Workload and influencing factors in non-emergency medical transfers: a\xa0multiple linear regression analysis of a cross-sectional questionnaire study

Johann Georg Keunecke,Christine Gall,Johannes Prottengeier,Christian Eiche,Torsten Birkholz,Andreas Moritz

doi:10.1186/s12913-019-4638-4

Johann Georg Keunecke, Christine Gall + Show 4 more

Open Access

https://doi.org/10.1186/s12913-019-4638-4

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Abstract

BackgroundHuman 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.MethodsParamedics 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.ResultsA 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.ConclusionThe 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.

Highlights

Human workload is a key factor for system performance, but data on emergency medical services (EMS) are scarce
Workload was measured by the NASA Task Load Index (NASA-TLX), and we investigated a set of candidate variables that were assumed to possibly have an influence on workload, such as medical or organizational aspects of each transfer, paramedics’ teamwork, and their interactions with patients and third parties
While non-emergency transports and minor emergencies are autonomously managed by paramedics, emergency physicians are called to the scene for lifethreatening emergencies

Summary

Introduction

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. In contrast to the obvious importance and dynamics of non-emergency transfers, there is a lack of scientific data concerning the human factors behind the work in this subset of EMS activities. Such explorations of human factors and ergonomics aim to simultaneously improve system performance and paramedics’ well-being. It required a two-year training that was similar but of lesser extent than the training of the “Notfallsanitäter”

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