Background Pandemics such as Covid-19 place psychological burden upon individuals and communities. However, social, and behavioural research examining the behaviours and collective psychological responses of those in healthcare occupations deemed at greatest risk of exposure, are limited. Taking a social identity approach, this study sought to examine the emotional, behavioural, and social psychological impact upon those working as frontline NHS ambulance personnel in England during the height of the pandemic (April 2020 – April 2021).

Methods Focused ethnographical methods utilising in-depth semi-structured interviews, were triangulated with the researcher’s reflexive account (as an operational paramedic) and relevant published documents. Thirty participants undertook three phases of interviews held at the start, mid-way through, and end of the study period.

Results Thematic analysis of the empirical data from phase one of the interviews revealed four key themes: the social representation of Covid-19 as a threat; collective prosocial behaviours versus stigma; moral decision-making, moral distress, and psychological impact; and sociocultural group processes and behaviours including leadership dynamics. Analysis of the data findings from phase two and three is ongoing at present.

This study identified that in the early months of the pandemic, the social identity of ambulance staff was challenged and presented significant pressure and conflict between, for example, shifting community perceptions of staff as ‘heroes’ versus individuals’ perceptions of self-worth -elaborated through a discourse of ‘we’re just doing our job’. Shared identity within an occupational group was considered important by the participants in terms of recognising shared experience and coping with adversity arising from the pandemic, yet, also presented stigmatisation associated with perceptions of ‘dirty work’ and ‘contagion’ from aspects of the community including in some instances, from their own family members. However, this was not experienced by participants upon arrival at the scene of emergencies. Indeed, members of the public were seemingly, on the whole, grateful for their attendance.

Almost all participants elaborated on attending calls that provoked considerable psychological and moral distress, particularly those where challenging decisions had to be made, patients were seriously unwell, or where families were facing bereavement in the context of strict restrictions. After such events, support from ambulance leaders was sometimes seen to be lacking, with the culturally stoic attitude of ‘man up and get on with it’ prevailing. This appeared to magnify in-group and out-group divisions between staff and managers within ambulance organisations, and heighted feelings of depersonalisation and burnout.

Conclusion To the authors knowledge, this is the first study to explore in-depth the unique narrative experiences of those working within the field of paramedicine in England during the Covid-19 pandemic. For these participants, the early months of the pandemic was socially representative of a period of chaos, uncertainty, and behavioural conflict; challenging social identity and at times, provoking emotional and moral distress.