Riverina paramedics will strike for 24 hours next week, vowing only to attend to the most urgent, life-threatening cases.
Health Services Union paramedics are planning the statewide stand for June 10 to demand better pay.
Last year paramedics were awarded "a paltry 0.3 per cent", according to the union, and this year's proposed 1.5 per cent pay offer was again less than inflation, which NSW Treasury forecasts at 2.2 per cent for the coming year.
HSU Riverina representative Mick Grayson said last year paramedics were on the front line of a pandemic, floods and raging bushfires.
"We are frustrated with how the government has dealt with our pay over a number of years," he said.
"We have not taken this decision lightly, but we will only be responding to lights and sirens cases, so just emergencies.
"For far too long the government has utilised our goodwill, and enough is enough. We are drawing a line in the sand."
HSU Secretary Gerard Hayes said paramedics transporting COVID-positive patients without adequate protective equipment had been exposed to the disease.
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"They were exposed to a wild and deadly disease, yet they continued to serve the people of NSW and protect their health," he said.
Mr Grayson said NSW paramedics are the lowest paid across Australia and must cover the cost of their professional registration and education.
He said they had flagged the action to avoid impacting life-threatening emergencies, but there will be significant disruption on the day.
NSW Health Minister Brad Hazzard is in discussions with the union but said any industrial action must follow the processes outlined by the Industrial Relations Commission. A spokesperson for NSW Treasurer Dominic Perrottet said the impacts of the pandemic are still being felt across the economy.
"Last month, the full bench of the Industrial Relations Commission of NSW reaffirmed the government's plan to prioritise job-creation to keep as many people in jobs as possible as we get our economy back on its feet," he said.
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