The Health and Community Services Union has said that the government's updated wages and conditions offer "falls well short of what it had indicated to the government was needed to reach a deal".
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HACSU industrial manager Robbie Moore said the union would be sitting at the negotiation table on December 29 with the state government.
"The current offer still doesn't address the main issues for paramedics, and that's about ramping, meal break, and we still have a significant issue with wages because they will still be the lowest-paid paramedics in the country by the end of this agreement if they accept it.
"We're hoping that the government will enter into genuine negotiations and try to reach an agreement so that they can address their fundamental issues and move in terms of their position enough for us to be able to get something to recommend to members.
Mr Moore said paramedics around the state were frustrated with the situation.
"They're dealing with a situation where they're being advised that patient transport officers are being used because of the lack of staff that they have due to COVID and other leaves.
"The working environment demonstrates why it is desperate that we get movement in negotiations so we can actually get something to attract staff to Tasmania.
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If upcoming negotiations with the government are unsuccessful, Mr Moore said paramedics would escalate industrial action.
"And that's because they have no other choice.
"They can't let the service go on the way it is, and unless we get a deal that can actually help attract people to Tasmania, the situation for Tasmanians is just going to get more and more dire.
"It's pretty bad at the moment when you're actually asking workers that aren't paid or trained to drive ambulances because of the shortage of paramedics."
A spokesperson for the Tasmanian government said the current offer put forward to HACSU is "fair, affordable, and reasonable, and gives our hard-working state service employees a pay rise, eases cost of living pressures, and improves conditions".
"The Government will continue to negotiate with unions in good faith."
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