Developing workload-informed crew configuration recommendations for emergency medical services

Abstract

While crew configuration in primary care settings has been studied in terms of its impact on patient outcomes, less is known about how it influences the members' workload experience. This study investigates the workload implications of crew configuration based on members' certification in emergency medical services (EMS). Advanced life support (ALS) ambulance crews are commonly comprised of two paramedics (homogeneous crew) or an emergency medical technician (EMT) and a paramedic (heterogeneous crew). The goals of this study were the following: (1) to investigate differences in workload among members of the same crew, and (2) to use workload assessments to inform crew configuration strategies. We mapped one year of an EMS system's dispatch data to members' workload estimates using the visual, auditory, cognitive, and psychomotor (VACP) approach. We found that lead members (lead paramedics) experience higher workload levels compared to support members (support paramedics or EMTs) in both types of crews. Neither configuration had a consistently lower workload than the other, but differences varied for different shifts and stations. These results informed crew configuration recommendations for stations and shifts in the collaborating system, and in terms of more generalizable variables. A minimum number of staffed crews, half-half shift type (covering both day and night hours), and 30-day frequency of calls with priority P7 most significantly impacted the recommended crew configurations.