Search Results (937)

Background/Objectives: Musculoskeletal disorders (MSDs) represent a significant occupational health concern among medical laboratory workers (MLWs) worldwide. However, in cross-sectional epidemiological assessments, these are more accurately characterized as self-reported musculoskeletal symptoms (MSSs). Despite growing awareness of physical ergonomic risk factors, the multifactorial etiology of these symptoms, such as psychosocial factors, remains incompletely understood in research laboratory settings. Consequently, this study aimed to determine the prevalence of MSSs among MLWs in a Malaysian research institute, assess physical ergonomic risk in their daily tasks, and evaluate the empirical association between MSSs and psychosocial work engagement. Methods: A cross-sectional study was conducted among MLWs at a Malaysian medical research institute. The 12-month prevalence of self-reported MSSs was assessed using the Nordic Musculoskeletal Questionnaire. Physical ergonomic risk was evaluated utilizing the Rapid Entire Body Assessment (REBA). Psychosocial work engagement was measured using the 17-item Utrecht Work Engagement Scale. Results: A total of 115 MLWs participated, with 73 (63.5%) reporting MSSs. The neck had the highest complaints (n = 43, 37.4%), followed by the lower back (n = 35, 30.4%) and shoulders (n = 33, 28.7%). Multivariable modified Poisson Generalized Estimating Equations revealed that physical ergonomic risk (REBA) was significantly associated with symptoms in the shoulder, upper back, and lower back. Female sex was independently correlated with the overall prevalence of MSSs (aPR = 1.39; 95% CI = 1.14–1.68), with marked associations observed for the neck and knees. Psychosocially, high “absorption” in work was significantly associated with upper back symptom prevalence (aPR = 1.57; 95% CI = 1.15–2.14). Conclusions: Ergonomic strain demonstrates a strong association with axial and shoulder symptoms among MLWs, while demographic characteristics and cumulative tenure correlate with specific extremity symptoms. Paradoxically, high psychological absorption emerges as a distinct correlate of upper back symptoms, likely due to prolonged postural neglect during deep concentration. Occupational health programs may benefit from combining targeted ergonomic accommodations with strategies designed to mitigate the potential physical vulnerabilities of highly absorbed personnel. Full article

Objective: Modern high-intensity warfare, such as the Russo-Ukrainian conflict, generates a high incidence of multisystem polytrauma, blast-induced traumatic brain injury, and limb amputations often complicated by post-traumatic stress disorder and chronic pain. Traditional specialised rehabilitation protocols are structurally inadequate for these co-occurring symptoms and rely heavily on medical treatments, increasing the risk of opioid dependency. The primary aim of this review is to conceptualise a multidimensional integrative framework for war-related polytrauma; a secondary aim is to evaluate and summarise the evidence underpinning its key rehabilitation strategies for limited-resource, post-conflict environments. Methods: This narrative review synthesises evidence identified through targeted database searches and purposive selection guided by clinical relevance, methodological quality, and applicability to war-related polytrauma across physical, technological, and non-pharmacological rehabilitation domains. Evidence was evaluated using a four-tier (A–D) hierarchy, comprising Tier A (systematic reviews and RCTs), Tier B (prospective cohort studies and non-randomised controlled trials), Tier C (descriptive, case-series, and retrospective studies), and Tier D (exploratory, mechanism-based, or expert opinion evidence). No systematic inclusion/exclusion protocol was applied, and no claims of comprehensive search coverage are made. Results: Concurrent physical and trauma-focused psychological rehabilitation, evidenced by reduced pain and psychological symptom burden alongside improved functional independence, is supported by high-quality evidence (Tier A) for managing comorbid polytrauma. Robotic exoskeletons and AI-supported tele-rehabilitation demonstrate dose-dependent motor benefits in selected rehabilitation populations (Tier A–B), but their scalability in wartime settings is contingent on electricity supply, connectivity, equipment maintenance, and trained personnel. Acupuncture shows Tier A evidence for neuropathic pain and Tier B cost-effectiveness; evidence for phantom limb pain and PTSD is preliminary (Tier C–D) and requires dedicated RCTs in veteran populations. Ayurvedic herbal interventions are exploratory (Tier C–D) with no war-specific clinical trials; mechanistic plausibility is discussed as hypothesis-generating only. Conclusions: Addressing the war-related rehabilitation gap requires integration of biomedical care, technology-assisted rehabilitation, and evidence-graded non-pharmacological adjuncts within a structured biopsychosocial framework. Future priorities include pragmatic, adapted trial designs (e.g., stepped-wedge or cohort-embedded designs, which are more feasible than classical RCTs under wartime conditions) for acupuncture in phantom limb pain, feasibility trials for robotic rehabilitation in frontline-adjacent facilities, and health-economic modelling adapted to the Ukrainian context. Full article

