https://doi.org/10.4081/ecj.2026.15994
Compassion fatigue among emergency medical services personnel: an integrative review of contributing factors and consequences
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Accepted: 31 August 2026
Published: 8 October 2026
This integrative review focuses on the phenomenon of compassion fatigue in Emergency Medical Services (EMS). Specifically, it explores the available literature on the causes of compassion fatigue and its impact on personal well-being, performance, and the quality of care delivered by emergency medical services professionals. An integrative literature review was conducted following the PRISMA 2020 guidelines. Relevant studies were searched using PubMed, ScienceDirect, Google Scholar, ProQuest, and EBSCO/CINAHL electronic databases, and after further analysis 13 were selected for review. A qualitative approach involving content and thematic analyses was used to identify repeated patterns. This integrative review was carried out from January 15 to June 30, 2026. In total, there were thirteen (13) articles that met the requirements for inclusion in this paper. Five major themes were found: trauma experience, occupation-related stressors, self-criticism, accumulation of emotional burden, and work environment. All of the mentioned issues had negative consequences for personal welfare and job performance. Major outcomes were poor psychological well-being, dissatisfaction, deterioration of care standards, increased risk of experiencing burnout, and detachment. Despite the few studies focused specifically on EMS providers, the literature indicates that compassion fatigue is quite prevalent. This review not only underscores its significant contributions but also brings out issues that may arise within the institution when implementing this initiative. With such findings, there is an increased need for further research to validate the effectiveness of this initiative and address future challenges.
Downloads
1. Parker D. The essential role of healthcare services in modern society. J Healthc Commun 2024;9:39.
2. Joseph B, Joseph M. The health of the healthcare workers. Indian J Occup Environ Med 2016;20:71-2. DOI: https://doi.org/10.4103/0019-5278.197518
3. Trindade LL, Schoeninger MD, Carneiro J, et al. Compassion fatigue in emergency care professionals. Rev Bras Enferm 2025;78:e20230367.
4. Dehghannezhad J, Zamanzadeh V, Gilani N, et al. Compassion satisfaction and compassion fatigue among emergency medical technicians in Iran. Australasian J Paramed 2020;17:1-7. DOI: https://doi.org/10.33151/ajp.17.642
5. Beres KE, Zajac LM, Mason H, et al. Addressing compassion fatigue in trauma emergency and intensive care settings: A pilot study. J Trauma Nurs 2022;29:210-7. DOI: https://doi.org/10.1097/JTN.0000000000000663
6. Ericsson CR, Nordquist H, Lindström V, Rudman A. Finnish paramedics' professional quality of life and associations with assignment experiences and defusing use - a cross-sectional study. BMC Public Health 2021;21:1789. DOI: https://doi.org/10.1186/s12889-021-11851-0
7. Suokonautio B, Kouvonen A, Nordquist H. Role identities of emergency medical services personnel and their associations with intention to leave the profession. BMC Emerg Med 2024;24:96. DOI: https://doi.org/10.1186/s12873-024-01008-8
