In March 2020, the World Health Organization (WHO) announced COVID-19 to be a global pandemic. Together with the governments of nearly all countries in the world, the WHO decided that coordinated strategies are required in order to limit its spread. These strategies differed between the countries. However, the corona virus pandemic (COVID-19) has negatively impacted nearly each sector of global society regardless, and the healthcare sector has borne the brunt of this burden, unprecedented for the last hundred years, the most. The COVID-19 that recently hit the entire world has revealed a previously unseen number of consequences for physical and mental health of individuals and for society at large (Hanna et al., 2018; Brooks et al., 2020; Fiorillo and Gorwood, 2020; Lima et al., 2020). Working on the first line of contact with patients in situations of sudden health or life risk, paramedics play an important role in the healthcare system. This role has become even more important during the COVID-19 pandemic due to the increased number of people requiring immediate medical attention. The work of a paramedic involves high physical demands, such as being routinely exposed to physical demands, such as lifting, lowering, carrying, pushing, and pulling (Coffey et al., 2016). They are also exposed to high psychological demands, and their well-being is further impacted by stress and traumatic experiences (Ogińska-Bulik, 2014a).

Due to the character of their work, paramedics are at risk for workplace accidents (Garus-Pakowska et al., 2016). Moreover, their work involves traumatic experiences, such as contact with death (Ogińska-Bulik, 2014a,b; Rasmus et al., 2020). During the COVID-19 pandemic, the healthcare system has become severely strained by the number of additional patients. Direct contact of the medical staff with bodily fluids and pathogens in the air puts them at an especially high risk of infection with the SARS-CoV-2 coronavirus (Tysiąc-Miśta et al., 2021). Research results show that there is a risk of infection through contact with contaminated surfaces and items (Hanke and Pietrzak, 2021). In turn, due to unavoidable contact with the patients’ bodily fluids and airborne transmission, paramedics are at a high risk of exposure to pathogens (Gańczak and Topczewska, 2018; Tysiąc-Miśta and Bulanda, 2021).

The pandemic situation has caused concern for own life as well as the life of one’s significant others to become a constant source of stress for paramedics. Their work has also become more demanding due to an increased number of patients and a reduced number of available personnel due to infection and quarantine. In many countries, medical staff make up for the greatest amount of COVID-19 deaths—estimated at 30% in the initial stages of the pandemic (Nolan et al., 2020). Such constant sense of threat can cause intense stress in paramedics (Stasiła-Sieradzka and Turska, 2019). Directly witnessing the effects of the disease, awareness of the number of deaths, and difficulties in preventing and combating infections are sources of anxiety for paramedics (Shahzad et al., 2020). However, such anxiety is common, as research shows that around 80% of all Poles are afraid of contracting COVID-19, and over 85% experience related anxiety, restlessness, and tension (Babicki and Mastalerz-Migas, 2020).

An overview of scientific databases, such as BASE, EBSCO, PubMed, Medline, Web of Science, and Scopus shows that over 150 articles about the COVID-19 pandemic are published every day. The most scientifically useful ones are based almost exclusively on medical studies. Sadly, few studies thus far have examined the functioning of paramedics during the pandemic. A study by Wasim et al. (2020) showed that 62% of paramedics exhibited symptoms of depression, 65% exhibited symptoms of anxiety, and 55% exhibited symptoms of stress. During the COVID-19 pandemic, paramedics are also at greater risk of stigmatization due to the direct risk of contracting COVID-19 (Zolnikov and Furio, 2020).

The aim of the current study was to establish the role of personal resources (resilience) in the experience of stress by paramedics during the COVID-19 pandemic. Resilience was taken as a measure of personal resources, as during a pandemic situation, strategies of coping with stress are revealed to be insufficient, especially against traumatic stress (Jasielska and Ziarko, 2019).

The following research questions were put forward:

First, stress and resilience levels before and during the pandemic were compared. The results are shown in Table 1.

Paramedics reported higher levels of intrapsychic stress before the pandemic. No differences in emotional tension and external stress were observed.

Tolerance of failure and treating life as a challenge was higher during the pandemic, in contrast to optimism and the ability to mobilize in difficult situations.

Table 2 shows the results of the correlation analysis (Pearson’s r) between the stress and resilience levels before and during the pandemic.

All stress scales were related to the five resilience scales. All correlations were negative and statistically significant. Thus, it can be concluded that the lower the paramedics’ personal resources (resilience), the more stress they experience.

In the second phase of the study, the paramedics were asked if they have contact with patients with COVID-19. The stress and resilience results are shown in Table 3.

Statistically significant differences were observed between all stress scales. Paramedics who had contact with COVID-19 patients were characterized by average stress levels (4–5 sten), whereas paramedics who did not have such contact exhibited low stress levels (2–3 sten).

