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

Abstract

IntroductionVery 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.MethodsWe 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.ResultsSurvey 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.ConclusionMedical 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.

Review article: Prevalence of burnout in paramedics: A systematic review of prevalence studies

“…Boland et al . reported a similarly low burnout prevalence of 18% in their study of BLS and ALS paramedics in the USA (response rate 54%; 190 participants) 8 . Theirs was the only study in those included to use the MBI for instrumentation.…”

“…The characteristics of the five included studies are illustrated in Table 1. Two were from the USA, 8,9 one each from Australia, 12 South Africa 11 and Israel 10 . There was heterogeneity in the instrumentation used to assess prevalence, with the Copenhagen Burnout Inventory (CBI) used in three studies, 9,11,12 and the General Burnout Measure (GBM) 10 and the Maslach Burnout Inventory (MBI) 8 in one each.…”

“…Two were from the USA, 8,9 one each from Australia, 12 South Africa 11 and Israel 10 . There was heterogeneity in the instrumentation used to assess prevalence, with the Copenhagen Burnout Inventory (CBI) used in three studies, 9,11,12 and the General Burnout Measure (GBM) 10 and the Maslach Burnout Inventory (MBI) 8 in one each. Response rates ranged between 8.3% and 88%, and samples included paramedics qualified to Advanced Life Support (ALS) 11 or a combination of both ALS and Basic Life Support (BLS) 8‐10,12 …”

“…The inter‐rater agreement between quality assessors was excellent (K = 0.91). One was deemed to have a low risk of overall bias, 10 three a moderate risk, and one a high risk 8 . All five studies were at high risk of bias with regard to non‐representative sampling.…”

“…5 While those working in any occupation may be susceptible to burnout, it has been found to be prevalent in acute healthcare settings such as emergency medicine, 6 nursing 7 and paramedicine. [8][9][10][11][12] The occupational environment in which paramedics work is conducive to stressors including but not limited to regular exposure to traumatic and emotionally taxing situations, 13 frequently changing, dynamic and uncontrolled environments, increasing rates of occupational violence, 14 physical fatigue and risk of injury, 15 irregular hours generally involving nightshifts, 16,17 unpredictable and frequently extended shift lengths, 18 infrequent rest breaks during shifts, and high workloads. 19 In addition, paramedics are susceptible to the more generic workplace stressors such as organisational culture and politics, and workplace conditions that are previously linked to burnout in other professions.…”