The Victorian Ambulance Union (VAU) on Tuesday confirmed 86.8 per cent of its members had voted down Ambulance Victoria's latest enterprise bargaining agreement offer.
The offer, presented to paramedics in late December, included a three per cent pay rise and a $1800 lump sum payment at the end of each year of the agreement.
But Ambulance Victoria (AV) also sought a reduction in paramedics' sick leave and overtime entitlements as well as reduced travel allowances, union secretary Danny Hill said.
The union has instead put forward claims around improving end-of-shift management provisions so paramedics can finish on time.
"AV had a combined overtime bill of over $95 million in the last financial year," Mr Hill said.
"The VAU has put forward suggestions to reduce that expense including reducing incidental overtime but AV would rather target paramedic entitlements."
The union is also seeking shorter night shifts that can be worked by part-time members, new health and safety provisions, and safer staffing levels in control rooms.
Ambulance Victoria has rejected those suggestions, Mr Hill said.
The union secretary said paramedics would take industrial action if an agreement was not reached within the next two weeks.
"Over the past few years, our members have faced the worst of the pandemic head on," Mr Hill said.
"It would be a mistake to think they won't stand up to an employer that doesn't value them."
Ambulance Victoria has been approached for comment.
The standoff comes after thousands of Victorian police officers took two weeks of industrial action in December.
The strike ended once Victoria Police committed to addressing shift lengths but the dispute over wages has not been resolved, with negotiations to continue this year.
The United Firefighters Union is also in an ongoing pay dispute against Fire Services Victoria, with the case now before the Fair Work Commission.
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