Burnout Links Job Engagement to Job Satisfaction: Moderating Effects of Demographics in Emergency Medical Technicians

Abstract

Introduction

Prehospital emergency medical services play a critical role in caring for patients with urgent medical needs. However, the time-pressured and unpredictable nature of this work places substantial stress on emergency medical technicians (EMTs). Over time, such stress may lead to job dissatisfaction and turnover intentions, ultimately undermining the quality of prehospital emergency care and adversely affecting both patient outcomes and EMTs’ physical and psychological well-being. Accordingly, this study aimed to: (1) examine the effects of job engagement on burnout among EMTs; (2) analyze the effects of burnout on EMTs’ job satisfaction; and (3) investigate whether the effects of burnout on job satisfaction differs by age, gender, education, marital status, EMT certification level, and work experience.

Methods

In this cross-sectional study, convenience sampling was used to collect data from 300 EMTs, which were analyzed using partial least squares structural equation modeling.

Results

The results reveal that job engagement has significant negative effects on emotional exhaustion and depersonalization, and a significant positive effect on personal accomplishment. Emotional exhaustion and personal accomplishment, in turn, have significant negative and positive effects on job satisfaction, respectively, whereas depersonalization has no significant effect on job satisfaction. Gender and EMT certification level were demonstrated to moderate the effect of emotional exhaustion on job satisfaction.

Conclusion

Based on these findings, health authorities should closely monitor EMTs’ workload, particularly among male EMTs and those holding advanced EMT certification. Fostering a sense of accomplishment derived from emergency medical work may help mitigate burnout and sustain prehospital emergency care capacity.

Introduction

Background

Prehospital emergency medical services are a critical component of healthcare systems and play an essential role in caring for patients with urgent medical needs. ¹ However, the nature of prehospital emergency care is characterized by high information demands, time pressure, unpredictability, and the constant need to sustain patients’ lives, all of which place substantial stress on emergency medical technicians (EMTs).^2,3 Prior research has shown that prolonged occupational stress among EMTs is associated with various adverse outcomes, including job burnout, job dissatisfaction, and increased turnover intention.^2,4,5 Among these outcomes, job burnout is particularly consequential, as it has been linked to absenteeism, intention to leave, actual turnover, and heightened psychological distress. ⁶ Job burnout can be understood as a work-related psychological syndrome characterized by emotional exhaustion, cynicism, and reduced personal accomplishment,^6,7 and is increasingly understood as part of a broader spectrum of occupational stress responses in high-intensity settings. ⁸ Given the central role of EMTs within the emergency medical system, inadequate understanding and management of their job burnout and job satisfaction may not only compromise individual well-being and workforce retention but also indirectly undermine the overall quality of prehospital emergency care. Accordingly, an in-depth examination of job burnout among EMTs and its relationship with job satisfaction carries important practical and policy implications.

Emergency Medical Technicians’ Job Pressure and Burnout

Existing research consistently indicates that EMTs are chronically exposed to high-pressure and traumatic situations, making them particularly vulnerable to occupational stress, job fatigue, reduced job satisfaction, and mental health problems. Individual characteristics, organizational and operational stressors, and maladaptive coping strategies may further exacerbate burnout, post-traumatic symptoms, and diminished personal accomplishment. For example, Witczak-Błoszyk et al ⁹ reported that Polish EMTs may experience occupational burnout when responding to suicide cases, and that the coping strategies adopted in such situations were often suboptimal. Boudreaux et al ⁴ studied the relationship between stress and job satisfaction among EMTs and found that higher stress levels were associated with lower job satisfaction. Donnelly ² further demonstrated that chronic organizational and operational stressors, exposure to extreme critical incidents, and alcohol use were significantly associated with post-traumatic stress symptoms among EMTs. Similarly, Tanabe et al ⁵ reported that when EMTs are required to initiate resuscitation for prehospital cardiac arrest patients who have previously opted for end-of-life care, approximately 30% experience substantial psychological distress.

In addition to work-related stressors, individual personality traits have also been frequently associated with EMTs’ stress and burnout. Bahadori et al ¹⁰ examined the relationships between the Big Five personality traits, job stress, and occupational fatigue among EMTs. Their regression analyses showed that neuroticism was positively related to job stress, whereas agreeableness was negatively linked with job stress. Moreover, neuroticism, extraversion, and conscientiousness were negatively related to occupational burnout. Furthermore, Sahebi et al ¹¹ conducted a meta-analysis of studies using the Maslach Burnout Inventory ⁶ among EMTs and found that Iranian EMTs exhibited moderate levels of depersonalization and high levels of reduced personal accomplishment.