The COVID-19 pandemic has impacted global functioning. Most countries had to confront its consequences to a greater or lesser extent. A rapid increase in patient numbers, insufficient equipment stocks and personnel numbers, and the shrinking capacities of the medical sector have put significant strains on medical personnel. For paramedics, overwork and concern for own health, as well as the health of one’s significant others, have joined the standard workplace stressors of hurry, shift work, and responsibility for the patients. In such a situation, the paramedics’ psychological condition becomes even more important for their effectiveness. The current study attempted to answer the following questions: What were the stress levels among the paramedics before the pandemic, and what are they during the pandemic? Which aspects of the personal resource of resilience lower the stress levels experienced by paramedics during the pandemic?

The results revealed that intrapsychic stress is lower than in the pre-pandemic period. On the other hand, there were no differences in emotional stress and external stress. We can assert that the differences shown for intrapsychic stress are due to the COVID-19 pandemic (and not to individual differences), taking into account that almost 85% of the participants where the same individuals, tested in the two phases of the research (pre-pandemic and during the pandemic). It can be expected that, during the COVID-19 pandemic, stress levels would increase rather than decrease. These results can be interpreted in several ways.

First, activating of personal resources—resilience. In difficult situations, people activate their personal resources (including resilience), which might stimulate their development. An analysis by Labrague (2020) shows that medical personnel exhibits medium to high resilience levels during the pandemic. Also, in light of the first corollary which follows from the Conservation of resources (COR) theory’ basic principles (Hobfoll, 1989; Halbesleben et al., 2014), people having greater resources are less vulnerable to negative stress following traumatic or chronic stress (Holmgreen et al., 2017). Together with the medium or high resilience, paramedics had more resources to begin with, including privileged social status (e.g., most being men, white race, and having a good income), and cultural capital—comprising education, intellect, skills, etc. But activating personal resources (such as resilience) can be exhausting for paramedics, which can lead to increased stress levels in the long term (a demanding job can erode health). As Linton et al.’s (2015) review highlighted, high job demands predict future sleep difficulties/disturbances. Also, work stress, alongside organizational climate predict the emotional exhaustion of employees and are linked with depressive symptoms (Gayman and Bradley, 2013). The current study was carried out in May and June 2020, at the beginning of the pandemic, when the level of reported infections was relatively low. Thus, the personal resource of resilience might not have become depleted yet. If facing this depletion, replenishment can take place (sleep being an essential component in this dynamic) or depletion can spiral downwards, with negative consequences on work-related outcomes (Barnes, 2012). In this context, we also mention Österberg et al. (2014) findings, according to which, despite considerable recovery, employees with previous work-stress-related exhaustion manifested important signs of a minor attention deficit when returning to work.

Second, habituation—loss of reaction to repeated stimuli. Reactions decrease, and, in time, can disappear, as a result of repeated exposures to a constant stimulus (Wochyński et al., 2020). Habituation plays an adaptive function, as it allows for an effective utilization of emotional and cognitive resources.

Third—the COVID-19 pandemic has placed appropriately high priority on the basic issues of health and life. The threat of infection with the coronavirus, in a situation of rigorous following of health and social isolation protocols, was low during the period in which the study was carried out. On the other hand, in the face of a global pandemic, other stressors are unable to lower one’s mood. If such fundamental values and health and life are at risk, people judge everyday problems differently (Ogińska-Bulik and Juczyński, 2016).

In the second phase of the study, the paramedics were asked if they had contact with patients with COVID-19 during their work. In the sample of 84 paramedics, 52 (62%) had such contact. A comparison of these groups showed that they were characterized by higher stress levels on each dimension (emotional tension, external stress, and intrapsychic stress). However, it must be noted that those paramedics who had contact with patients with COVID-19 exhibited medium stress levels, whereas other paramedics exhibited low stress. Experiencing stress can increase a sense of threat to one’s health and life (Stasiła-Sieradzka and Turska, 2019).

Both paramedics who had and who did not have contact with patients with COVID-19 were characterized by similar resilience levels. Resilience was revealed to be negatively correlated with stress on a moderate level. As resilience increases, experienced stress decreases (Ogińska-Bulik and Michalska, 2019). In order to examine the effect of resilience on stress, a regression analysis was carried out with the three dimensions of stress considered in the current study as the dependent (explanatory) variables and with the five dimensions of resilience as the independent variables. The analysis was intended to indicate which of the aspects of resilience decrease or increase the experienced stress among paramedics during the pandemic. However, it must be noted that the regression analysis only included those paramedics who had contact with patients with COVID-19. Those paramedics who did not have such contact were not included, as they constituted too small a sample.

The analysis of the predictive power of the individual aspects of resilience for the subjective experience of stress revealed that perseverance and determination played a key preventive role. This factor was a statistically significant explanatory variable in both regression equations. A study on grieving people showed that perseverance and determination was the main predictor of positive post-traumatic changes (Felcyn-Koczewska and Ogińska-Bulik, 2012). This suggests that different aspects of resilience may have a significant influence on post-traumatic growth, and this, in turn, depends on its kind, among others. Perseverance and determination were the most significant for preventing increases in experienced stress. It can be expected that experiencing stress at work every day builds immunity. Negative consequences of stress can coexist with its positive effects. Effective coping with difficult situations builds personal resilience, which makes individual cope more effectively with future difficulties. A study by Janoff-Bulman (2004) shows that earlier coping with traumatic experiences builds and strengthens personal resources, including resilience. This may cause individuals to cope more effectively with similar situations in the future. Paramedics are expected to function effectively in traumatic situations.

