Unions have claimed that ambulance crews are being fined for driving in bus lanes and banned from public transport lanes when not on a 999 emergency.
Unison revealed that many ambulance drivers have received penalties for using the lanes to avoid traffic and speed up journeys for patients needing vital care.
The union warned that patients could end up stuck in traffic congestion if the fines continue.
Delegates at the union's annual health conference in Bournemouth spoke of a mixed picture, with towns and cities across the UK adopting different approaches.
Richard Bentley from Unison's Yorkshire Ambulance Service Branch said he can use bus lanes in Leeds but not in other cities.
The paramedic said: "If I leave Leeds and head to Bradford or York, I'm subject to a £60 fine.
"That's if I forget I'm not allowed to use their bus lanes.
"Several colleagues have fallen foul of this and there's nothing we can do."
The union's North East Ambulance Service branch secretary, Joel Byers, said: "If ambulance services use taxis to transport patients, those vehicles can use bus lanes yet ambulances designed for that very purpose will be fined."
Some councils have dropped fines following appeals, but drivers' time is wasted on paperwork, said Unison.
National ambulance officer Colm Porter said: "Crews need to get patients to hospital quickly but not every call requires lights and sirens.
"Councils must stop leaving crews out of pocket for putting patients first, and being taken out of action because they then get stuck in traffic jams."
The picture is mixed, the conference heard, with individual towns and cities across the UK adopting different approaches.
National ambulance officer Colm Porter said: "Crews need to get patients to hospital quickly but not every call requires lights and sirens.
"Councils must stop leaving crews out of pocket for putting patients first, and being taken out of action because they then get stuck in traffic jams."
