulance Service
• East Midlands Ambulance Service
• London Ambulance Service
• North East Ambulance Service
• North West Ambulance Service
• South Central Ambulance Service
• South East Coast Ambulance Service
• South West Ambulance Service
• Welsh Ambulance Service
• West Midlands Ambulance Service
• Yorkshire Ambulance Service

The GMB said its members were angry over the government's imposed 4% pay award, describing it as "another massive real terms pay cut".

Rachel Harrison, GMB acting national secretary, said: "Ambulance workers don't do this lightly and this would be the biggest ambulance strike for 30 years.

"But more than 10 years of pay cuts, plus the cost-of-living crisis, means workers can't make ends meet.

"They are desperate. This is much more about patient safety at least as much about pay.

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"Delays up to 26 hours and 135,000 vacancies across the NHS mean a third of GMB ambulance workers think a delay they've been involved with has led to a death.

"Ambulance workers have been telling the government for years things are unsafe.

"No one is listening. What else can they do?"