8. Torres AJ, McCoy RG. How to better value EMS clinicians as key care team members. AMA J Ethics 2022;24:E898-905.
9. Rimensberger, P. Role of Emergency Medical Services (EMS) in prehospital care. Qual Prim Care 2024;32:39.
10. Renkiewicz GK, Hubble MW. Secondary Traumatic Stress in Emergency Services Systems (STRESS) project: quantifying and predicting compassion fatigue in emergency medical services personnel. Prehosp Emerg Care 2022;26:652-63. DOI: https://doi.org/10.1080/10903127.2021.1943578
11. Giaume L, Jimenez A, Kedzierewicz R, et al. FIRECARE: an evidence-based prevention program to reduce burnout among prehospital caregivers: benefits of a combined mindfulness, heart coherence training, and positive psychology intervention. Prehosp Emerg Care 2024;28:342-51. DOI: https://doi.org/10.1080/10903127.2023.2258204
12. Won NY, Palamar JJ, Mike SA, et al. A qualitative analysis of Emergency Medical Services (EMS) personnel experiences and perceptions responding to drug overdoses in the United States (US) during the COVID-19 pandemic. J Health Res 2023;37:270–9. DOI: https://doi.org/10.56808/2586-940X.1045
13. Van Puyvelde M, Van Herck J, Van den Bossche J, et al. Walk the line: a systemic perspective on stress experienced by emergency medical personnel by comparing military and civilian prehospital settings. Front Public Health 2023;11:1136090. DOI: https://doi.org/10.3389/fpubh.2023.1136090
14. Parker B, Ashton A, Fletcher I, Eccles F. The relationship between emotional intelligence, self-compassion and wellbeing in ambulance staff. Int J Paramed 2024;6:62–82. DOI: https://doi.org/10.56068/JNUD3075
15. Cocker F, Joss N. Compassion fatigue among healthcare, emergency and community service workers: a systematic review. Int J Environ Res Public Health 2026;13:618. DOI: https://doi.org/10.3390/ijerph13060618
16. Kovács P, Papp-Zipernovszky O. Paramedics' experiences of trauma and its processing: An interpretative phenomenological analysis. EXPERIENCE – J Qual Res Mental Health 2026;1:16-30. DOI: https://doi.org/10.1556/1122.2025.00007
17. Minnie L, Goodman S, Wallis L. Exposure to daily trauma: The experiences and coping mechanism of Emergency Medical Personnel. A cross-sectional study. Afr J Emerg Med 2015;5:12-8. DOI: https://doi.org/10.1016/j.afjem.2014.10.010
18. Al Adwani SA, Baabdullah FH, Alqahtani SA, et al. Empathy and trauma in ambulance paramedics: navigating human tragedy. Int J Med Toxicol Legal Med 2024;27:931-40.
19. Jeanmonod D, Irick J, Munday AR, et al. Compassion fatigue in emergency medicine: current perspectives. Open Access Emerg Med 2024;16:167-81. DOI: https://doi.org/10.2147/OAEM.S418935
20. Tikkanen V, Kääriäinen M, Roivainen P. The effect of ambulance clinicians’ well-being on occupational and patient safety in prehospital emergency medical services: a scoping review. Emerg Crit Care Med 2025;5:20-39. DOI: https://doi.org/10.1097/EC9.0000000000000145
21. Iordache RM, Cioca G, Mihaila D, et al. Occupational stress factors and psychosocial environment for ambulance personnel. Sustainability 2025;17:4518. DOI: https://doi.org/10.3390/su17104518
22. Palma A, Cater K. Compassion fatigue: The real emergency paramedics face. Whitireia J Nurs Health Soc Serv 2024;31:21–34. DOI: https://doi.org/10.34074/whit.3103
23. Pergol-Metko P, Staniszewska A, Metko S, et al. compassion fatigue and perceived social support among polish nurses. Healthcare 2023;11:706. DOI: https://doi.org/10.3390/healthcare11050706
24. Hăisan A, Hogas S, Mairean C, et al. Compassion fatigue and compassion satisfaction among Romanian emergency medicine personnel. Front Med 2023;10:1189294. DOI: https://doi.org/10.3389/fmed.2023.1189294
25. Lluch C, Galiana L, Doménech P, Sansó N. The impact of the COVID-19 pandemic on burnout, compassion fatigue, and compassion satisfaction in healthcare personnel: a systematic review of the literature published during the first year of the pandemic. Healthcare (Basel) 2022;10:364. DOI: https://doi.org/10.3390/healthcare10020364
