Dubbo paramedics and Ambulance Division of the Health Services Union (ADHSU) members Melissa Todhunter and Allison Moffitt said they had been performing higher duties for 12 years, with no reflection in their pay packets.

This included making clinical decisions to safely leave patients at home and therefore reduce the pressure on emergency departments and the health system, as well as performing tasks that required greater clinical capacity and training.

The industrial action includes writing chalk messages on ambulance vehicles and obtaining signatures for a petition, and is part of rolling action planned by ADHSU members until the NSW state election day.

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The state-wide campaign, called 'Priority 1', began with an online stop-work meeting on Friday, February 17, and a doorstop with HSU NSW Secretary Gerard Hayes in Martin Place, Sydney.

Paramedics announced they would ban using higher skills for which they had been trained but were not paid. They wore protest t-shirts over their uniforms and announced a range of further actions could roll out over the next five weeks.

The Dubbo pair are demanding pay parity with what they claim is a similar health role, that of a clinical nurse specialist.

Ms Todhunter said: "Sometimes we're delivering really high risk medications for a couple of hours in the back of an ambulance."

She said NSW paramedics were the lowest paid paramedics in Australia, and paramedic training was an additional expense for NSW Health, often without reward as NSW paramedics were "leaving in their droves" to other states and territories due to "poor wages and work conditions".

"The NSW government has borne the brunt of the significant expense in training these clinicians to try and keep up with staff enhancements and attrition, but they are not getting any value back from this cost due to staff fleeing at such large rates," Ms Todhunter said.

Ms Moffitt said paramedics were "simply asking to be recognised for the clinical contribution they make to their communities" and to be paid accordingly.

"In some cases we're making decisions only a doctor would make," she said.

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The duo are calling for NSW Premier Dominic Perrottet to sit down and chat with the HSU following the findings of a 2022 taskforce that showed paramedics were saving the government money.

Ms Todhunter said the premier "ghosted" them after agreeing to discuss it further.

"We are living and working in, and committed to our communities. We're also being caught up in all these natural disasters on a personal level and then going to work and having to deal with it on a professional level as well. I don't think a little pandemic medal is adequate recognition," she said.

Ms Moffitt said: "We work crazy hours, we work weekends, we miss holidays events, birthdays, our families suffer, and we're still not recognised for all the professional decisions we're making on a day-to-day basis."

Ms Todhunter said: "The days of us merely going to an address and being a taxi driver are long gone. We are clinicians. It is imperative we are recognised that way."