Work-Related Stress And Burnout Among Emergency Medical Technicians In The Saudi Red Crescent Authority: A Systematic Review Of Risk Factors And Mitigation Strategies

Abstract

Background:
Emergency Medical Technicians (EMTs) working in prehospital care are highly vulnerable to work-related stress and burnout due to high workloads, exposure to traumatic events, and irregular shifts. In Saudi Arabia, the Saudi Red Crescent Authority (SRCA) is the primary provider of emergency medical services, yet systematic evidence on the extent, risk factors, and mitigation strategies for EMT stress and burnout remains limited.

Objective:
This review aimed to systematically synthesize evidence on the prevalence, risk factors, and mitigation strategies for work-related stress and burnout among EMTs, with a focus on SRCA personnel in Saudi Arabia.

Methods:
A systematic search was conducted in PubMed, Scopus, Web of Science, and Google Scholar for studies published between 2010 and August 2025. The review followed PRISMA 2020 guidelines. Eligible studies included quantitative, qualitative, and mixed-methods research on stress, burnout, or related psychological outcomes among EMTs/paramedics in Saudi Arabia and comparable international EMS systems. Data extraction focused on prevalence, risk factors, and evaluated interventions. Quality appraisal was performed using the Newcastle–Ottawa Scale (NOS) and CASP checklist.

Results:
Out of 624 records screened, 24 studies were included (7 from Saudi Arabia; 17 international). Saudi studies consistently reported moderate-to-high prevalence of stress (≈30–40%), anxiety (up to 40%), and burnout. Identified risk factors included heavy mission loads, extended and irregular shifts, inadequate sleep, stimulant dependence, and repeated exposure to traumatic incidents. International evidence corroborated these findings and highlighted additional psychosocial predictors such as poor coping strategies and low resilience. Mitigation strategies with demonstrated benefits included fatigue risk management (e.g., shift restrictions, strategic napping), sleep health interventions, structured peer-support models, and resilience/mindfulness training. However, Saudi-specific interventions remain scarce.

Conclusions:
EMTs in SRCA face considerable stress and burnout risks, mirroring international trends but with unique cultural and operational stressors such as mass gatherings (Hajj/Umrah). Evidence supports organizational interventions (fatigue management, workload distribution), structured peer-support programs, and culturally adapted resilience training as priority strategies. Further longitudinal and interventional research is needed in Saudi contexts to evaluate the effectiveness of these approaches.