Maslach Burnout Inventory

The Maslach Burnout Inventory™ (MBI), proposed by Maslach et al, ⁶ is widely recognized as one of the most commonly used instruments for assessing burnout. The MBI consists of 22 items designed to assess job-related psychological strain and work-related attitudes among human service professionals, with responses recorded on a seven-point Likert scale. It conceptualizes burnout through three dimensions: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Emotional exhaustion refers to a state in which individuals feel emotionally drained and fatigued as a result of their work ¹² and is measured by nine items. Depersonalization captures an impersonal or detached response toward the recipients of one’s services ¹² and is measured by eight items. Personal accomplishment reflects individuals’ perceptions of competence and successful achievement in their work with others ¹² and is assessed using eight items. Higher levels of EE and DP combined with lower levels of PA indicate a higher degree of burnout. ⁶

Despite the extensive use of the MBI in burnout research, findings across studies have not been entirely consistent. ⁶ Regarding the determinants of job burnout, Maslach et al ⁶ suggested that, at the individual level, demographic characteristics, personality traits, and job-related attitudes may all play a role. Demographic factors commonly examined include age, years of work experience, gender, marital status, and level of education. However, the effects of these demographic variables on burnout remain inconclusive. For instance, some studies have reported higher burnout levels among men, whereas others have found higher levels among women, indicating that the influence of demographic characteristics on burnout remains unclear and warrants further research. Moreover, job-related attitudes have also been identified as potential contributors to burnout. ¹³ Maslach et al ⁶ further noted that empirical findings concerning job attitudes and burnout are among the most inconsistent in the literature, highlighting a clear research gap that warrants further investigation.

Research Purposes

Addressing the above research gaps, this study integrates perspectives on the antecedents and outcomes of burnout, focusing on the effects among EMTs’ job attitudes, burnout, and job satisfaction. Specifically, two job attitudes, namely job engagement and job satisfaction, are conceptualized as the antecedent and consequence of burnout, respectively, to clarify the inconsistent effects between job attitudes and burnout. Job engagement describes an employee’s energetic and engaged psychological connection to their work, reflected in enthusiasm, commitment, and deep immersion in job tasks. ¹⁴ Job satisfaction refers to an individual’s overall affective evaluation of their job, arising from how they perceive and interpret their work-related experiences. ¹⁵ In addition, this study examines demographic characteristics (age, gender, work experience, EMT certification level, marital status, and educational attainment) as moderators of the effects of burnout on job satisfaction, thereby clarifying the inconsistent findings regarding the role of demographic factors in burnout-related outcomes.

The main objectives of this study are to: (1) investigate the effects of job engagement on EMTs’ burnout; (2) analyze the effects of burnout on EMTs’ job satisfaction; and (3) investigate whether the effect of burnout on job satisfaction differs by age, gender, education, marital status, EMT certification level, and work experience.

Research Framework and Hypothesis

Based on the research objectives, this study proposes the research framework illustrated in Figure 1 and the corresponding hypotheses.

Figure 1.

Research-framework

The Effect of Job Engagement on Burnout

The review of Adanaqué-Bravo et al ¹⁶ indicated that job engagement is significantly and negatively associated with burnout during the COVID-19 pandemic. Previous research indicates that job engagement is closely connected with the three subdimensions of burnout, namely emotional exhaustion, depersonalization, and personal accomplishment. For instance, Tan and Yeap ¹⁷ reported that higher levels of job engagement were associated with lower emotional exhaustion and depersonalization among social workers, as well as better personal accomplishment. Drawing on these findings, this study proposes the following hypotheses:

H1

EMTs’ job engagement has a negative effect on emotional exhaustion.

H2

EMTs’ job engagement has a negative effect on depersonalization.

H3

EMTs’ job engagement has a positive effect on personal accomplishment.

