Quotes from participants

Patient recruitment
Q1I agree that we normally see so many more COPD patients than we have, like when you came and gave us four packs, I was like this in't gonna be enough, I'll see four COPD patients in a week, and then COVID-19 hit.
I think because we've seen so much less of them, clearly these people are managing in the community in some way, shape or form, and I don't know how that is. (ParamedicFG6)
Q2These last 18 months, it's been really difficult; I've not seen those chronic patients that I would normally see. (ParamedicFG7)
Intervention: patients’ and carers’ views
Q3But some patients are just so unreceptive to help from us, like some people just think they need to be in hospital. I did them all (parts of the intervention) and he was not cooperative with any of them, but also he didn't enter the study anyway. I think a lot of COPD patients are like, ‘I don't want to go to hospital’, cos they spend their whole lives there, and so they are really receptive, but some people are just not.# (ParamedicFG6)
Q4And then they had a good talk to me and I was really distressed. All me family came, they was worried and I weren't quite all there, if you know what I mean. The paramedic, he was absolutely brilliant; he talked me through, pulled me round a bit and then after about an hour maybe I was a lot better. (Patient12)
Q5They did the right thing when they came, they sat me down and calmed the fears I had over it and gave us some good advice, yeah, it was good, thanks. (Patient11)
Q6They walked in, they were so friendly, they were very reassuring to me mum. They weren't patronising in any way, they just dealt with her but also included me, which I thought were really nice, they had time for me as well, and just chatted as well, which just reassured me mum a lot. (CarerofPatient4)
Q7Well I think it was good because they gave an immediate solution; they talked him right through what was needed to be done, but also with the written information for him to read when he felt better. Cos obviously being given lots of instructions and talking through alternative treatments, it's OK, but when you're unwell you don't absorb all the information, and to be left with really clear concise information was really good. (CarerofPatient12)
Q8I haven't used the Ventolin for two days because every time I feel like it I use that little fan and do what it says in the book, breathe in and hold it, you know, like a rectangle it is, and then breathe out. (Patient12)
Intervention: paramedics’ views
Q9Opening the window and using a window to visualise the breathing is easy and effective. It calms people down and once the patient is calmer the relatives seem to take over with the coaching. (ParamedicSurvey6)
Q10I really loved the idea behind this research. (ParamedicSurvey8)
Q11If we're gonna start this intervention, we're gonna give you an alternative, instead of relying on somebody else (another clinician) that doesn't do it and we still see that patient next week, then I'm all for it. (ParamedicFG7)
Q12There was the little laminated sheet, I think that was good and I think that that's really helpful for relatives to be able to use to coach people through, because I would notice that after sorta five minutes of me coaching them they would start to step in, because it's not hard, and so I think that was effective. (ParamedicFG6)
Q13I think that coaching it and the ease of access for it, for patients to be able to do it, it might take a few minutes, but it's very doable if the patient is receptive to it. (ParamedicFG6)
Q14We usually go to a lot of breathless patients and we are making a move as a profession to try and treat more people within the community so, yeah, I definitely think it's something that's worth incorporating. (ParamedicFG7)
Q15I feel like it's definitely a worthwhile thing, because it's gonna be better for the long-term care of patients and healthcare needs to change, it needed to change cos it's not managing. So, this is something that can help with that change and help people manage on their own and that can only be a good thing. (ParamedicFG6)
Q16I think it (the intervention) is necessary for people to know, I don't think it's a specialist thing because you don't need a specialist skill set to be able to do any of it, anybody could do it. (ParamedicFG6)
Implementation issues
Q17She was probably the one that was like, yes, I can take this woman, I can do it with this woman, but that was the one time where I then ended up, couldna get any access to the database at all. (ParamedicFG6)

#: did not provide retrospective consent. : did not provide retrospective consent due to access issues but was prepared to join the study.