Background

The COVID-19 pandemic has significantly tested the resilience of global healthcare systems, particularly in emergency medical services. This study delves into the Swedish ambulance services' response to the pandemic, focusing on the dynamics of resilient performance and decision-making processes under extreme pressure. Understanding these responses is crucial for strengthening system-wide preparedness for future healthcare crises. 

Objective

The aim of the study was to explore frontline decision-making, adaptation, and learning over time in ambulance care during the COVID-19 pandemic.

Methods

We gathered data from twenty-eight registered nurses in the Swedish ambulance services, who reported on 56 critical incidents during the pandemic using free-text questionnaires. The Critical Incident Technique, supplemented by Interpretive Description, was employed to analyze these incidents, concentrating on aspects of resilience in the context of emergency healthcare practice.

Results

Analysis of the data revealed four main themes: ‘Navigating uncharted waters under never-ending pressure’ which underscores the continuous adaptation to evolving care challenges; ‘Balancing on the brink of an abyss’ reflecting the critical nature of decision-making amidst limited resources; ‘Sacrificing the few to save the many’ addressing the ethical complexities in prioritization and resource allocation; and ‘Bracing for the next wave’ indicating the importance of proactive planning for future resilience. These themes highlight a healthcare system's capacity to not only endure disruptions but to also evolve through them. Key to resilient practices were effective information sharing and the ability to discern between beneficial and harmful adaptations.

Conclusions

The study emphasizes the crucial role of dynamic leadership in crisis scenarios. It highlights the need for a balance between autonomous decision-making by frontline workers and structured guidance from management. Building ethical competence through situational awareness, reflective practices, and participation in ethical discourse is vital. These practices empower frontline workers to confidently manage ethical decision-making in crisis situations, thereby enhancing the adaptive capacity of healthcare systems in the face of future challenges.