An Eye on Operational Readiness in Paramedics: A Review of Wearable Technology

The link between fatigue and operational readiness is crucial within high stress (i.e., High Pressure/High Demand) professions, particularly in the field of paramedicine. Paramedics often work demanding rotational shifts that disrupt sleep-wake cycles, increasing psychophysiological fatigue and contributes to a fatigue debt accumulation, negatively impacting the ability to recover. Such fatigue, coupled with the high cognitive load inherent in some of their duties, significantly compromises operational readiness. Paramedics must rapidly process, prioritize, and interpret diverse stimuli, increasing cognitive demands, especially in high stress situations. These stimuli include rapidly changing occupant behaviours (patients, bystanders) and environmental conditions (hazardous locations, weather risks), as well as time pressures, all requiring simultaneous processing within finite cognitive resources. Additionally, frequent manual manoeuvres in confined spaces, such as homes and vehicles, can further challenge paramedics operational readiness. Effective and practical methods of monitoring fatigue is vital within paramedicine; however, traditional long-term subjective fatigue monitoring may create responder bias and lacks objective measures. The emergence of non-invasive wearable technology, measured in real-time such as heart rate variability (HRV), reflecting physiological demand and recovery; and technological advancements of eye-tracking devices, allowing assessment of cognitive demand via pupillary responses, provides precise analysis of autonomic nervous system dominance within paramedicine allowing for objective psychophysiological insight. The aim of this review is to (1) identify effective strategies for monitoring operational load among paramedics; and (2) present a conceptual model framework utilising novel integration of psychophysiological biometrics through wearable technology to assess and monitor physical and cognitive load in high-pressure occupations.