Association between prehospital medical service complexity and perceived task load of emergency calls among paramedics in Taiwan: a nationwide survey study

Evidence on paramedics' task load is limited despite the growth of prehospital emergency medical services (EMS). This study aims to investigate the association between the clinical complexity of prehospital EMS patients and paramedics' (EMT-P's) perceived task load during their most recent call. In this nationwide cross-sectional study, a total of 430 paramedics attending 10 out of the 13 training groups of the "2023 Refresher Training Program for EMT-Ps" in Taiwan were asked to complete an anonymous online survey. The survey included the Chinese version of the NASA Task Load Index (NASA-TLX), which generated a global TLX score ranging from 0 to 100. The clinical complexity of the most recent call was also assessed and divided into three groups based on whether the services provided during the call involved procedures that could be performed by EMT-1, EMT-2, or EMT-P personnel. We built multivariable linear regression models to account for confounders such as paramedics' demographics, job tenure, and details of their most recent EMS dispatch (e.g., patient information, procedures performed, and call duration.). Among the 242 (56.3%) respondents, EMT-P and/or cardiopulmonary resuscitation calls were significantly associated with a 14.04-point (95% CI: 5.01-23.07) increase in the global TLX score when compared with EMT-1 missions after adjusting for confounders. These findings were consistent across the subdimensions of NASA-TLX, specifically, mental demand and frustration. Additionally, every additional year of a patient's age was correlated with a 0.14-point increase in paramedics' perceived global TLX (95% CI: 0.02-0.25) after model adjustment. Handling EMS cases that require advanced clinical skills and treating older patients is associated with increased paramedics' perceived task load. Our findings highlight the need to improve prehospital EMS workforce management in aging countries like Taiwan.