A new study led by Professor Helen Snooks at Swansea University has examined how ambulance staff adapted their triage and decision-making processes during the Covid-19 pandemic. The research is part of the TRIM project, which investigates which triage models are safest and most effective for managing emergency calls involving suspected Covid-19 cases.
Dr Alison Porter, Associate Professor in Health Services Research, oversaw the portion of the study focusing on ambulance services and those working with them in emergency departments. The research explored how teams changed their approach to handling 999 calls about suspected Covid-19 patients and considered both clinical outcomes and staff experiences.
The study involved 25 remote interviews with paramedics, call handlers, and clinicians from four NHS ambulance services and regional hospitals. It identified four main themes: prioritising care while limiting contact to reduce infection risk; shifting to remote triage methods instead of traditional in-person assessments; widespread disruption across healthcare systems that complicated ambulance operations; and significant mental and emotional strain on staff as they navigated changing protocols, ethical challenges, and ongoing psychological pressure.
One call handler described the experience: “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 these difficulties, participants expressed pride in their work. 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.”
Dr Porter commented: “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 findings suggest that future emergency services should emphasize flexibility, compassion, and psychological support for staff. Lessons from this period can help health systems protect frontline workers better during future crises.
Dr Mike Brady (PhD), Assistant Clinical Director for Remote Clinical Care at Welsh Ambulance Service University NHS Trust who contributed to the research team added: “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.”