Associations of Health Care System Deficiency–Related Patient Deterioration With Burnout, Depressive Symptoms, and Sleep Problems Among Emergency Medical Service Providers: Cross-Sectional Study

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 health care 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 likelihood of depression, anxiety, and posttraumatic stress disorder. However, studies specifically examining the association between health care–related patient deterioration experiences caused by health care service disruptions and mental health outcomes among EMS providers remain limited. Objective This study evaluated the associations of patient deterioration due to health care service disruptions (hereafter referred to as health care–related patient deterioration experiences [HPDEs]) with burnout, depressive symptoms, and sleep problems among prehospital 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 3 mental health outcomes (personal burnout [PB], work-related burnout [WRB], and citizen-related burnout [CRB]), depressive symptoms, and sleep problems. χ 2 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 HPDEs, which were 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 HPDEs—a form of potentially morally injurious event resulting from emergency medical resource shortages—had significantly elevated odds of burnout, depressive symptoms, and sleep problems. These findings underscore the urgent need for systematic psychological interventions and regular mental health screenings, such as for moral injury, to mitigate adverse mental health outcomes during future health care service disruptions.