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PLoS One. 2020 Mar 10;15(3):e0229954. doi: 10.1371/journal.pone.0229954. eCollection 2020.

First look at emergency medical technician wellness in India: Application of the Maslach Burnout Inventory in an unstudied population.

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Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC, United States of America.
Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA, United States of America.
College of Medicine, Medical University of South Carolina, Anderson, SC, United States of America.
University of San Diego, San Diego, CA, United States of America.
National Reference Simulation Centre, SGT University, Budhera, Gurugram Haryana, India.
GVK Emergency Management and Research Institute, Devar Yamzal, Secunderabad, Telangana, India.



Professional wellness is critical to developing and maintaining a health care workforce. Previous work has identified burnout as a significant challenge to professional wellness facing emergency medical technicians (EMTs) in many countries worldwide. Our study fills a critical gap by assessing the prevalence of burnout among emergency medical technicians (EMTs) in India.


This was a cross-sectional survey of EMTs within the largest prehospital care organization in India. We used the Maslach Burnout Inventory (MBI) to measure wellness. All EMTs presenting for continuing medical education between July-November 2017 from the states of Gujarat, Karnataka, and Telangana were eligible. Trained, independent staff administered anonymous MBI-Medical Personnel Surveys in local languages.


Of the 327 EMTs eligible, 314 (96%) consented to participate, and 296 (94%) surveys were scorable. The prevalence of burnout was 28.7%. Compared to EMTs in other countries, Indian EMTs had higher levels of personal accomplishment but also higher levels of emotional exhaustion and moderate levels of depersonalization. In multivariate regression, determinants of burnout included younger age, perceived lack of respect from colleagues and administrators, and a sense of physical risk. EMTs who experienced burnout were four times as likely to plan to quit their jobs within one year.


This is the first assessment of burnout in EMTs in India and adds to the limited body of literature among low- and middle-income country (LMIC) prehospital providers worldwide. Burnout was strongly associated with an EMT's intention to quit within a year, with potential implications for employee turnover and healthcare workforce shortages. Burnout should be a key focus of further study and possible intervention to achieve internationally recognized targets, including Sustainable Development Goal 3C and WHO's 2030 Milestone for Human Resources.

Conflict of interest statement

The authors have declared that no competing interests exist.

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