Tens of thousands of ambulance workers in England and Wales went on strike on Wednesday, walking out on their shifts and joining picket lines to demand pay increases and better working conditions in the largest labor unrest to hit Britain’s emergency services in decades.

The walkout, an effort by three unions, comes as Britain is experiencing weeks of labor strikes across numerous industries as a mounting cost-of-living crisis, spurred by double-digit inflation, grips the country. On Tuesday, nurses went on strike over pay that has not kept up with inflation, and rail workers and border control workers are scheduled to do the same this week.

In the ambulance services, workers have raised alarms about record delays for patients seeking emergency treatment, and paramedics have pointed to staffing shortages and burnout, as well as fears of arriving too late to help some callers.

Those issues have been exacerbated by entrenched problems within the National Health Service, where a high level of staffing vacancies has led to backlogs and long waits in hospital emergency rooms.

On Wednesday, the ambulance services were responding only to the most critical cases.

Before the walkout — in which over 20,000 workers were expected to take part — some hospitals asked people to arrange their own transportation to hospitals, including pregnant women going into labor. Patients needing nonurgent care were advised to look elsewhere for advice, including by telephone or from general practitioners or pharmacists.

With Christmas and end-of-year celebrations underway, health leaders urged people to avoid risky behavior on a day when services would be stretched. “Don’t get so drunk that you end up with an unnecessary visit to A. & E.,” Stephen Powis, the N.H.S. medical director for England, said in a BBC interview, referring to the Accident and Emergency departments at hospitals.

The health service’s management said before the strike that there was “deep worry” about potential harm to patients at a time when the service was already under intense pressure.

“This is not something N.H.S. leaders would ever say lightly, but some now tell us that they cannot guarantee patient safety tomorrow,” Matthew Taylor, the chief executive of the N.H.S. Confederation, which represents the service’s organizations in England, said on Tuesday.

The N.H.S. planned to manage the walkouts by calling in military personnel and volunteers, increasing staffing at call centers and discharging patients from hospitals where possible to free up beds.

Unions representing ambulance workers blamed the government and called on political leaders to come to the negotiating table. Workers argue that a pay increase of about 4 percent proposed by a government review body amounts to a cut in real terms. Inflation in the country has soared to as much as 11.1 percent in recent months, the highest in four decades.

“We don’t want patients to suffer in any way, shape or form,” said Sharon Graham, the general secretary of the Unite union, told the BBC on Wednesday. “I’ve never seen such an abdication of leadership like it in 25 years of negotiating.”

In a letter to Prime Minister Rishi Sunak, N.H.S. England leaders said that on health grounds “it is clear that we have entered dangerous territory.”

“We urge you to do all you can to bring about an agreed solution,” they said. “Otherwise more members of the public will suffer unnecessarily.”

Mr. Sunak has called the industrial action disappointing and threatened to impose laws that would limit the reach of trade unions.

Despite worries over the strikes’ impact, some people affected by delays in ambulance services expressed sympathy for the workers.

In North London, Robin Lockyer said while walking to work on Wednesday morning that his father had been forced to wait seven hours for an ambulance after breaking his hip recently. “He’s 86 — it was really traumatic for him,” Mr. Lockyer said. “But I don’t blame the ambulance service,” he added. “I blame the government.”

“The government is taking a strange stance,” Mr. Lockyer said. “And I think there’s going to be a lot more action.”

Saskia Solomon contributed reporting.

Isabella Kwai

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