The Effect of Burnout on Job Satisfaction

The meta-analysis by Madigan and Kim ¹⁸ demonstrated that emotional exhaustion, depersonalization, and reduced personal accomplishment are negatively associated with job satisfaction. Other studies have likewise shown that the three subdimensions of burnout, namely emotional exhaustion, depersonalization, and personal accomplishment, are differentially related to individuals’ job satisfaction across various industries, with emotional exhaustion and depersonalization showing negative effects and personal accomplishment showing a positive effect. For example, Parray et al ¹⁹ reported that emotional exhaustion negatively affects job satisfaction among employees in the higher education sector. Similarly, Zafrul et al ²⁰ found that emotional exhaustion negatively influences job satisfaction among bank employees, a finding also supported by Park and Kim ²¹ in their study of hotel front desk employees. With regard to depersonalization, Tarcan et al ²² reported a negative effect on intrinsic job satisfaction among emergency health service professionals, and Zafrul et al ²⁰ likewise demonstrated a negative effect of depersonalization on job satisfaction among bank employees. In contrast, Zafrul et al ²⁰ further confirmed that personal accomplishment is positively associated with job satisfaction among bank employees. Drawing on the prior findings, this study proposes the following hypotheses:

H4

EMTs’ emotional exhaustion has a negative effect on job satisfaction.

H5

EMTs’ depersonalization has a negative effect on job satisfaction.

H6

EMTs’ personal accomplishment has a positive effect on job satisfaction.

The Moderating Effects of Demographics on the Effect of Burnout on Job Satisfaction

Given the inconsistent findings in the existing literature regarding the relationships between demographic variables and burnout, ⁶ prior methodological work ²³ suggests that these inconsistencies may be clarified by examining moderating effects. Accordingly, this study proposes the following hypotheses:

H7

At least one EMT demographic characteristic (age, gender, education level, marital status, EMT certification level, and work experience) moderates the effects of emotional exhaustion, depersonalization, and personal accomplishment on job satisfaction.

H7a

At least one EMT demographic characteristic moderates the effect of emotional exhaustion on job satisfaction.

H7b

At least one EMT demographic characteristic moderates the effect of depersonalization on job satisfaction.

H7c

At least one EMT demographic characteristic moderates the effect of personal accomplishment on job satisfaction.

The primary contribution of this study lies in identifying the antecedents and consequences of burnout in terms of directional effects. In addition, by employing moderation analyses, this study clarifies the inconsistent moderating effects of demographic variables on the effects of burnout on job satisfaction reported in prior research. The findings may provide healthcare administrative authorities with empirical evidence to develop targeted intervention strategies aimed at alleviating burnout and improving job satisfaction among EMTs.

Methods

This study adopted a cross-sectional survey design to examine the effects among job burnout, job engagement, and related factors among EMTs, following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. ²⁴

Measurement Development

This study employed previously validated questionnaires,^6,14,15 which were adapted to fit the research context. Emotional exhaustion, depersonalization, and personal accomplishment were assessed with 9, 5, and 8 items, respectively, based on the Maslach Burnout Inventory™–Human Services Survey (MBI-HSS) developed by Maslach et al, ⁶ which has been widely validated in healthcare populations. Job engagement was measured with an 8-item scale adapted from Houle et al, ¹⁴ while job satisfaction was rated using a 4-item scale adapted from Chong and Monroe, ¹⁵ both of which have demonstrated acceptable validity and reliability in prior studies. All items for the Maslach Burnout Inventory, job engagement, and job satisfaction were rated on a Likert-type 7-point scale. The questionnaire was reviewed and revised based on feedback from two emergency physicians responsible for EMT training and one expert with extensive experience in the EMT field. Due to copyright restrictions, the specific items of the Maslach Burnout Inventory cannot be publicly disclosed. The items used to measure job engagement and job satisfaction are provided in Appendix A.

Sampling and Data Collection

As of 2024, there are approximately 30,832 EMTs in Taiwan. ²⁵ Given the distribution of EMTs across counties and cities based on population size, and considering that EMTs work on a 24-hour shift system, conducting a comprehensive survey of all EMTs nationwide is impractical. Therefore, this cross-sectional study focused on EMTs from two southern Taiwanese cities, Kaohsiung and Pingtung. Eligible participants were certified EMTs actively employed in prehospital emergency medical services and attending annual continuing education training during the study period.

Inclusion criteria were as follows: (1) certified EMTs; (2) actively employed in prehospital emergency medical services; and (3) attendance at annual continuing education training during the study period.

