Describing a 12-Hour Ambulance Shift during a Second Wave of Covid-19 in London

Abstract

The coronavirus disease (COVID-19), caused by the virus SARS-CoV-2, has strained international healthcare systems, including ambulance availability. Ambulance officers and paramedics are at the frontline of this pandemic and are therefore particularly exposed. Under normal operational circumstances, ambulance delivery is challenging; the effects of COVID-19 have exacerbated both the delivery of services and the stress placed on paramedics. In this case report, we describe a 12-hour emergency ambulance dayshift in central London during the second wave city-wide lockdown. We also discuss the impact COVID-19 has on day-to-day operations and the strategies employed to reduce paramedic infection.

Care Under Pressure 2: a realist synthesis of causes and interventions to mitigate psychological ill health in nurses, midwives and paramedics

“…8 The message that healthcare professionals should give 100% to patients, in a context where there are few strategies to help staff manage complex/distressing clinical situations, may reinforce compliance to institutional needs but to the detriment of staff 's psychological health 58 60 (CMO8). This was amplified during the pandemic [61][62][63][64][65] with normalisation of a 'serve and sacrifice' approach. 63 66 67 A further tension emerged between promoting staff psychological well-being in the context of staff shortages.…”

Causes and solutions to workplace psychological ill-health for nurses, midwives and paramedics: the Care Under Pressure 2 realist review

“…Paramedics expressed frustration with the media scaring people into not calling for emergency support when they had valid reasons to seek help unrelated to COVID-19. 250 At the same time, they were being called to homes of people who were in a state of fear and confusion from watching the news and needed professional reassurances that they were not sick or dying.…”

“…Various papers described the taxing use of PPE by nurses and midwives and paramedics during the pandemic. 250 This included the difficulty taking breaks and eating, going to the bathroom, and the additional time and labour caused by the need to don and doff PPE. 250 Paramedics often had to stay in full PPE for several hours while transporting a patient to hospital and waited for admission, and then had to spend further time and labour to decontaminate the ambulance after a COVID-19 patient transport, while concurrently receiving calls for more emergencies.…”

“…250 This included the difficulty taking breaks and eating, going to the bathroom, and the additional time and labour caused by the need to don and doff PPE. 250 Paramedics often had to stay in full PPE for several hours while transporting a patient to hospital and waited for admission, and then had to spend further time and labour to decontaminate the ambulance after a COVID-19 patient transport, while concurrently receiving calls for more emergencies. Donning and doffing PPE often had to happen inside the ambulance en-route to patients and different patient cases required different levels of PPE based on a tiered system.…”

“…Donning and doffing PPE often had to happen inside the ambulance en-route to patients and different patient cases required different levels of PPE based on a tiered system. 250 'Tragic choices' caused moral distress and injury: staff experienced MD in relation to making difficult choices with limited resources 206,255 and those working on the front lines in ICU departments experienced high rates of mental health disorders and thoughts of self-harm. 241 The literature indicated that staff experienced heightened distress during the pandemic due to making 'tragic choices'; 248 personal; organisational and societal.…”