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A qualitative analysis of stressors affecting 999 ambulance call handlers’ mental health and well-being

A collaboration between the University of Bradford and Yorkshire Ambulance Service NHS Trust

Authors: Catherine Powell 1; Beth Fylan 1,2; Fiona Bell 3; Kathryn Lord 1; Liz Breen 1,2

  1. University of Bradford, Schools of Pharmacy & Medical Sciences and Health Studies, Richmond Road, Bradford, BD7 1DP
  2. Yorkshire and Humber Patient Safety Research Centre, Bradford Institute for Health Research, Temple Bank House, Bradford, BD9 6RJ
  3. Yorkshire Ambulance Service NHS Trust, Brindley Way, Wakefield, WF2 0XQ
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Focus on the health and well-being of healthcare staff is critical to reduce the risk of “occupational burnout”, a syndrome arising from poorly managed workplace stress leading to exhaustion, cynicism or negativity and lower professional confidence levels (World Health Organisation, 2020). In times of crisis, 999 ambulance call handlers are the first point of contact for patients. They handle a wide variety of complex and emotional calls and must quickly assess the severity of the caller/patient’s condition (Wennlund et al., 2022). It has been reported that more than 40% of emergency call handlers exhibit signs of burnout, yet these staff are the point of entry for patients into urgent and emergency care. They make critical decisions in assessing the type of emergency responses required (Wennlund et al., 2022; Golding et al., 2017).

This study was conducted to explore the views of 999 call handlers. The 999 ambulance call handler is critical in responding to emergency patient treatment; however, the call handlers are often a hidden component of the healthcare workforce and an under-researched group. The objective of this study was to understand stress triggers experienced by 999 ambulance call handlers that could lead to burnout and examine personal and organisational mechanisms and strategies which reduced the risk of burnout.

An NHS call handler at a computer

A single interview case study approach applying qualitative methods was undertaken. Participants were identified through a purposive sample of 999 ambulance call handlers with the Yorkshire Ambulance Service National Health Service Trust (UK). Participants were interviewed via telephone between July 2019 and September 2019.

In total, 18 staff participated in this study. Societal factors including public incivility and media representation and organisational factors, such as a demanding environment, lack of appreciation and career progression, training issues and protocols were key stressors. Organisational well-being services were helpful for some, but for others lacked accessibility and appropriateness. Positive public feedback and speaking with peers bolstered well-being. 999 ambulance call handlers suggested that sufficient breaks, co-design or feeding back on training and protocols and creating more informal opportunities to discuss ongoing everyday stressors as methods to reduce stress and burnout.

This paper explores a previously under researched area on stressors and potential burnout in 999 ambulance call handlers. This paper highlights the need for improved organisational support services and appropriate public and sector peer recognition of the role of ambulance 999 ambulance call handlers.

Our study is explored in greater depth in the International Journal of Emergency Services - IJES-12-2021-0080_proof 1..12 (

There's more information on the YAS Research Support page, including a poster and infographic relating to the study. 

If you wish to discuss this study with us, please contact Professor Liz Breen –

Supporting references

Golding, S.E., Horsfield, C., Davies, A., Egan, B., Jones, M., Raleigh, M., Squires, A., Start, K., Quinn, T. and Cropley, M. (2017), Exploring the psychological health of emergency dispatch centre operatives: a systematic review and narrative synthesis, PeerJ, 5, e3735, 29062596, doi: 10. 7717/peerj.3735.

Powell C., Lord K., Fylan B., Bell, F. and Breen L. (2022) A qualitative analysis of stressors affecting 999 ambulance call handlers’ mental health and wellbeing. International Journal of Emergency Services.  12(2), 231-242.

Torlén Wennlund, K., Kurland, L., Olanders, K., Khoshegir, A., Kamil, HA., Castrén M,. Bohm, K. (2022) Emergency medical dispatchers' experiences of managing emergency calls: a qualitative interview study. BMJ Open. Apr 13;12(4):e059803. doi: 10.1136/bmjopen-2021-059803. PMID: 35418440; PMCID: PMC9014079.

World Health Organisation (2020), Burn-out an ‘occupational phenomenon’: international classification of diseases, available at: (accessed 18 July 2022).