Background The coronavirus infectious disease 2019 (COVID-19) places significant demand on the NHS. This study aimed to measure the preparedness of healthcare professionals working for ambulance services, in both direct-contact patient facing and remote roles, and the impact the COVID-19 pandemic had on their psychological stress and perceived ability to deliver care.

Methods Clinicians working for NHS ambulance services were invited to participate in a three-phase sequential online survey during the acceleration phase of the first wave of COVID-19 in the UK. Participants who participated in the first survey and who consented to be re-contacted were asked to complete two further surveys during the peak and deceleration phases of the pandemic. Open and closed-ended questions were used to assess participants’ perceived preparedness in undertaking their clinical duties. In addition, the General Health Questionnaire-12 (GHQ-12) was utilised to measure participants’ anxiety, mood and general health through each phase of the study. A score greater than 12 indicates the participant may be experiencing psychological distress.

Results Phase one recruited 3717 participants, reducing to 2709 (73%) by phase two and 2159 (58%) by phase three. Overall, mean GHQ-12 scores were 16.5 (± 5.2) during phase one, reducing to 15.2(±6.7) by phase three. Most participants were found to have a GHQ-12 score great than 12 during the first phase (n = 3112, 84%). Factors leading to higher mean GHQ-12 scores were feeling unprepared for the pandemic, a lack of confidence in both using personal protective equipment and managing out of hospital cardiac arrests in patients with confirmed or suspected COVID-19.

Conclusions A significant number of participants reported psychological distress, the reasons for which are multifactorial. Ambulance managers need to be aware of the risks to staff mental health and take action to mitigate these, to support staff in delivery of unscheduled, emergency and urgent care under these additional pressures.