Integrated Field Monitoring of Paramedic Workload and Exposure A Multi-Modal Methodological Study

Abstract

Introduction: Paramedics experience demanding physical tasks, acute stressors, and chronic under‑recovery, defined as an accumulation of incomplete physiological and psychological recovery. However, occupational exposure research has primarily relied on retrospective self‑report, simulation, or single‑modality monitoring that poorly capture within‑shift variation and operational context.

Objective: The objective of this paper was to describe, implement, and evaluate a field-embedded, multi-modal protocol for measuring paramedic occupational exposure across routine rostered shifts, cross-referenced to CAD data. Specifically, we report protocol feasibility, data completeness, artifact burden, and field validity as methodological endpoints.

Methods: We conducted a prospective methodological observational study embedded in the routine operations of a large Australian ambulance service. A workforce‑aligned sample of operational paramedics completed multiple monitored shifts wearing Hexoskin smart garments for continuous heart rate, respiratory rate, and accelerometry data, with pre‑/post‑shift and pre/post call blood pressure measurement and Borg Rating of Perceived Exertion (RPE) where feasible. Anonymized computer-aided dispatch (CAD) records provided call type, priority, and phase timestamps (assign, en route, on scene, to hospital, at hospital), enabling minute‑level linkage with biometric data. Standardized procedures were specified a priori for recruitment, device fitting, shift monitoring, logbooks, data export, cleaning, missing‑data thresholds and an epoch‑based hierarchical data structure (epochs within calls, calls within shifts, shifts within paramedics). Primary procedural endpoints were feasibility and adherence, data completeness and artifact profile, and field validity of Hexoskin measures.

Results: Thirty-two paramedics completed 232 monitored shifts, yielding 918 emergency calls and approximately 2,700 hours of analyzable multi modal monitoring. Protocol adherence was high, with most rostered monitoring opportunities proceeding as planned and shifts meeting the predefined ≥75% biometric data completeness threshold despite approximately 5% of ECG data being removed as artifact. Hexoskin heart and respiratory rate patterns demonstrated expected gradients across CAD-defined call priorities and operational phases. They were consistent with prior laboratory validation, supporting the field validity of the protocol.

Conclusions: This protocol provides a replicable, EQUATOR‑aligned framework for multi‑modal paramedic exposure research that could be adapted to other emergency services. By foregrounding design, measurement, data processing, and analytic structure, it provides methodological infrastructure to support future etiologic and intervention studies.