CoChat
Sign Up
Cited by 68Occupational Health and BurnoutHealthcare professionals’ stress and burnoutStress and Burnout Research

Burnout and Exposure to Critical Incidents in a Cohort of Emergency Medical Services Workers from Minnesota

Open access
Boland, Lori, Kinzy, Tyler, Myers, Russell, Fernstrom, Karl, Kamrud, Jonathan, Mink, Pamela, Stevens, Andrew·2018·Western Journal of Emergency Medicine
DOI 10.5811/westjem.8.39034PMC PMC6225931
Open this paper in CoChat — free accountOpen PDF

Abstract

INTRODUCTION: Very little quantitative data on occupational burnout and exposure to critical incidents are available from contemporary United States emergency medical services (EMS) cohorts. Given that burnout has been associated positively with turnover intentions and absenteeism in EMS workers, studies that uncover correlates of burnout may be integral to combating growing concerns around retention in the profession. METHODS: We administered a 167-item electronic survey that included the Maslach Burnout Inventory (MBI) and a modified version of the Critical Incident History Questionnaire (n=29 incident types) to paramedics, emergency medical technicians (EMTs), and dispatchers of a single ambulance service. We defined the presence of burnout as a high score on either the emotional exhaustion or depersonalization subscales of the MBI. RESULTS: Survey respondents who provided regular 911 response at the time of the survey and completed the MBI portion of the survey were included in our analysis (190 paramedics/EMTs, 19 dispatchers; 54% response). The overall prevalence of burnout was 18%, with prevalence reaching 32% among dispatchers. The seven pediatric critical incident types presented in the survey accounted for seven of the top eight rated most difficult to cope with, and severity ratings for pediatric critical incidents did not differ by parental status (all p>0.30). A significant number of respondents reported that they had been threatened with a gun/weapon (43%) or assaulted by a patient (68%) at least once while on duty. Being over the age of 50, a parent, or in a committed relationship was associated with reduced odds of burnout in unadjusted models; however, these associations did not remain statistically significant in multivariate analysis. Increasing tertile of career exposure to critical incidents was not associated with burnout. CONCLUSION: Medical dispatchers may be an EMS subgroup particularly susceptible to burnout. These data also demonstrate quantitatively that in this EMS agency, responders find pediatric critical incidents especially distressing and that violence against responders is commonplace. In this study, a simple measure of career exposure to potentially critical incidents was not associated with burnout; however, individual reactions to incidents are heterogeneous, and assessment tools that more accurately enumerate encounters that result in distress are needed.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.5811/westjem.8.39034

Cites

7 of 7 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Exposure to critical incidents is linked to an increased risk of mental health problems, notably PTSD and burnout, and this risk increases further with cumulative exposure to critical incidents.

    “Exposure to critical incidents is linked to an increased risk of mental health problems, notably PTSD and burnout, and this risk increases further with cumulative exposure to critical incidents (Alexander & Klein, 2001; Boland et al., 2018).”

    From Understanding the Occupational Factors that Influence Paramedic Health and Wellbeing (2024) · cites this paper as Boland et al., 2018

    The Introduction links critical-incident exposure to post-traumatic stress symptoms, but the Results found no significant association between increasing cumulative exposure and burnout. The Discussion explicitly says the study found no evidence of an independent association with burnout, contrary to the claim that burnout risk rises with cumulative exposure. (LLM, conf=0.88)

