At the height of the pandemic, we analysed the opinions of service staff on the practicalities and potential value of testing for SARS-CoV-2 in an ambulance.

The life science industry made a massive contribution to the worldwide response to the COVID-19 pandemic including manufacturing tests for SARS-CoV-2. Some of these tests included lateral flow devices, which produce rapid results and do not require laboratory equipment or staff. Potentially ambulance services could use these tests to assess patients prior to their transport to hospital. However, in the winter of 2020-21 it was unclear whether it was practical and valuable to test for SARS-CoV-2 in an ambulance.

We designed and distributed two surveys to practicing members of the ambulance service including paramedics, technicians and call-handling staff from across England and Northern Ireland during December 2020 – February 2021. The surveys captured their opinions on the ideal characteristics of SARS-CoV-2 tests, scenarios where the tests could improve patient management and the feasibility of using these tests in an ambulance. We performed statistical analysis to summarise responses to multiple choice and Likert scale questions. We also included some open-ended questions to allow for in-depth comments. We used a framework analysis method to organise these responses and identify common themes.

The work was led by Dr Kile Green and Dr Joy Allen from the NIHR Newcastle In Vitro Diagnostics Co-operative (NIHR Newcastle MIC) and involved a nationwide collaboration with the NIHR London MIC, Queen Mary University of London, University of Leeds, the CONDOR steering group and Stroke Research Group within Newcastle University. The Newcastle MIC Insight panel for patients, public and carers and CONDOR Patient and Public Involvement group also provided a public perspective at various stages. This included helping to refine the questions and language used in the surveys.

We collected 179 full responses to the first survey. Around ¾ of respondents indicated that testing for SARS-CoV- 2 in an ambulance was potentially feasible. Respondents indicated that a test for SARS-CoV-2 could add value to the following clinical scenarios and ranked them in this order:

1. Assessing patients before they arrive in hospital to improve handover
2. Aiding decision making on where a patient should go next
3. Determining if a patient can be safely left at home
4. Deciding whether personal protective equipment is needed

However, respondents did raise some concerns. These included the potential misuse of the service, which could lead to increased workload, a delay in patients receiving the most appropriate care and the possibility that erroneous results could lead to incorrect decision making. Ideally, respondents wanted tests to give highly accurate and rapid results, which would help to overcome some of their concerns.

This research provides insights into testing for other infectious conditions in an ambulance, which could help the UK prepare for future pandemics.

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