Evaluating the effectiveness of the SHEL model in reducing occupational exposure risks among pre-hospital emergency personnel: a retrospective cohort study (2018–2024)

Background: Pre-hospital emergency personnel face significant occupational exposure risks, yet traditional training approaches often prove inadequate. This study evaluated the effectiveness of SHEL (Software, Hardware, Environment, Liveware) model-based training versus standard operating procedure training (SOPT) in reducing occupational exposure incidents. Methods: This retrospective cohort study included pre-hospital emergency personnel from an emergency center between January 2018 and June 2024. Participants were divided into SOPT and SHEL groups based on the training received. Knowledge, Attitude, and Practice (KAP) scores and safety behavior compliance were assessed before and 6 months after training. Occupational exposure incidents and root causes were analyzed throughout the one-year follow-up. Psychological status was evaluated using the Nursing Stress Scale and Maslach Burnout Inventory before and 6 months post-training. Results: = 0.001). Conclusion: Training based on the SHEL model is more effective than traditional SOPT in enhancing occupational safety, reducing exposure incidents, and improving the psychological well-being of pre-hospital emergency personnel. These findings support the need for more integrated training approaches in emergency medical services.