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‘Every day was a learning curve’: implementing COVID-19 triage protocols in UK ambulance services—a qualitative study of staff experiences

Alison Porter Orcid Logo, Fiona Bell Orcid Logo, Mike Brady Orcid Logo, Shona Brown, Andrew Carson-Stevens, Timothy Driscoll, Bridie Angela Evans, Theresa Foster, John Gallanders, Imogen Gunson Orcid Logo, Robert Harris-Mayes, Mark Kingston, Ronan Lyons, Elisha Miller, Andy Rosser Orcid Logo, Aloysius Niroshan Siriwardena Orcid Logo, Robert Spaight, Victoria Williams, Helen Snooks

Emergency Medicine Journal, Volume: 42, Issue: 11, Pages: 747 - 751

Swansea University Author: Alison Porter Orcid Logo

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DOI (Published version): 10.1136/emermed-2024-214495

Abstract

Background TRIM (What TRIage model is safest and most effective for the Management of 999 callers with suspected COVID-19? A linked outcome study) was an evaluation of models used to triage and manage emergency ambulance service care for patients with suspected COVID-19. In an embedded qualitative c...

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Published in: Emergency Medicine Journal
ISSN: 1472-0205 1472-0213
Published: BMJ 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa70194
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In an embedded qualitative component, we aimed to understand experiences and concerns of clinical and managerial staff about processes for responding to patients with suspected COVID-19, in the call centre and on scene.Methods Research paramedics in four study sites across England interviewed purposively selected stakeholders from ambulance services (call handlers, clinical advisors in call centres, clinicians providing emergency response, managers) and emergency department clinical staff. Interviews (n=25) were conducted remotely, recorded and transcribed. Thematic analysis was conducted by a group of researchers and PPI (patient and public involvement) partners working together.Results We present four themes, developed from the data. Services made efforts to target their response to those most in need, while trying to minimise infection risk; they reduced face-to-face contact where possible, dealing with more calls remotely. Adjustments by other providers in the wider healthcare system affected the flow of patients to and from ambulance services. There was substantial work and heavy cognitive load for staff at all levels in updating knowledge and repeatedly implementing changes. Staff working in the range of roles in ambulance services also carried a heavy emotional load.Conclusions Services made flexible changes to triage processes using the best level of understanding available at the time, in a healthcare setting which always operates in high levels of uncertainty. Implementing triage protocols in response to the COVID-19 pandemic was a complex and fluid process which had to be actively managed by a range of front-line staff, dealing with external pressures and a heavy emotional load. 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spelling 2026-01-27T11:27:32.8061127 v2 70194 2025-08-18 ‘Every day was a learning curve’: implementing COVID-19 triage protocols in UK ambulance services—a qualitative study of staff experiences fcc861ec479a79f7fb9befb13192238b 0000-0002-3408-7007 Alison Porter Alison Porter true false 2025-08-18 MEDS Background TRIM (What TRIage model is safest and most effective for the Management of 999 callers with suspected COVID-19? A linked outcome study) was an evaluation of models used to triage and manage emergency ambulance service care for patients with suspected COVID-19. In an embedded qualitative component, we aimed to understand experiences and concerns of clinical and managerial staff about processes for responding to patients with suspected COVID-19, in the call centre and on scene.Methods Research paramedics in four study sites across England interviewed purposively selected stakeholders from ambulance services (call handlers, clinical advisors in call centres, clinicians providing emergency response, managers) and emergency department clinical staff. Interviews (n=25) were conducted remotely, recorded and transcribed. Thematic analysis was conducted by a group of researchers and PPI (patient and public involvement) partners working together.Results We present four themes, developed from the data. Services made efforts to target their response to those most in need, while trying to minimise infection risk; they reduced face-to-face contact where possible, dealing with more calls remotely. Adjustments by other providers in the wider healthcare system affected the flow of patients to and from ambulance services. There was substantial work and heavy cognitive load for staff at all levels in updating knowledge and repeatedly implementing changes. Staff working in the range of roles in ambulance services also carried a heavy emotional load.Conclusions Services made flexible changes to triage processes using the best level of understanding available at the time, in a healthcare setting which always operates in high levels of uncertainty. Implementing triage protocols in response to the COVID-19 pandemic was a complex and fluid process which had to be actively managed by a range of front-line staff, dealing with external pressures and a heavy emotional load. Increased understanding