Paramedic experiences of providing care in Wales (UK) during the 2020 COVID-19 pandemic (PECC-19): a qualitative study using evolved grounded theory

Abstract

ObjectiveTo explore paramedic experiences of providing care during the 2020 COVID-19 pandemic and develop theory in order to inform future policy and practice.DesignQualitative study using constructivist evolved grounded theory (EGT) methodology. One-to-one semistructured interviews were conducted using a general interview guide. Voice over Internet Protocol was used through Skype.SettingConducted between March 2020 and November 2020 in the Welsh Ambulance Services National Health Services Trust UK which serves a population of three million.ParticipantsParamedics were recruited through a poster circulated by email and social media. Following purposive sampling, 20 Paramedics were enrolled and interviewed.ResultsEmergent categories included: Protect me to protect you, Rapid disruption and adaptation, Trust in communication and information and United in hardship. The Basic Social Process was recognised to involve Tragic Choices, conceptualised through an EGT including Tragic personal and professional choices including concerns over personnel protective equipment (PPE), protecting themselves and their families, impact on mental health and difficult clinical decisions, Tragic organisational choices including decision making support, communication, mental health and well-being and Tragic societal choices involving public shows of support, utilisation and resourcing of health services.ConclusionsRich insights were revealed into paramedic care during the COVID-19 pandemic consistent with other research. This care was provided in the context of competing and conflicting decisions and resources, where Tragic Choices have to be made which may challenge life’s pricelessness. Well-being support, clinical decision making, appropriate PPE and healthcare resourcing are all influenced by choices made before and during the pandemic, and will continue as we recover and plan for future pandemics. The impact of COVID-19 may persist, especially if we fail to learn, if not we risk losing more lives in this and future pandemics and threatening the overwhelming collective effort which united society in hardship when responding to the COVID-19 Pandemic.Trial registration numberIRAS ID: 282 623.

Psychological Responses of Health Care Workers Are Strongly Associated With Pandemic Management

“…This is in line with other studies, which showed that sadness emerged in HCWs when the perceived information was insufficient, and levels of anxiety were higher in those working with COVID-19 patients or using PPE (bad-fitting, discomfort, many layers), whereas irritability was one of the main symptoms of vicarious traumatization (Alenazi et al, 2020;Li et al, 2020;Savitsky et al, 2020;García-Fernández et al, 2021;Ruskin et al, 2021). Furthermore, many HCWs reported that public solidarity manifestations, such as gifts or clapping hands, were nice, but some of them felt embarrassed (Rees et al, 2021). An explanation might be that HCWs perceived psychological jobrelated stress from bad-fitting or uncomfortable respirators, which increased the work of breathing or irritated their skin (Malik et al, 2020), as well as from frequency and adequacy of pandemic information.…”

Quality improvement in a crisis: a qualitative study of experiences and lessons learned from the Irish National Ambulance Service response to the COVID-19 pandemic

“…The results suggest that working in a response room can affect well-being, especially during case surges. Previous investigations confirm that the well-being of EMS professionals can be impaired by the pandemic, though they largely focused on paramedics and first responders, rather than dispatch or response room staff 46–49. In the current study, staff reported benefiting from organisational and peer support, as well as networking and learning opportunities.…”

“…Previous investigations confirm that the well-being of EMS professionals can be impaired by the pandemic, though they largely focused on paramedics and first responders, rather than dispatch or response room staff. [46][47][48][49] In the current study, staff reported benefiting from organisational and peer support, as well as networking and learning opportunities. Greater teambuilding and training would have bolstered integration and cooperation, particularly for staff recruited from external organisations.…”

Mental Health Symptoms and Workplace Challenges among Australian Paramedics during the COVID-19 Pandemic

“…Frontline HCWs working in the community are particularly affected by such events, which intensify existing stressors and create additional challenges, such as increased uncertainty in the workplace [ 1 , 2 ]. Paramedics are a vital and fundamental part of this frontline healthcare response to COVID-19 and have faced increased risk and workplace stress during the pandemic [ 3 ]. Paramedics have had to adapt quickly to multiple challenges, including fear of contracting the virus, increased workloads, insufficient resources and large amounts of new and constantly changing information.…”