JMIR Publications

ABSTRACT

Background:

On February 6, 2024, the Korean government announced an increase in medical school enrollment quotas, triggering a nationwide strike by medical residents that precipitated a severe healthcare crisis. Prehospital emergency medical service (EMS) providers were forced to transport patients to distant hospitals, resulting in some patients experiencing symptom deterioration or death due to delayed critical care. Recent studies have examined moral injury —a mental health response to events that undermine moral values—among EMS providers, with exposure to potentially morally injurious events increasing the risk of depression, anxiety, and post-traumatic stress disorder. However, studies specifically examining the association between healthcare-related patient deterioration experiences caused by healthcare system deficiencies and mental health outcomes among EMS providers remain limited.

Objective:

This study evaluated the associations of patient deterioration due to healthcare system deficiencies (hereafter referred to as healthcare-related patient deterioration experience, HPDE) with burnout, depressive symptoms, and sleep problems among prehospital emergency medical service (EMS) providers during government–medical community disputes.

Methods:

We conducted a retrospective cross-sectional survey from November 1 to December 31, 2024, among EMS providers across South Korea using a web-based questionnaire. The independent variable was the presence or absence of HPDE, and the dependent variables were three mental health outcomes (personal burnout [PB], work-related burnout [WRB], and citizen-related burnout [CRB]), depressive symptoms, and sleep problems. Chi-square tests and multivariable logistic regression were used to assess associations and identify influencing factors after adjustment for potential confounders.

Results:

Of 845 participants, 75% (n=626) reported experiencing HPDE, which was associated with higher odds of PB, WRB, CRB, depressive symptoms, and sleep problems. Additionally, sex, age, educational attainment, and work region significantly influenced burnout, depressive symptoms, and sleep problems.

Conclusions:

During government–medical community disputes, EMS providers exposed to HPDE—a form of potentially morally injurious event resulting from emergency medical resource shortages—had significantly elevated risks of burnout, depressive symptoms, and sleep problems. These findings underscore the urgent need for fundamental solutions, such as real-time emergency resource information systems, to mitigate mental health risks in future resource-scarce crises.