Exclusion criteria included: (1) individuals who were not certified EMTs; (2) EMTs not currently engaged in active duty; and (3) those who declined to participate in the study.

According to regulations, EMTs are required to participate in annual continuing education and training. Using a convenience sampling approach, EMTs were invited to participate in the study upon completion of their annual training courses. Those who agreed to participate completed an online questionnaire, which took approximately 5 minutes to complete. Data collection was conducted between October 1, 2024, and January 30, 2025, resulting in 300 completed questionnaires, all of which were valid. Ethical approval for this study was obtained from the Institutional Review Board of E-Da Hospital (IRB No. EMRP-112-092).

Statistical Analysis

In addition to using descriptive statistics to profile the respondents, this study employed partial least squares structural equation modeling (PLS-SEM) to evaluate reliability and validity and to test the proposed hypotheses. Following SEM guidelines that consider model complexity and measurement characteristics, a minimum sample size of 150 is considered appropriate for models containing seven or fewer constructs. ²⁶ A parallel mediation analysis ²⁷ was used to assess the mediating effects of emotional exhaustion, depersonalization, and personal accomplishment in the effect of job engagement on job satisfaction. Furthermore, multi-group analysis was performed to investigate the moderating effects of demographic variables. ²⁸ No missing data were observed, as all submitted questionnaires were complete and included in the analysis.

Results

Descriptive Statistics

Among the 300 EMTs surveyed, the majority were male (84.67%). Most respondents had a university degree or higher (71.00%), and nearly 60% were married (59.00%). In terms of certification level, Intermediate EMTs constituted the largest group (50.00%), followed closely by Advanced EMTs (48.67%). The mean age of the respondents was 35.91 years (SD = 6.92), and the average EMT work experience was 11.44 years (SD = 7.02). Detailed descriptive statistics are presented in Table 1.

Table 1.

Characteristics of Respondents (N = 300)

Variable	Category	n	%	Mean (SD)
Gender	Female	46	15.33	—
	Male	254	84.67	—
Education	Senior high school	7	2.33	—
	College	80	26.67	—
	University or above	213	71.00	—
Marital status	Married	177	59.00	—
	Not married	115	38.33	—
	Divorced	8	2.67	—
EMT certification level	Basic	4	1.33	—
	Intermediate	150	50.00	—
	Advanced	146	48.67	—
Age (years)	—	—	—	35.91 (6.92)
Experience (years)	—	—	—	11.44 (7.02)

Notes. 1. Values for continuous variables are presented as mean (SD). 2. EMT means emergency medical technician and SD means standard deviation.

Measurement Model

The measurement model was first evaluated. As shown in Table 2, all item loadings for the five constructs exceeded the recommended threshold of 0.707. In addition, both Cronbach’s α and composite reliability values were above the suggested cutoff of 0.70²⁹, indicating adequate internal consistency reliability. The average variance extracted (AVE) values for all five constructs were higher than 0.50, demonstrating sufficient convergent validity. Moreover, the square roots of the AVE for each construct were higher than the corresponding inter-construct correlations. ²⁹ As further evidence of discriminant validity, Appendix B shows that all heterotrait–monotrait (HTMT) ratios of correlations were below the recommended threshold of 0.90³⁰. It should be noted that the HTMT values reported in Appendix B differ from the correlation coefficients presented in Table 2, as HTMT represents a ratio of between-construct correlations to within-construct correlations rather than a simple correlation coefficient. ³⁰ Consequently, the two sets of values are not directly comparable. Collectively, these results indicate that all constructs in this study exhibit adequate discriminant validity.

Table 2.

Reliability and Validity

​	Loadings	M	SD	Cronbach’s α	CR	AVE	Correlation among constructs
							JE	EE	DP	PA	JS
JE	0.84-0.89	4.92	1.22	0.89	0.92	0.75	0.86	​	​	​	​
EE	0.78-0.91	4.17	1.40	0.93	0.94	0.70	-0.39*	0.83	​	​	​
DP	0.83-0.92	3.57	1.57	0.89	0.92	0.75	-0.42*	0.57*	0.87	​	​
PA	0.75-0.85	4.33	1.22	0.80	0.87	0.63	0.69*	-0.49*	-0.51*	0.79	​
JS	0.81-0.92	4.27	1.42	0.93	0.95	0.78	0.78*	-0.58*	-0.51*	0.78*	0.88

Notes. 1. JE = job engagement, EE = emotional exhaustion, DP = depersonalization, PA = personal accomplishment, JS = job satisfaction, M = mean, SD = standard deviation, CR = Cronbach’s alpha, and AVE = average variance extraction. The bolded diagonal values represent the square root of the AVE. 2. * p < 0.001.