26. Cogan N. Persistent traumatic stress exposure: rethinking PTSD for frontline workers. Healthcare (Basel) 2026;14:255. DOI: https://doi.org/10.3390/healthcare14020255
27. Ondrejková N, Halamová J. Prevalence of compassion fatigue among helping professions and relationship to compassion for others, self-compassion and self-criticism. Health Soc Care Comm 2022;30:1680–94. DOI: https://doi.org/10.1111/hsc.13741
28. Rojas R, Hickmann M, Wolf S, et al. Coping in the emergency medical services: associations with the personnel's stress, self-efficacy, job satisfaction, and health. Clin Psychol Eur 2022;4:e6133. DOI: https://doi.org/10.32872/cpe.6133
29. Lawn S, Roberts L, Willis E, et al. The effects of emergency medical service work on the psychological, physical, and social well-being of ambulance personnel: a systematic review of qualitative research. BMC Psychiatry 2020;20:348. DOI: https://doi.org/10.1186/s12888-020-02752-4
30. ALmutairi MN, El Mahalli AA. Burnout and coping methods among emergency medical services professionals. J Multidiscip Healthc 2020;13:271-9 DOI: https://doi.org/10.2147/JMDH.S244303
31. Bardhan R, Byrd T. Psychosocial work stress and occupational stressors in emergency medical services. Healthcare 2023;11:976. DOI: https://doi.org/10.3390/healthcare11070976
32. Zee MS, Philipsen BDO, Witkamp E, et al. From applause to disappointment - appreciation among healthcare providers that provided end-of-life care during the COVID-19 pandemic and its impact on well-being - a longitudinal mixed methods study (the CO-LIVE study). BMC Health Serv Res 2024;24:1613. DOI: https://doi.org/10.1186/s12913-024-11999-6
33. Çiftçi-Kıraç F, Yağcı-Özen M, Kıraç R, Seyfioğlu S. The impact of compassion fatigue and work-life balance on life satisfaction: A study of healthcare professionals in Türkiye. WORK 2026;85:246-59. DOI: https://doi.org/10.1177/10519815251410103
34. Johnston S, Waite P, Laing J, et al. Why do emergency medical service employees (not) seek organizational help for mental health support? A systematic review. Int J Environ Res Public Health 2025;22:629. DOI: https://doi.org/10.3390/ijerph22040629
35. Crampton DJ. Comparison of PTSD and compassion fatigue between urban and rural paramedics (Order No. 3558333). Available from Health Research Premium Collection; ProQuest Dissertations & Theses Global 2014:1350627026.
36. Metcalf SA, Saunders EC, Moore SK, et al. Compassion, stigma, and professionalism among emergency personnel responding to the opioid crisis: An exploratory study in New Hampshire, USA. JACEP Open 2022;3:e12641, DOI: https://doi.org/10.1002/emp2.12641
37. Taskan TK, Karadag M, Sahin I. A national cross-sectional assessment of emotional labor and compassion fatigue among emergency response personnel in Turkey. Discov Public Health 2026;23:489. DOI: https://doi.org/10.1186/s12982-026-01865-7
38. Delamare-Fauvel A, Powell JR, Kurth JD, et al. Differences in characteristics between EMS clinicians with patient care and non-patient care roles. Prehosp Emerg Care 2023;27:432–8. DOI: https://doi.org/10.1080/10903127.2022.2103757
39. García-Iglesias JJ, Gómez-Salgado J, Martín-Pereira J, et al. Impact of SARS-CoV-2 (COVID-19) on the mental health of healthcare professionals: A systematic review. Rev Esp Salud Publica 2020;94:e202007088.
40. Betts C, Stoneley A, Picker T. Exploring paramedic personality profiles and the relationship with burnout and employment retention: A scoping review. Australasian Emerg Care 2024;27:227-36. DOI: https://doi.org/10.1016/j.auec.2024.04.003
Ethics Approval
CRediT authorship contribution
Rolven N. Ciriaco, project administration and conceptualization; Rock P. Cordero, writing - original draft; Rayson G. Javines, methodology; Yasir M. Aslam, writing – review & editing; Efren P. Molina, resources and validation; Jake B. Canapi, visualization; Ahmadraja Abubakar, formal analysis.
Supporting Agencies
Data Availability Statement
Data analyzed in this study are available from the corresponding author upon reasonable request.
How to Cite

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.




