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Ercolani J, Cure L, Misasi P. Identifying and validating perceived workload metrics for emergency medical services. APPLIED ERGONOMICS 2024; 118:104270. [PMID: 38518729 DOI: 10.1016/j.apergo.2024.104270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 02/24/2024] [Accepted: 03/07/2024] [Indexed: 03/24/2024]
Abstract
The most common workload surrogates used by Emergency Medical Services (EMS)- overall call volume (CV) and unit hour utilization (UHU)-have not been validated. This study investigates the relationship between EMS operational metrics and perceived workload, measured through the NASA task load index (TLX) survey. We paired crew member survey responses with the operational metrics based on dispatch data. Linear regression was used to evaluate the influence of each metric on perceived workload. Logistic regression was used to identify values of workload indicating a fair day's work. We found that the overall CV (p < 0.001, R2=0.32) and UHU (p < 0.001, R2=0.22) explained less variability in perceived workload than a priority (P)-stratified CV (p < 0.001, R2=0.41). However, we found no clear fair day's workload threshold. We conclude that a priority-stratified CV is a better workload surrogate than a CV and UHU.
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Affiliation(s)
- Jenna Ercolani
- Industrial, Systems and Manufacturing Engineering, Wichita State University, 1845 Fairmount St, Wichita, KS, 67220, USA.
| | - Laila Cure
- Industrial, Systems and Manufacturing Engineering, Wichita State University, 1845 Fairmount St, Wichita, KS, 67220, USA.
| | - Paul Misasi
- Sedgwick County EMS, 1015 Stillwell, Wichita, KS, 67213, USA.
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Zaphir JS, Murphy KA, MacQuarrie AJ, Stainer MJ. Understanding The Role of Cognitive Load In Paramedical Contexts: A Systematic Review. PREHOSP EMERG CARE 2024:1-23. [PMID: 38922409 DOI: 10.1080/10903127.2024.2370491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 06/11/2024] [Indexed: 06/27/2024]
Abstract
Objectives: Cognitive load refers to the working memory resources required during a task. When the load is too high or too low this has implications for an individual's task performance. In the context of paramedicine and emergency medical services (EMS) broadly, high cognitive load could potentially put patient and personnel safety at risk. This systematic review aimed to determine the current understanding of the role of cognitive load in paramedical contexts.Methods: To do this, five databases were searched (Elsevier Embase, ProQuest Psychology, CINAHL, Ovid Medline, and Ovid PsychINFO) using synonyms of cognitive load and paramedical contexts. Included articles were full text, peer reviewed empirical research, with a focus on cognitive load and EMS work. Two reviewers screened titles, abstracts, and full text using a traffic light system against the inclusion and exclusion criteria. The quality of evidence was assessed using the GRADE framework. This study was registered on PROSPERO (CRD42022384246). No funding was received for this research.Results: The searches identified 73 unique articles and after title/abstract and full text screening, 25 articles were included in the final review. Synthesis of the research revealed 10 categories of findings in the area. These are clinical performance, cognitive processes, emotional responses, physical expenditure, physiological responses, equipment and ergonomics, expertise and experience, multiple loads, cognitive load measures, and task complexity.Conclusions: From these findings it was determined that there is agreement in terms of what factors influence cognitive load in paramedical contexts, such as cognitive processes, task complexity, physical expenditure, level of experience, multiple types of loads, and the use of equipment. Cognitive load influences clinical task performance and has a bi-directional relationship with emotion. However, the literature is mixed regarding physiological responses to cognitive load, and how they are best measured. These findings highlight potential intervention points where cognitive load can be managed or reduced to improve working conditions for EMS clinicians and safety for their patients.
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Affiliation(s)
- Jasmine S Zaphir
- School of Applied Psychology, Griffith University, Queensland, Australia 4222
| | - Karen A Murphy
- School of Applied Psychology, Griffith University, Queensland, Australia 4222
| | | | - Matthew J Stainer
- School of Applied Psychology, Griffith University, Queensland, Australia 4222
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Keselica M, Peřan D, Renza M, Duška F, Omáčka D, Schnaubelt S, Lulic I, Sýkora R. Efficiency of two-member crews in delivering prehospital advanced life support cardiopulmonary resuscitation: A scoping review. Resusc Plus 2024; 18:100661. [PMID: 38784406 PMCID: PMC11111834 DOI: 10.1016/j.resplu.2024.100661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/29/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
Background Advanced Life Support (ALS) during cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) is frequently administered by two-member crews. However, ALS CPR is mostly designed for larger crews, and the feasibility and efficacy of implementing ALS guidelines for only two rescuers remain unclear. Objective This scoping review aims to examine the existing evidence and identify knowledge gaps in the efficiency of pre-hospital ALS CPR performed by two-member teams. Design A comprehensive search was undertaken across the following databases: PubMed, Web of Science, SCOPUS, Cochrane Library Trials, and ClinicalTrials.gov. The search covered publications in English or German from January 1, 2005, to November 30, 2023. The review included studies that focused on ALS CPR procedures carried out by two-member teams in adult patients in either simulated or clinical settings. Results A total of 22 articles were included in the qualitative synthesis. Seven topics in two-person prehospital ALS/CPR delivery were identified: 1) effect of team configuration on clinical outcome and CPR quality, 2) early airway management and ventilation techniques, 3) mechanical chest compressions, 4) prefilled syringes, 5) additional equipment, 6) adaptation of recommended ALS/CPR protocols, and 7) human factors. Conclusion There is a lack of comprehensive data regarding the adaptation of the recommended ALS algorithm in CPR for two-member crews. Although simulation studies indicate potential benefits arising from the employment of mechanical chest compression devices, prefilled syringes, and automation-assisted protocols, the current evidence is too limited to support specific modifications to existing guidelines.