Structural Model

This study subsequently conducted structural model analysis to test the proposed hypotheses. Because demographic variables were examined separately for their moderating effects, they were not included as control variables in the structural model.

As shown in Table 3, job engagement exerted significant negative effects on emotional exhaustion (β = −0.31, p < 0.001) and depersonalization (β = −0.38, p < 0.001), supporting H1 and H2. In addition, job engagement had a significant positive effect on personal accomplishment (β = 0.52, p < 0.001), supporting H3.

Table 3.

Hypothesis Testing Results

Hypothesis	Path	β	SE	t value	p value	R 2
H1	JE→EE	-0.31	0.06	-5.56	p < 0.001	9.52%
H2	JE→DP	-0.38	0.05	-7.04	p < 0.001	14.45%
H3	JE→PA	0.52	0.05	10.58	p < 0.001	27.37%
H4	EE→JS	-0.19	0.06	-3.24	p = 0.001	​
H5	DP→JS	-0.07	0.05	-1.36	p = 0.173	56.45%
H6	PA→JS	0.58	0.06	10.37	p < 0.001	​

Note: JE = job engagement, EE = emotional exhaustion, DP = depersonalization, PA = personal accomplishment, JS = job satisfaction, and SE = standard error, β = path coefficient, R ² = coefficient of determination.

Emotional exhaustion had a significant negative effect on job satisfaction (β = −0.19, p = 0.001), supporting H4. Depersonalization had a negative but non-significant effect on job satisfaction (β = −0.07, p = 0.173); therefore, H5 was not supported. Personal accomplishment had a significant positive effect on job satisfaction (β = 0.58, p < 0.001), supporting H6.

Regarding explanatory power, job engagement accounted for 9.52%, 14.45%, and 27.37% of the variance in emotional exhaustion, depersonalization, and personal accomplishment, respectively. Together, emotional exhaustion, depersonalization, and personal accomplishment explained 56.45% of the variance in job satisfaction.

Additional Analysis: Mediation Effects

This study further examined the parallel mediating effects of emotional exhaustion, depersonalization, and personal accomplishment in the effect of job engagement on job satisfaction. A parallel mediation analysis was conducted using Model 4 proposed by Hayes, ²⁷ as presented in Appendix C. The results indicated that job engagement had a positive and significant direct effect on job satisfaction (β = 0.864, p < 0.001).

Regarding indirect effects, job engagement exerted a significant indirect effect on job satisfaction through emotional exhaustion (β = 0.025, p = 0.005). In contrast, the indirect effect via depersonalization was not significant (β = −0.003, p= 0.733). Additionally, job engagement had a significant indirect effect on job satisfaction through personal accomplishment (β = 0.062, p < 0.001). The total indirect effect was significant (β = 0.084, p < 0.001), indicating partial mediation, as both the direct effect of job engagement on job satisfaction and the total indirect effect were statistically significant.

Moderating Effect

To test Hypothesis 7, a multi-group analysis was conducted following the procedure proposed by Sarstedt et al ²⁸ According to this approach, if the path estimate of one group falls outside the confidence interval of the corresponding path estimate of another group—and vice versa—the difference between the path coefficients is considered statistically significant at the α level. ²⁸ Based on this rationale, the results shown in Appendix D indicate that only gender and marital status exhibited moderating effects, whereas the remaining demographic variables did not.

More specifically, the negative effect of emotional exhaustion on job satisfaction was significantly stronger for male EMTs (-0.21) than for female EMTs (0.05). However, no significant gender differences were observed in the effects of personal accomplishment on job satisfaction or depersonalization on job satisfaction. In addition, EMTs holding an Advanced EMT license showed a significantly stronger effect (-0.28) of emotional exhaustion on job satisfaction than those without an Advanced EMT license (-0.07). In contrast, EMT certification level did not significantly moderate the effects of personal accomplishment on job satisfaction or depersonalization on job satisfaction (see Appendix D). Based on the results of the multi-group analysis, only H7a was supported, whereas H7b and H7c were not supported.

