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Union bosses say plans by East Midlands Ambulance Service (EMAS) to half the number of fast response cars in its fleet will 'put lives at risk'.
The ambulance service said the move was part of wider proposals to increase the number of ambulances which can transport patients. EMAS officials argue this would in turn improve patient safety.
Under the plans, which remain subject to consultation, EMAS would decrease the number of fast response vehicles from 28 to 14.
The vehicles, which are often medically equipped cars, transport clinically trained staff such as paramedics to patients as quickly as possible and are often the first at the scene.
Unison, which represents staff across EMAS, said the organisation was planning to keep its remaining fast response vehicle in rural areas, which would leave people in towns and cities relying on ambulances instead.
The union said the vehicle drivers would also be moved onto ambulance crews under the plans, leading to the risk of them being stuck in queues outside hospitals.
Unison East Midlands ambulance lead Dave Limer described the proposals as "dangerous and short-sighted".
"Fast response vehicles are often first on the scene when someone's heart has stopped or they're not breathing," he said.
"Taking away half of them will result in people waiting longer for help when every second counts."
Ben Holdaway, director of operations at EMAS, said the trust was "improving patient safety - not putting lives at risk".
"Our aim is to improve patient outcomes, service delivery, and staff wellbeing, including creating an increase in double-crewed ambulance capacity," he said.
"To enable this, a rostering and rotas review for accident and emergency ambulance teams is in progress and includes proposals to increase double crewed ambulances by reducing fast response vehicles (FRV) - without reducing cover in any areas.
"We currently put out more fast response vehicle (FRV) hours compared to ambulance trusts of a similar size and geography.
"A 45-day rota consultation is underway, with staff encouraged to book a one-to-one meeting with local leaders and attend station meetings to help design rotas, ask questions, and share feedback. Trade unions have been working closely with us on this.
"Consultation and dialogue continue, and feedback, along with wider evidence, will inform final decision-making. The aim is to enhance patient outcomes, service delivery, and staff wellbeing and safety, while boosting overall ambulance capacity."