A Swansea University study has uncovered the intense emotional and operational strain experienced by emergency ambulance staff across the UK during the Covid-19 pandemic.
Part of the TRIM project (What TRIage model is safest and most effective for the Management of 999 callers with suspected Covid-19), this latest research was led by Swansea’s professor Helen Snooks, and shines a light on how frontline responders adapted triage and decision-making under extreme pressure.
Dr. Alison Porter, associate professor in health services research, oversaw the strand focusing on ambulance services and those working alongside them in emergency departments—examining how teams changed their way of working to handle 999 calls involving suspected Covid-19 cases, and exploring both clinical outcomes and the lived experiences of staff.
Developed in collaboration with patient and public involvement partners, the study draws on 25 remote interviews with personnel—including paramedics, ambulance emergency call handlers, and emergency department clinicians working across four NHS ambulance services and corresponding regional hospitals.
The study identified four key themes:
Prioritized care with limited contact: Ambulance teams focused on the most urgent cases while reducing face-to-face interactions to minimize infection risk.
Shift to remote triage: Call handling practices underwent major changes, with remote assessments replacing traditional in-person evaluations.
Widespread system disruption: Broader changes across the healthcare landscape affected patient flow and added complexity to ambulance operations.
Mental and emotional strain: Staff navigated evolving protocols, ethical dilemmas, and sustained psychological pressure.
The emotional toll of the pandemic was a recurring focus throughout the interviews.
One call handler shared: “It was probably the toughest thing I’ve ever done […] I was coming home and standing in the corridor taking my uniform off and running in the shower, and sobbing my heart out day after day after day.”
Despite the immense challenges, the study also highlighted a strong sense of pride and resilience among emergency healthcare staff.
An ambulance service manager said: “I think that we rose to the challenge during Covid, and we did an absolutely astounding job. And every single clinician on the ground […] the call takers, the dispatchers, just showed how flexible and how adaptable, and how resilient we are as a service.”
Porter said, “Emergency ambulance services operate in high-stakes environments even in normal times. During Covid-19, that pressure escalated rapidly. Our research reveals the reality frontline staff faced—constant change, uncertainty, and overwhelming emotional demands—while striving to deliver safe, effective care.”
The study’s insights are clear: future emergency services should be based on the foundations of flexibility, compassion, and psychological support. By learning from the experiences of the Covid-19 pandemic, health systems can better protect frontline staff and deliver responsive, high-quality care when it matters most.
Dr. Mike Brady (PhD), assistant clinical director for remote clinical care at the Welsh Ambulance Service University NHS Trust, who was part of the research team, said, “The TRIM study findings reveal the intense emotional and operational strain Emergency Operations Centre staff faced during the pandemic, as well as their remarkable adaptability in rapidly evolving circumstances. These insights are highly relevant today, as UK health services undergo large-scale clinical model transformations, winter preparation responses, and future pandemic preparedness exercises. These findings reiterate the importance of UK ambulance services contributing to high-quality and important research.”
Source: Swansea University