Britain's health service faces further disruption in December after thousands of ambulance workers represented by three different trade unions voted for strike action in disputes over pay and conditions.
The GMB union said more than 10,000 ambulance workers across England and Wales had voted in favour of industrial action, while the Unite and Unison trade unions also said their ambulance service members had backed walkouts.
Britain's state-run National Health Service (NHS) is braced for a wave of unprecedented industrial action this winter, with up to 100,000 nurses due to take strike action on Dec 15 and 20 for the first time in their union's 100-year history.
"No one in the NHS takes strike action lightly, today shows just how desperate they are," GMB National Secretary Rachel Harrison said.
"This is as much about unsafe staffing levels and patient safety as it is about pay... Something has to change or the service as we know it will collapse."
Inflation has soared in Britain this year, causing a cost of living crisis, in the wake of Russia's invasion of Ukraine.
The GMB said it would convene in the coming days to discuss potential strike dates before Christmas.
The NHS, which has provided healthcare free at the point of use since 1948, is dealing with record levels of patients on waiting lists for hospital treatment due to the Covid-19 pandemic and a staffing crisis which has left thousands of vacancies.
Accident and emergency departments are also under strain, with ambulances often facing lengthy waits to transfer patients to hospitals.
Separately, the Unite union said its ambulance service members had also voted for industrial action, with strikes likely to begin before Christmas. It had balloted 3,000 staff including paramedics and emergency call handlers.
Unison said on Tuesday thousands of health workers it represents, including call handlers, ambulance technicians and paramedics, were set to take industrial action in December after voting in favour of strikes.
In response to Unison's announcement, Britain's health and social care minister Steve Barclay said he regretted that some NHS staff would be walking out as the country approached "a challenging winter".
"Our priority is keeping patients safe during any strikes and the NHS has tried and tested plans to minimise disruption and ensure emergency services continue to operate," Barclay said in a statement.