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220 ‘Family members screaming for help makes it very difficult to don PPE.’ A qualitative report on ambulance staff experiences of personal protective equipment (PPE) use and infection prevention and control (IPC) practices during the COVID-19 pandemic
  1. P Eaton-Williams1,
  2. J Williams1,2,
  3. the COVID-19 Ambulance Response Assessment (CARA) Study Steering Group
  1. 1South East Coast Ambulance Service NHS Foundation Trust, UK
  2. 2College of Paramedics, UK


Background The COVID-19 Ambulance Response Assessment (CARA) study was a prospective, longitudinal survey of UK ambulance staff during the first wave of the COVID-19 pandemic. CARA aimed to evaluate perceptions of preparedness and wellbeing, and to collect staff suggestions to benefit working practices and conditions.

Method Three online questionnaires were presented, coinciding with the acceleration, peak and deceleration phases of the first COVID-19 wave in 2020. Inductive thematic analysis was employed to represent 14,237 free text responses from 3,717 participants to 18 free-text questions overall. This report focuses on experiences of IPC practices.

Results Many participants lacked confidence in using PPE because of low familiarity, an inadequate evidence-base and changing policy. Some experienced insufficient supply, items of poor quality and suboptimal fit-testing procedure. PPE use was further influenced by discomfort, urgency, and perceptions of risk. Various suggestions were made to improve IPC practices, including decontamination personnel, staff ‘bubbles’ and limiting exposure through public education and remote triage improvements.

Conclusion Repeated poor experiences of implementing IPC practices1 2 demand that lessons are learnt from this pandemic. PPE developed with specific regard for ambulance staff’s unique working environment and for them to receive regular familiarization training in its use would likely benefit performance and confidence. Overall, ambulance staff emphasised the need for IPC policies to be pragmatic, evidence-based and communicated with clarity.


  1. Billings J, Ching B C F, Gkofa V, Greene T, & Bloomfield M. (2020). Healthcare workers experiences of working on the frontline and views about support during COVID-19 and comparable pandemics: A rapid review and meta-synthesis. MedRxiv.

  2. Houghton C, Meskell P, Delaney H, Smalle M, Glenton C, Booth A, Chan XHS, Devane D. & Biesty L M. (2020). Barriers and facilitators to healthcare workers’ adherence with infection prevention and control (IPC) guidelines for respiratory infectious diseases: a rapid qualitative evidence synthesis. Cochrane Database of Systematic Reviews, (4).

Conflict of interest None.

Funding College of Paramedics.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: .

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