Ambulance staff along with the union, Unite, have rejected a new deal to increase payments for breaks being interrupted by emergency calls.
According to Unite 62% of ballot papers returned by ambulance staff rejected the proposal.
It would have seen paramedics and technicians receive a one-off payment of £1,500, then £100 each time their rest break is interrupted to attend an emergency call.
The death of Mandy Mathieson, of Tomintoul, highlighted the issue more publicly when an ambulance technician stationed close to her home did not respond to a call as he was on a break. Unions and management have been trying to find a solution to the issue since Ms Mathieson died in October 2010.
An ambulance crew based 21 minutes away in Grantown-on-Spey responded to the call because the technician was on a break.
Ms Mathieson’s relatives were shown a transcript of the call which confirmed that while the ambulance technician knew about the incident, he was not formally asked to attend.