Scoping review identifies operational and organizational drivers of burnout in public safety personnelWhy do we know so little about moral injury in first responders?

Despite growing awareness of mental health, stress, and trauma among public safety workers (EMTs, firefighters, and emergency dispatchers), gaps remain in programs and research addressing burnout and moral injury -especially when compared to the attention given to healthcare professionals and, to some extent, police officers. The objective of this study is to systematically review the literature on the environmental, relational, and operational drivers, processes, and outcomes associated with burnout and moral injury among public safety personnel according to a national framework. A systematic search following PRISMA extension for Scoping Reviews guidelines was conducted across six databases for peer-reviewed publications from 2004 to 2024. Search terms focused on burnout, moral injury, and public safety professions. Reference lists from included studies and key journals were also hand-searched. Identified studies were uploaded to Covidence and screened by three reviewers using defined criteria. Of nearly 13,000 articles identified, 43 were included. Only three studies examined moral injury. Most studies examined individual burnout factors (e.g., age, gender), with less attention to organizational drivers. Key drivers included operational factors (e.g., occupational stress, organizational support) and non-organizational factors (e.g., traumatic events, work-family conflict). Burnout outcomes, discussed in fewer studies, primarily related to individual-level physical and mental health or job satisfaction and turnover. Understanding burnout and moral injury from the perspective of public safety workers is critical to public health, given their frontline role during crises. While they safeguard the well-being of others, their own health has significant implications for downstream providers and patient outcomes. Although systems-level contributors to burnout and moral injury are increasingly acknowledged in broader healthcare, this lens is less often applied to public safety workers-especially in relation to moral injury. Addressing these issues requires a deeper understanding of their origins, particularly the organizational factors that shape how burnout and moral injury manifest in this workforce. Future research must address multi-level drivers to inform more effective and targeted interventions.