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Affiliation(s)
- Miroslav Keselica
- Department of Anesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Šrobárova 1150/50, Prague 100 34, Czech Republic
| | - David Peřan
- Department of Anesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Šrobárova 1150/50, Prague 100 34, Czech Republic
- Emergency Medical Services of the Karlovy Vary Region, Závodní 390/98C, 360 06 Karlovy Vary, Czech Republic
| | - Metoděj Renza
- Department of Anesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Šrobárova 1150/50, Prague 100 34, Czech Republic
| | - František Duška
- Department of Anesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Šrobárova 1150/50, Prague 100 34, Czech Republic
| | - David Omáčka
- Department of Anesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Šrobárova 1150/50, Prague 100 34, Czech Republic
| | - Sebastian Schnaubelt
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
- PULS - Austrian Cardiac Arrest Awareness Association, Vienna, Austria
| | - Ileana Lulic
- Department of Anesthesiology, Intensive Care and Pain Medicine, Clinical Hospital Merkur, Zajceva 19, 10000 Zagreb, Croatia
| | - Roman Sýkora
- Department of Anesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Šrobárova 1150/50, Prague 100 34, Czech Republic
- Emergency Medical Services of the Karlovy Vary Region, Závodní 390/98C, 360 06 Karlovy Vary, Czech Republic
- Air Rescue Service and Emergency Medicine Department Pilsen-Line, Military Medical Agency, U Letiště, 330 21 Líně, Czech Republic
- Medical College, Duškova 7, 150 00 Prague, Czech Republic
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Keunecke JG, Gall C, Birkholz T, Moritz A, Eiche C, Prottengeier J. Workload and influencing factors in non-emergency medical transfers: a multiple linear regression analysis of a cross-sectional questionnaire study. BMC Health Serv Res 2019; 19:812. [PMID: 31699084 PMCID: PMC6836439 DOI: 10.1186/s12913-019-4638-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 10/14/2019] [Indexed: 11/11/2022] Open
Abstract
Background Human workload is a key factor for system performance, but data on emergency medical services (EMS) are scarce. We investigated paramedics’ workload and the influencing factors for non-emergency medical transfers. These missions make up a major part of EMS activities in Germany and are growing steadily in number. Methods Paramedics rated missions retrospectively through an online questionnaire. We used the NASA-Task Load Index (TLX) to quantify workload and asked about a variety of medical and procedural aspects for each mission. Teamwork was assessed by the Weller teamwork measurement tool (TMT). With a multiple linear regression model, we identified a set of factors leading to relevant increases or decreases in workload. Results A total of 194 non-emergency missions were analysed. Global workload was rated low (Mean = 27/100). In summary, 42.8% of missions were rated with a TLX under 20/100. TLX subscales revealed low task demands but a very positive self-perception of performance (Mean = 15/100). Teamwork gained high ratings (Mean TMT = 5.8/7), and good teamwork led to decreases in workload. Aggression events originating from patients and bystanders occurred frequently (n = 25, 12.9%) and increased workload significantly. Other factors affecting workload were the patient’s body weight and the transfer of patients with transmittable pathogens. Conclusion The workload during non-emergency medical transfers was low to very low, but performance perception was very positive, and no indicators of task underload were found. We identified several factors that led to workload increases. Future measures should attempt to better train paramedics for aggression incidents, to explore the usefulness of further technical aids in the transfer of obese patients and to reconsider standard operating procedures for missions with transmittable pathogens.
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Affiliation(s)
- Johann Georg Keunecke
- Faculty of Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
| | - Christine Gall
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Torsten Birkholz
- Faculty of Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Department of Anaesthesiology, University Hospital Erlangen, Erlangen, Germany
| | - Andreas Moritz
- Faculty of Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Department of Anaesthesiology, University Hospital Erlangen, Erlangen, Germany
| | - Christian Eiche
- Faculty of Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Department of Anaesthesiology, University Hospital Erlangen, Erlangen, Germany
| | - Johannes Prottengeier
- Faculty of Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Department of Anaesthesiology, University Hospital Erlangen, Erlangen, Germany
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