Discussion

Based on the PLS-SEM results, this study found that EMTs’ job engagement significantly reduces emotional exhaustion and depersonalization, while significantly increasing personal accomplishment. Høigaard et al ¹³ conceptualized work engagement as comprising vigor (high energy and a strong willingness to invest effort in work), dedication (a sense of meaning, enthusiasm, pride, and inspiration toward one’s job), and absorption (a state of deep concentration and full involvement in work activity). Their findings indicated that vigor and dedication are negatively and significantly associated with burnout, whereas absorption is positively associated with burnout.

Consistent with and extending prior research, the present study shows that job engagement has a significant negative effect on emotional exhaustion, suggesting that EMTs who are more psychologically involved in their work are less likely to experience emotional depletion. In addition, job engagement has a significant negative effect on depersonalization, indicating that higher levels of engagement are linked to lower tendencies toward emotional detachment and cynical attitudes toward work. Finally, job engagement has a significant positive effect on personal accomplishment, implying that EMTs with higher job engagement are more likely to experience feelings of competence, accomplishment, and effectiveness in their work.

Taken together, these findings suggest that enhancing EMTs’ job engagement may help alleviate burnout by reducing emotional exhaustion and depersonalization while simultaneously strengthening personal accomplishment.

Chong and Monroe ¹⁵ demonstrated that emotional exhaustion significantly and negatively affects job satisfaction among junior accountants. Using a sample of EMTs, the present study similarly found that emotional exhaustion has a significant negative effect on job satisfaction, signifying that higher levels of emotional exhaustion are associated with lower job satisfaction among EMTs.

Contrary to the proposed hypothesis and prior empirical findings, this study did not find a significant effect of depersonalization on EMTs’ job satisfaction. This suggests that emotional detachment or cynical attitudes toward work may not directly translate into lower job satisfaction in this sample. One possible explanation is that job satisfaction represents an overall, multidimensional evaluation that incorporates both affective and cognitive components, rather than being determined by a single burnout dimension such as depersonalization. ³¹ In contrast, depersonalization captures a more specific, interpersonal and coping-oriented response to work stress. ⁶ These findings may indicate that depersonalization does not influence EMTs’ job satisfaction primarily through affective pathways.

Chong and Monroe, ¹⁵ in their examination of burnout among junior accountants, found that diminished personal accomplishment was significantly and negatively associated with job satisfaction. Consistent with these findings, the present study shows that EMTs’ personal accomplishment has a significant positive effect on job satisfaction, indicating that EMTs who perceive themselves as competent, effective, and successful in their work tend to report higher levels of job satisfaction.

The mediation results provide important practical insights. Specifically, job engagement enhances job satisfaction primarily through reducing emotional exhaustion and increasing personal accomplishment, rather than through depersonalization. This suggests that interventions aimed at improving EMTs’ job satisfaction should prioritize strategies that alleviate work-related fatigue and strengthen feelings of competence and achievement.

Based on the above results, emotional exhaustion and personal accomplishment among the burnout dimensions emerge as the primary predictors of job satisfaction, whereas depersonalization does not appear to be a significant predictor of job satisfaction. These findings highlight the importance of both reducing energy depletion and fostering feelings of accomplishment in order to enhance EMTs’ job satisfaction.

Furthermore, the multi-group analysis revealed that only gender and EMT certification level moderate the effect of emotional exhaustion on job satisfaction. Specifically, male EMTs may be more likely to experience a direct translation of emotional exhaustion into reduced job satisfaction, possibly reflecting the traditional social roles and expectations placed on men. In addition, because advanced EMTs bear greater clinical responsibilities, emotional exhaustion exerts a substantially stronger negative effect on job satisfaction among advanced EMTs.

Implications

Several important implications can be derived from these findings. First, the significant effects of job engagement on emotional exhaustion, depersonalization, and personal accomplishment suggest that EMTs who perceive their work as meaningful and engaging may be better equipped to cope with job-related stressors, thereby reducing the likelihood of emotional depletion. Moreover, meaningful engagement may counteract depersonalization by fostering a stronger sense of connection to and identification with one’s work. Finally, higher levels of job engagement may activate motivational processes that promote personal growth and reinforce positive self-evaluations in the workplace.

