The link between fatigue and operational readiness is crucial within high-pressure (i.e., High Demand/High Stress) occupations, such as emergency responders, military, and elite athletes. Many high-pressure roles include disruptions to sleep-wake cycles, such as rotational shiftwork, domestic and international travel at irregular hours, contributing to a physiological fatigue debt accumulation, and negatively impacting recovery. Such fatigue, coupled with high cognitive demand, such as rapidly processing diverse stimuli with high-stakes decision making, increases the cognitive load in high-pressure situations. These rapidly changing stimuli include behaviours of others, environmental conditions (hazardous locations, weather risks), as well as time pressures, all requiring simultaneous processing within finite cognitive resources. Additionally, frequent neuromuscular loading, such as prolonged manual handling and intense physical manoeuvres, can further challenge operational readiness. Effective and practical methods of monitoring fatigue is vital within high-pressure occupations; 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, reflecting physiological demand and recovery; and technological advancements of wearable eye-tracking devices, allowing assessment of cognitive load via pupillary responses, provides precise analysis of autonomic nervous system dominance within high-pressure environments allowing objective psychophysiological insight. The review aims to (1) examine the use of wearable technology for monitoring and managing operational load in high-pressure occupations; and (2) present a conceptual model that utilizes novel integration psychophysiological biometrics through wearable technology, serving as a framework to assess and monitor physical and cognitive load in high-pressure occupations.