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.

Background: Exceptional demands have been placed on paramedics and other healthcare workers (HCWs) during the COVID-19 pandemic. An overwhelming outpouring of public support has unfolded, bringing into focus the relationship between paramedics, other HCWs and society, where they are portrayed as heroes. Scholars have studied the notion of heroism to society, and characteristics of such heroic status include: the voluntary nature of a heroic act, risk of physical or social harm, willingness to accept the consequences of action, acting for the benefit of others and without the expectation of gain. While some HCWs and paramedics may reflect these characteristics, many may not. Such heroic narratives can be damaging, stifling meaningful discussion around limits to duties, failing to acknowledge the importance of reciprocity and potentially imposing demands on paramedics and HCWs to be heroic.Aim: This article prospectively presents the protocol for a metasynthesis which aims to identify, appraise and synthesise the qualitative literature in order to develop theory on heroism and paramedic practice.Methods: Evolved grounded theory methodology is followed along with the procedural guidelines of Noblit and Hare (1988) to guide the analysis. The Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) have also been adopted when preparing this protocol and will be followed in the study proper. The protocol has been registered with the International Prospective Register of Systematic Reviews PROSPERO 2021, registration number CRD42021234851.Results: We do not currently have results, but PRISMA guidelines will be followed when reporting our findings.Conclusion: Current narratives on heroism and paramedic practice are important in terms of the relationship between paramedics and society. The metasynthesis prospectively reported in this article serves as the first point in our journey of making sense of and developing theory on heroism and paramedic practice.

Background: COVID-19 has been declared an international emergency by the World Health Organization. Despite personal concerns, frontline health professionals, such as paramedics, nurses and doctors, continue to treat patients. Ensuring these workers' mental wellbeing is supported during these stressful times is key to their maintaining good mental health in the longer term. Aim: To conduct a review of the literature exploring practitioners' attitudes during a pandemic. Methods: A scoping literature review was conducted to assess information on health professionals' attitudes during COVID-19 and previous pandemics, and to identify their main concerns and whether these were addressed. PubMed, CINAHL, the Cochrane Library and Google Scholar were searched and PRISMA guidelines were followed. Titles and abstracts were screened and emergent themes were identified and discussed. Results: 141 articles were screened; 15 articles were sourced through Google Scholar and reference lists. There were 18 articles in the final sample. There was a lack of published data on COVID-19 at the time of writing. Themes include that health professionals' mental health may be affected during a pandemic. Their biggest concerns are infecting family members and overcoming personal anxieties to continue treating patients. Key themes in protecting staff mental health during a pandemic include increasing their understanding of how to protect themselves and their families, better confidence in personal protective equipment and good managerial communication. Conclusions: Practitioners experience heightened stress levels during pandemics, which may affect their mental health. This has implications for workforce resilience. More research is needed on frontline staff attitudes during the COVID-19 pandemic to protect their mental health.

ObjectivesWe aimed to identify, appraise, and synthesise the qualitative literature to develop theory on heroism and paramedic practice.Hypothesis/research questionWhat does published literature tell us about heroism and paramedic practice?SettingParamedics and other healthcare workers (HCWs) faced an outpouring of public support for them early in the COVID-19 pandemic which brought into focus the relationship between them and society, where they are portrayed as heroes.ParticipantsWe conducted a metasynthesis using Evolved Grounded Theory and procedural guidelines of Noblit and Hare to guide analysis. Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) guidelines were also applied.Results151 papers were retrieved and eleven included in the final sample. Studies were moderate to very low quality, involving a wide range of methodologies and settings; none specifically explored heroism and paramedic practice. The following interrelated themes were constructed on heroism and paramedic practice: (a) Myth, Folk law, and storytelling in heroism and paramedic practice (b) The epic journey of heroism and paramedic practice (c) Heroes and Zeroes: The fluctuating Societal Value in heroism and paramedic practice (d) Politicisation, and objectification in Heroism and Paramedic practice.ConclusionParamedics have long been characterised as heroes, but this may not reflect their everyday experiences. Heroism in paramedic practice can provide scripts for prosocial action, inspiring others, and leading to more social heroic actions. Paramedics may however be ambivalent to such heroism narratives, due to politicisation, and objectification in the media and society. This metasynthesis is only one of many possible constructions of heroism and paramedic practice and is the first point in making sense of and developing theory on heroism and paramedic practice.Study registrationPROSPERO: CRD42021234851.