Second, the significant effects of emotional exhaustion and personal accomplishment on EMTs’ job satisfaction indicate that EMTs who feel emotionally drained are less likely to experience positive affect or fulfillment at work, resulting in lower job satisfaction. Conversely, enhancing EMTs’ sense of accomplishment may represent a key pathway for improving job satisfaction.

Third, the significant moderating effects of gender and EMT certification level suggest that interventions aimed at improving the relationship between burnout and job satisfaction should take gender differences into account, with particular attention to emotional exhaustion among male EMTs. Furthermore, retention and well-being strategies should prioritize advanced EMTs as a high-risk group, as emotional exhaustion has a particularly strong negative impact on job satisfaction among advanced EMTs.

Limitations of This Study

The primary limitation of this study lies in the scope of the sample, which restricts the generalizability of the findings. Nevertheless, the results can be compared with findings from studies conducted in other regions. Future research may extend this work by conducting cross-regional or cross-national comparisons to gain a more comprehensive understanding of the antecedents and consequences of burnout among EMTs. Because convenience sampling was used, selection bias cannot be ruled out. EMTs who attended training and agreed to participate may differ systematically from those who did not, potentially affecting representativeness.

Conclusion

EMTs serve on the front lines of emergency medical care and bear substantial occupational stress, making them particularly vulnerable to burnout. How to alleviate burnout without compromising frontline emergency response capacity has therefore become a critical concern in both academic and practical domains. This study investigated the antecedents and consequences of EMTs’ burnout using data collected from 300 respondents. The results indicate that job engagement significantly influences all three burnout subdimensions—emotional exhaustion, depersonalization, and personal accomplishment. However, only emotional exhaustion and personal accomplishment were found to significantly influence EMTs’ job satisfaction. Moreover, gender and EMT certification level were found to moderate the relationship between emotional exhaustion and job satisfaction.

Based on these findings, healthcare authorities should pay close attention to EMTs’ workload, particularly among male EMTs and those holding advanced EMT certification. In addition, fostering a sense of accomplishment derived from emergency medical work may be an effective strategy for mitigating the negative effects of burnout and sustaining frontline emergency medical capacity.

Appendices.

Appendix A. Questionnaire

Constructs	Items	Source
Job engagement	I exert my full effort to my job (Scale: 1-Strongly disagree to 7: Strongly agree)	Houle et al. 13
	I try my hardest to perform well on my job (Scale: 1-Strongly disagree to 7: Strongly agree)
	I am enthusiastic about my job (Scale: 1-Strongly disagree to 7: Strongly agree)
	I am interested in my job (Scale: 1-Strongly disagree to 7: Strongly agree)
	I am excited about my job (Scale: 1-Strongly disagree to 7: Strongly agree)
	At work, I focus a great deal of attention on my job (Scale: 1-Strongly disagree to 7: Strongly agree)
	At work, I am absorbed by my job (Scale: 1-Strongly disagree to 7: Strongly agree)
	At work, I concentrate on my job (Scale: 1-Strongly disagree to 7: Strongly agree)
Job satisfaction	How much time do you feel satisfied with your job (Scaled: 1-never to 7-all the time)	Chong and Monroe 14
	One of the statements best tells how well you like your job? (Scaled: 1: I hate it to 7-I love it)
	One of the statements best tells how you feel about changing your job? (Scale: 1-I would quit this job at once if I could to 7-I would not exchange my job for any other)
	One of the statements shows how you think you compare with other people? (Scale: 1: No one dislikes his/her job more than I dislike mine to 7-No one likes his job better than I like mine)

Appendix B. Heterotrait-Monotrait Ratio of Correlations

​	JE	EE	DP	PA
EE	0.33(0.22, 0.43)	​	​	​
DP	0.42(0.32, 0.52)	0.62(0.51, 0.70)	​	​
PA	0.61(0.51, 0.69)	0.69(0.61, 0.76)	0.62(0.56, 0.70)	​
JS	0.75(0.64, 0.82)	0.63(0.54, 0.71)	0.55(0.45, 0.63)	0.87(0.80, 0.92)

Notes: 1. JE = job engagement, EE = emotional exhaustion, DP = depersonalization, PA = personal accomplishment, and JS = job satisfaction. 2. Values represent HTMT ratios. Numbers in parentheses indicate 95% confidence intervals. Discriminant validity is established when the confidence interval does not include 1.

