What happens when ‘extreme contexts’ change?: The traumatic intensity of ambulance work during the Covid-19 pandemic

Professionals who operate in risky, demanding and potentially hazardous contexts often develop robust organizational and cultural norms that enable them to cope with extreme challenges. But what happens when these contexts change? This article explores the experiences of English National Health Service (NHS) ambulance workers during the Covid-19 pandemic. Drawn from over fifty interviews with senior leadership, managers, and frontline staff, our findings reveal three experiential phases of work intensification: crisis management, the new normal and ongoing traumatic response. We make two main contributions. First, we empirically explore what happens when an occupation already known for high levels of work intensity finds itself in a new context of extreme and sustained disruption. Second, we contribute to building a worker-centric conceptualization of extreme work by recognizing the reality of its human costs in terms of ‘traumatic intensity’, demonstrating the latent vulnerability of seemingly well-established organizational norms, practices and routines.