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 38

  1. [1]Graham NK Done in, fed up, burned out: too much attrition in EMS JEMS 1981 6 1 24 9 10295083
  2. [2]Boudreaux E Mandry C Sources of stress among emergency medical technicians (Part I): What does the research say? Prehosp Disaster Med 1996 11 4 296 301 10163612
  3. [3]Grisby DW McKnew MA Work-stress burnout among paramedics Psychol Rep 1988 63 1 55 64 3212140
  4. [4]Neale AV Work stress in emergency medical technicians J Occup Med 1991 33 9 991 7 1744749
  5. [5]Blau G Chapman S Retrospectively exploring the importance of items in the decision to leave the emergency medical services (EMS) profession and their relationships to life satisfaction after leaving EMS and likelihood of returning to EMS J Allied Health 2001 40 2 e29 32 21695362
  6. [7]Arora M Asha S Chinnappa J Review article: burnout in emergency medicine physicians Emerg Med Australas 2013 25 6 491 5 24118838
  7. [8]Bragard I Dupuis G Fleet R Quality of work life, burnout, and stress in emergency department physicians: a qualitative review Eur J Emerg Med 2015 22 4 227 34 25093897
  8. [9]Adriaenssens J De Gucht V Maes S Determinants and prevalence of burnout in emergency nurses: a systematic review of 25 years of research Int J Nurs Stud 2015 52 2 649 61 25468279
  9. [10]Leiter MP Harvie P Frizzell C The correspondence of patient satisfaction and nurse burnout Soc Sci Med 1998 47 10 1611 7 9823056
  10. [11]Crowe RP Bower JK Case RE Association of burnout with workforce-reducing factors among EMS professionals Prehosp Emerg Care 2018 22 2 229 236 28841102
  11. [12]Fragoso ZL Holcombe KJ McCluney CL Burnout and engagement: relative importance of predictors and outcomes in two health care worker samples Workplace Health Saf 2016 64 10 479 87 27282979
  12. [13]Weiss SJ Silady MF Roes B Effect of individual and work characteristics of EMTs on vital sign changes during shiftwork Am J Emerg Med 1996 14 7 640 4 8906760
  13. [14]Boudreaux E Mandry C Brantley PJ Stress, job satisfaction, coping, and psychological distress among emergency medical technicians Prehosp Disaster Med 1997 12 4 242 9 10179201
  14. [16]Gallagher S McGilloway S Experience of critical incident stress among ambulance service staff and relationship to psychological symptoms Int J Emerg Ment Health 2009 11 4 235 48 20524508
  15. [17]Sterud T Hem E Lau B A comparison of general and ambulance specific stressors: predictors of job satisfaction and health problems in a nationwide one-year follow-up study of Norwegian ambulance personnel J Occup Med Toxicol 2011 6 1 10 21450112 PMC3074526
  16. [18]Kashaba EO El-Sherif MAF Ibrahim AA Work-related psychosocial hazards among emergency medical responders (EMRs) in Mansoura City Indian J Community Med 2014 39 2 103 10 24963227 PMC4067921
  17. [19]Maslach C Jackson SE Leiter MP Maslach Burnout Inventory Manual 3rd Ed Palo Alo, CA Consulting Psychologists Press 1996
  18. [20]Patterson PD Jones CB Hubble MW The longitudinal study of turnover and the cost of turnover in emergency medical services Prehosp Emerg Care 2010 14 2 209 21 20199235 PMC2883888
  19. [21]Bennett P Williams Y Page N Associations between organizational and incident factors and emotional distress in emergency ambulance personnel Br J Clin Psychol 2005 44 Pt 2 215 26 16004656
  20. [23]Donnelly E Work-related stress and posttraumatic stress in emergency medical services Prehosp Emerg Care 2012 16 1 76 85 22128908
  21. [24]Schaufeli WB Van Dierendonck D A cautionary note about the cross-national and clinical validity of cut-off points for the Maslach Burnout Inventory Psychol Rep 1995 76 3 Pt 2 1083 90 7480470
  22. [25]Dyrbye LN Varkey P Boone SL Physician satisfaction and burnout at different career stages Mayo Clin Proc 2013 88 12 1358 67 24290109
  23. [26]Rafferty JP Lemkau JP Purdy RR Validity of the Maslach Burnout Inventory for family practice physicians J Clin Psychol 1986 42 3 488 92 3711351
  24. [27]Schaufeli WB Bakker AB Hoogduin K On the clinical validity of the Maslach Burnout Inventory and the burnout measure Psychol Health 2001 16 5 565 82 22804499
  25. [29]Dyrbye LN West CP Shanafelt TD Defining burnout as a dichotomous variable J Gen Intern Med 2009 24 3 440 19130150 PMC2642563
  26. [30]Weiss DS Brunet A Best SR Frequency and severity approaches to indexing exposure to trauma: the Critical Incident History Questionnaire for police officers J Trauma Stress 2010 23 6 734 43 21171134 PMC3974917
  27. [32]Halpern J Maunder RG Schwartz B The critical incident inventory: characteristics of incidents which affect emergency medical technicians and paramedics BMC Emerg Med 2012 12 10 22862821 PMC3549754
  28. [33]Shanafelt TD Boone S Tan L Burnout and satisfaction with work-life balance among US physicians relative to the general US population Arch Intern Med 2012 172 18 1377 85 22911330
  29. [34]Spinelli WM Fernstrom KM Galos DL Extending our understanding of burnout and Its associated factors: providers and staff in primary care clinics Eval Health Prof 2016 39 3 282 98 27000131
  30. [36]Clohessy S Elhers A PTSD symptoms, response to intrusive memories and coping in ambulance service workers Br J Clin Psychol 1999 38 Pt 3 251 65 10532147
  31. [37]Declercq F Meganck R Deheegher J Frequency of and subjective response to critical incidents in the prediction of PTSD in emergency personnel J Trauma Stress 2011 24 133 6 21351174
  32. [38]Mishra S Goebert D Char E Trauma exposure and symptoms of post-traumatic stress disorder in emergency medical services personnel in Hawaii Emerg Med J 2010 27 9 708 11 20466825
  33. [39]Pierce H Lilly MM Duty-related trauma exposure in 911 telecommunicators: considering the risk for posttraumatic stress J Trauma Stress 2012 25 2 211 5 22467384
  34. [40]Regehr C Goldberg G Hughes J Exposure to human tragedy, empathy, and trauma in ambulance paramedics Am J Orthopsychiatry 2002 72 4 505 13 15792036
  35. [41]Grevin F Posttraumatic stress disorder, ego defense mechanisms, and empathy among urban paramedics Psychol Rep 1996 79 483 95 8909073
  36. [43]Myers RN Kleinsasser A EMS chaplains provide spiritual support for providers and staff JEMS 2013 38 9 58 91 24404692
  37. [45]McFarlane AC Williamson P Barton CA The impact of traumatic stressors in civilian occupational settings J Public Health Policy 2009 30 3 311 27 19806072
  38. [47]Drewitz-Chesney C Posttraumatic stress disorder among paramedics: exploring a new solution with occupational health nurses using the Ottawa Charter as a framework Workplace Health Saf 2012 60 6 257 63 22624848