Appendix C. Direct and Indirect Effects from the Parallel Mediation Analysis

Path	Effect type	β	SE	z	p	95% CI
JE→JS	Direct	0.864	0.028	30.408	< 0.001	(0.809, 0.920)
JE→EE→JS	Indirect	0.025	0.009	2.816	0.005	(0.008, 0.042)
JE→DP→JS	Indirect	−0.003	0.008	−0.341	0.733	(−0.018, 0.013)
JE→PA→JS	Indirect	0.062	0.015	4.069	< 0.001	(0.032, 0.092)
JE→EE/DP/PA→JS	Total indirect	0.084	0.019	4.348	< 0.001	(0.046, 0.122)

Notes: 1. JE = job engagement, EE = emotional exhaustion, DP = depersonalization, PA = personal accomplishment, JS = job satisfaction, and SE = standard error, β = path coefficient, and CI = confidence interval. 2. Indirect effects represent specific indirect effects from the parallel mediation model. Confidence intervals are based on bootstrap estimates.

Appendix D. Moderation Effect of Age, Gender, Education, Marital Status, EMT Certification Level, and Experience

Moderator	Path	Group 1 (G1)			Group 2 (G2)			Sig./Nsig.
		Estimate	Lower CI	Upper CI	Estimate	Lower CI	Upper CI
Age	EE→JS	-0.23	-0.42	-0.05	-0.15	-0.42	-0.05	No
G1=Senior (n = 147)	DP→JS	-0.07	-0.23	0.11	-0.08	-0.23	0.11	No
G2=Junior (n = 153)	PA→JS	0.54	0.36	0.70	0.61	0.36	0.70	No
Gender	EE→JS	-0.21	-0.35	-0.09	0.05	-0.11	0.25	Yes
G1=Male (n = 254)	DP→JS	-0.05	-0.17	0.05	-0.23	-0.42	-0.04	No
G2=Female (n = 46)	PA→JS	0.56	0.42	0.67	0.73	0.56	0.89	No
Education	EE→JS	-0.20	-0.39	0.01	-0.20	-0.32	-0.05	No
G1=Under university (n = 87)	DP→JS	-0.15	-0.31	0.03	-0.04	-0.16	0.09	No
G2=University or above (n = 213)	PA→JS	0.50	0.27	0.72	0.60	0.46	0.71	No
Marital Status	EE→JS	-0.17	-0.33	0.00	-0.23	-0.38	-0.04	No
G1=Married (n = 177)	DP→JS	-0.06	-0.19	0.09	-0.10	-0.24	0.02	No
G2=Not married (n = 123)	PA→JS	0.63	0.46	0.74	0.49	0.32	0.69	No
EMT certification level	EE→JS	-0.07	-0.23	0.13	-0.28	-0.43	-0.13	Yes
G1=Non-advanced EMT (n = 154)	DP→JS	-0.07	-0.24	0.10	-0.11	-0.24	0.01	No
G2=Advanced EMT (n = 146)	PA→JS	0.62	0.49	0.78	0.52	0.36	0.67	No
Experience	EE→JS	-0.17	-0.38	-0.01	-0.21	-0.36	-0.08	No
G1=Experienced (n = 136)	DP→JS	-0.09	-0.27	0.09	-0.06	-0.18	0.06	No
G2=Less experienced (n = 164)	PA→JS	0.56	0.38	0.74	0.57	0.46	0.70	No

Notes: 1.CI = confidence interval, EE = emotional exhaustion, DP = depersonalization, PA = personal accomplishment, JS = job satisfaction, EMT = emergency medical technician. 2. Sig./Nsig.: “Yes” indicates a significant moderating effect based on the confidence interval comparison approach; “No” indicates a non-significant moderating effect. 3. All 95% confidence intervals (CIs) were estimated using bias-corrected and accelerated (BCa) bootstrapping.

ORCID iDs

Chao Sheng Chang https://orcid.org/0009-0004-6263-2959

Pen-Yuan Liao https://orcid.org/0000-0001-6476-6521

Kuang-Ming Kuo https://orcid.org/0000-0002-8552-3016