Single mission workload and influencing factors in German prehospital emergency medicine - a nationwide prospective survey of 1361emergency missions

Background Workload is a major determinant of system performance and human well-being. This study aims to evaluate workload in prehospital emergency medicine on a single mission level and investigates influencing factors originating from medical scenarios, patient-provider interaction, EMS logistics and teamwork. Methods In a nationwide study, German paramedics were asked to evaluate single missions for perceived workload by completing the NASA Task-Load-Index (TLX). A variety of candidate variables were documented and tested for influence on the TLX through multivariate regression analysis. Results One thousand three hundred sixty-one emergency missions were analysed. Global workload scored in medium ranges (Median TLX 41.00/100; IQR 24.25–57.50). 263 missions achieved very low (< 20/100) and 52 missions achieved very high (> 80/100) levels of workload. Severity of distress as indicated by the NACA score (delta TLX 2.71 per 1 NACA point), execution of invasive procedures (e.g. delta TLX 8.20 for intravenous access), obese patients (delta TLX 0.05 per 1 kg of weight) and aggression incidences (e.g. delta TLX 10.54 for physical aggression), amongst others, resulted in significant increases in workload. Good teamwork decreased workload by 2.18 points per 1 point on the Weller-Teamwork Measurement Tool. Conclusion Distinct factors result in significant increases in workload for EMS paramedics. Improvements in training for certain medical scenarios, strategies against aggression events and enhancements in EMS logistics - especially for the transfer of obese patients – should be implemented and tested for their presumably positive effect on workload, EMS performance and paramedics’ well-being.