Cited by

Sorted by citations

Authors
Boland, L., Kinzy, T., Myers, R., Fernstrom, K., Kamrud, J., Mink, P., & Stevens, A.
Affiliations
Allina Health (US)
Corresponding author
Boland, Lori
ORCID
Venue
Western Journal of Emergency Medicine
Publisher
California Digital Library (CDL)
Published
2018-09-19
Volume
19
Issue
6
Pages
987-995
ISSN
1936-900X (ISSN-L)
DOI
10.5811/westjem.8.39034
PMC
PMC6225931
OpenAlex
W2891857834
Cited by
68
References
7
Citations by year
2026: 11 · 2025: 8 · 2024: 11 · 2023: 10 · 2022: 9 · 2021: 10 · 2020: 7 · 2019: 2
FWCI
12.04
Type
journal article
Language
en
Open access
Licence
Locations
  • Western Journal of Emergency Medicine (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • eScholarship (California Digital Library) (submittedVersion, cc-by-nc)
Topics
  • Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Burnout
  • Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
  • Social Sciences › Psychology › Social Psychology › Stress and Burnout Research
Keywords
occupational burnout, emergency medical personnel, paramedics, emergency medical technicians, critical incidents, emotional exhaustion, depersonalization, patient assault, employee retention, Maslach Burnout Inventory
MeSH terms
Emergency Medical Dispatcher, Adolescent, Adult, Burnout, Professional, Cross-Sectional Studies, Emergency Medical Services, Emergency Medical Technicians, Female, Humans, Male, Middle Aged, Minnesota, Surveys and Questionnaires, Cohort Studies, Logistic Models, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review