Paramedics experience emotional tension and external stress every day. Only those with appropriate (low-reactivity) personality structures can work as paramedics without incurring excessive costs. Perseverance and determination are important for paramedics, and are shaped with experience. Paramedics never know the results of their actions in advance. Sometimes, lives can be saved even in a hopeless situation. Therefore, paramedics are expected to persevere until the end and to not express doubts, as they are responsible for their patients’ lives.

Paramedics who did not have contact with patients with COVID-19 exhibited low stress levels. On the other hand, paramedics who did have such contact were characterized by medium stress levels. This begs the question why their stress levels were medium instead of high. According to Hobfoll’s (1989) theory, stress occurs when (a) personal resources have been diminished, (b) there exists a likelihood, that they may become diminished, or (c) the invested resources are not yielding the expected gains. The extent of the experienced stress depends on the initial levels of personal resources (Chen et al., 2015). It is likely that, among paramedics, these were high. This may have led them to only use a part of their resources during the pandemic situation. This would result in average rather than high stress levels during the pandemic.

The results shown in Table 1 allow for hypothesizing that the COVID-19 pandemic has activated defense mechanisms, which prevented increases in emotional tension and external stress. Intrapsychic stress levels were even lower than before the pandemic. These mechanisms have caused tolerance of failure and treating life as a challenge to be higher during the pandemic. On the other hand, these mechanisms did not prevent optimism and the ability to mobilize in difficult situations from significantly decreasing during the pandemic.

Resilience, conceptualized as a self-regulation mechanism, is universal and should protect from the negative consequences of both traumatic experiences as well as everyday stressors. In the first model (regression equation), openness to new experiences and sense of humor largely determined emotional stress levels. So-called isolation is a defense mechanism frequently used by paramedics to cope with extreme situations. Humor and jokes allow for isolating oneself from such situations. Such reactions lower the tension in the emergency rescue team. Humor increases individual coping skills in the face of workplace stress through a shift in perspective, distancing from problems, and a change in the perception of stressors as less threatening (Kruczek and Basińska, 2018).

In the third regression equation, where the explained variable was intrapsychic stress, competences, and tolerance of negative emotions was the only significant predictor. Intrapsychic stress appears together with a sense of difficulty in realizing one’s tasks and overcoming everyday challenges, and of insufficient personal resources. People exhibiting high intrapsychic stress experience tension over accepting their problems and exhibit anxiety and withdrawal tendencies when thinking about their future. Such people blame themselves for their problems and they do not consider the role of the social environment. Professional competences are a resource which can lower this type of stress. Having competences necessary to fulfill given professional duties lowers the sense of overwork (Jurek, 2019). The second element of the predictors in the equation were competences and tolerance of negative emotions. The ability to cope and tolerate difficult emotions allows effective functioning in stressful situations (Fergus, 2018).

The results of the current study add to the understanding of the relationship between stress caused by the difficult COVID-19 pandemic situation and psychological resilience. Due to possessing the personal resource of resilience, paramedics are able to effectively cope with stress. Paramedics who have contact with patients with COVID-19 experienced higher stress. Activating personal resources in a long-term pandemic situation can lead to their depletion. Even if the sample of participants is not too large to generalize results (the representativeness of the sample could be seen as a limit of our research), it is important to monitor paramedics’ psychological condition also after the pandemic ends. This occupational group, together with hospital staff, are at the greatest risk of infection with the coronavirus. Another limitations of the research can be drawn. The results could be different in other settings, e.g., if paramedics from other countries, differently affected by the pandemic, would be investigated, or paramedics belonging to different social groups—knowing that being female, elderly and having a racial minority status, together with resource loss, represent predictors of psychological distress (Adeola, 2009; Paul et al., 2014).

Our research conclusions offer valuable resources for medical staff and psychologists (and not only these occupational groups), raising awareness of how stress levels tend to vary in a situation, such as a pandemic—in certain social categories—raising awareness, also, regarding the importance of developing personal resources in people, in order to maintain a “healthy stress” at work (on long-term). Even more during a pandemic, active managerial (see Harkness et al., 2005; Ganster et al., 2011; Wan, 2013) and psychological actions (effective means of coping with work stress) come to support employees (including paramedics), to prevent and reduce, on long run, “unhealthy stress.” However, as pointed out by Janes et al. (2021), the importance of building not only personal but also organizational and systemic resilience of front-line health professionals should be emphasized.

Considering the existing gap in the literature, our study results can represent a starting point for future researchers, eager to better understand the resilience and stress levels of paramedics, working in various settings.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethical approval was not provided for this study on human participants because this study was carried out in accordance with the recommendations of the APA and Code of Ethics and Professional Psychologist of the Polish Psychological Association (PTP). The patients/participants provided their written informed consent to participate in this study.

All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.