of the way in which services and staff had to adapt, and the cognitive and emotional burden this entailed, may help in planning for future pandemics. Journal Article Emergency Medicine Journal 42 11 747 751 BMJ 1472-0205 1472-0213 1 11 2025 2025-11-01 10.1136/emermed-2024-214495 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University SU Library paid the OA fee (TA Institutional Deal) Medical Research Council - UKRI-DHSC Covid-19 Rapid Response Rolling Call 2026-01-27T11:27:32.8061127 2025-08-18T15:39:55.9047802 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Alison Porter 0000-0002-3408-7007 1 Fiona Bell 0000-0003-4503-1903 2 Mike Brady 0000-0001-6675-9149 3 Shona Brown 4 Andrew Carson-Stevens 5 Timothy Driscoll 6 Bridie Angela Evans 7 Theresa Foster 8 John Gallanders 9 Imogen Gunson 0000-0001-8335-3335 10 Robert Harris-Mayes 11 Mark Kingston 12 Ronan Lyons 13 Elisha Miller 14 Andy Rosser 0000-0002-5477-4269 15 Aloysius Niroshan Siriwardena 0000-0003-2484-8201 16 Robert Spaight 17 Victoria Williams 18 Helen Snooks 19 70194__35197__67ff50a9a7e34dffb0450d9c2b010760.pdf 70194.VoR.pdf 2025-09-29T15:14:36.9656143 Output 393340 application/pdf Version of Record true © Author(s) (or their employer(s)) 2025. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license. true eng https://creativecommons.org/licenses/by/4.0/
title ‘Every day was a learning curve’: implementing COVID-19 triage protocols in UK ambulance services—a qualitative study of staff experiences
spellingShingle ‘Every day was a learning curve’: implementing COVID-19 triage protocols in UK ambulance services—a qualitative study of staff experiences
Alison Porter
title_short ‘Every day was a learning curve’: implementing COVID-19 triage protocols in UK ambulance services—a qualitative study of staff experiences
title_full ‘Every day was a learning curve’: implementing COVID-19 triage protocols in UK ambulance services—a qualitative study of staff experiences
title_fullStr ‘Every day was a learning curve’: implementing COVID-19 triage protocols in UK ambulance services—a qualitative study of staff experiences
title_full_unstemmed ‘Every day was a learning curve’: implementing COVID-19 triage protocols in UK ambulance services—a qualitative study of staff experiences
title_sort ‘Every day was a learning curve’: implementing COVID-19 triage protocols in UK ambulance services—a qualitative study of staff experiences
author_id_str_mv fcc861ec479a79f7fb9befb13192238b
author_id_fullname_str_mv fcc861ec479a79f7fb9befb13192238b_***_Alison Porter
author Alison Porter
author2 Alison Porter
Fiona Bell
Mike Brady
Shona Brown
Andrew Carson-Stevens
Timothy Driscoll
Bridie Angela Evans
Theresa Foster
John Gallanders
Imogen Gunson
Robert Harris-Mayes
Mark Kingston
Ronan Lyons
Elisha Miller
Andy Rosser
Aloysius Niroshan Siriwardena
Robert Spaight
Victoria Williams
Helen Snooks
format Journal article
container_title Emergency Medicine Journal
container_volume 42
container_issue 11
container_start_page 747
publishDate 2025
institution Swansea University
issn 1472-0205
1472-0213
doi_str_mv 10.1136/emermed-2024-214495
publisher BMJ
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description Background TRIM (What TRIage model is safest and most effective for the Management of 999 callers with suspected COVID-19? A linked outcome study) was an evaluation of models used to triage and manage emergency ambulance service care for patients with suspected COVID-19. In an embedded qualitative component, we aimed to understand experiences and concerns of clinical and managerial staff about processes for responding to patients with suspected COVID-19, in the call centre and on scene.Methods Research paramedics in four study sites across England interviewed purposively selected stakeholders from ambulance services (call handlers, clinical advisors in call centres, clinicians providing emergency response, managers) and emergency department clinical staff. Interviews (n=25) were conducted remotely, recorded and transcribed. Thematic analysis was conducted by a group of researchers and PPI (patient and public involvement) partners working together.Results We present four themes, developed from the data. Services made efforts to target their response to those most in need, while trying to minimise infection risk; they reduced face-to-face contact where possible, dealing with more calls remotely. Adjustments by other providers in the wider healthcare system affected the flow of patients to and from ambulance services. There was substantial work and heavy cognitive load for staff at all levels in updating knowledge and repeatedly implementing changes. Staff working in the range of roles in ambulance services also carried a heavy emotional load.Conclusions Services made flexible changes to triage processes using the best level of understanding available at the time, in a healthcare setting which always operates in high levels of uncertainty. Implementing triage protocols in response to the COVID-19 pandemic was a complex and fluid process which had to be actively managed by a range of front-line staff, dealing with external pressures and a heavy emotional load. Increased understanding of the way in which services and staff had to adapt, and the cognitive and emotional burden this entailed, may help in planning for future pandemics.
published_date 2025-11-01T05:30:46Z
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