Emergency chiefs fear commissioners will balk at paying for an ambitious plan to allow specialist paramedics into the heart of major incidents, including terrorist attacks.
Commissioners have questioned how running costs for hazardous area response teams (HART) will be funded, HSJ has learned.
Specialist teams will be based at each ambulance trust to provide treatment at the inner core of incidents such as terrorist chemical attacks and collapsing buildings.
Sue Wheatley, head of emergency preparedness at West Midlands Ambulance Service trust and NHS West Midlands, said HART was 'not on commissioners' radar'.
'It is going to be a challenge to sell it to the commissioners on the basis that it is not a mainstream service.
'I don't think commissioners see emergency preparedness as a priority. I think they see HART as something that belongs to the ambulance service. I don't think they have made the connection that the ambulance service will be custodians of the service, which will respond on behalf of the NHS,' she said.
Peter Old, emergency planning adviser at Shropshire PCT, said the Department of Health had failed to involve commissioners sufficiently in discussions about the project
'I think PCTs will be supportive of the scheme, but there's an ever-reducing pot of money and they will need guidance about where priorities sit.'
Mr Old said the value of the project lay in the way it would provide paramedics with the equipment and skills to attend to patients in settings in which they are currently untrained, such as confined spaces and contaminated zones.
The Department of Health will fund the capital costs of the scheme, with PCTs picking up the revenue bill. HSJ understands that strategic health authority commissioners have questioned how primary care trusts will pay for the service.
A senior regional ambulance manager said the issue was 'extremely sensitive' at the moment. They declined to comment further.
The service is being piloted at London Ambulance Service trust and, along with the urban search and rescue programme, at Yorkshire Ambulance Service trust. The London pilot uses five vehicles including two rapid response cars.
Ambulance trusts in the North West and West Midlands are expected to get the teams next, followed by a roll-out across England.
The DoH spokeswoman said: 'We haven't been contacted by commissioners expressing concerns.'
She said there were no plans to develop a commissioning framework for HART, but the DoH would consider developing commissioning guidance should NHS commissioners request it.
The NHS Confederation's primary care trust network and NHS Alliance were unable to comment.