Background/Objectives: Medical liability litigation in Romania has risen steadily over the past decade, yet the quantification of moral (non-pecuniary) damages remains entirely at the discretion of each judge, with no standardized reference. This raises concerns about consistency and predictability, with direct implications for healthcare professionals, who are increasingly exposed to this form of liability—a potential source of occupational stress—and to financial awards they cannot anticipate. The present pilot study analyzed Romanian court practice regarding the amount of moral damages awarded in cases of medical negligence resulting in the patient’s death. Methods: In a retrospective observational study, we examined ten final rulings (2018–2024; rejust.ro) convicting medical personnel for involuntary manslaughter (27 civil parties awarded). We computed the Claim-to-Award Ratio (CTAR), Claim Reduction Rate (CRR), Appeal Adjustment Rate (AAR), and Appeal Ratio (AR), Spearman correlation, the Wilcoxon signed-rank test, and linear regression. Results: Courts awarded on average only 18% of the amounts claimed (CRR 82%); claimed and awarded sums were correlated (ρ = 0.84, 95% CI 0.34–0.97, p = 0.0025; R² = 0.59). Appellate adjustments varied widely (AAR −84% to +79%; AR 0.16–1.79), with no systematic difference between instances (Wilcoxon p = 0.463; R² = 0.01). Comparable cases yielded substantially different awards. Conclusions: Moral damages in fatal malpractice show no recognizable pattern of quantification. This structural unpredictability leaves physicians without a reliable benchmark for their financial risk and may amplify the occupational stress and impaired well-being already linked to litigation, supporting the need for guiding reference standards. Full article

Medical tourism is among the fastest-growing segments of the global travel industry, and Taiwan’s internationally recognised healthcare system positions it well to compete in this market. Yet the companies best placed to lead this development have traditionally been identified through online word-of-mouth or personal recommendation rather than objective evidence, and performance criteria are rarely weighted to reflect both subjective opinion and objective data. This study addresses both gaps with a hybrid framework that uses main path analysis to identify, objectively, the companies most active in medical aesthetic technology, and integrates the Best–Worst Method (BWM), Entropy, Game Theory, and Grey-based TOPSIS to weight a four-dimensional, seventeen-criterion framework and rank company performance in medical tourism. An empirical application to seven Taiwanese companies engaged in medical aesthetics alongside medical tourism, drawing on industry expert assessments, shows that Service and Healthcare Resources is the most influential dimension, and that cloud-based customisation, multilingual personnel, and professional in-trip medical care are the most important criteria. Sensitivity analysis across nine weighting scenarios and comparison against four alternative ranking methods confirm the robustness of the ranking. The framework offers a replicable, objective template for evaluating medical tourism performance and provides managerial guidance for companies and policymakers seeking to strengthen Taiwan’s position in this market. Full article

Background: Increasing demand for emergency medical services (EMS) challenges prehospital resource availability, particularly for time-critical emergencies requiring advanced life support (ALS). Although tiered BLS and ALS response models are established in many non-physician-led EMS systems, evidence regarding qualification-based dispatch stratification within physician-led EMS systems remains limited. This study evaluated the clinical and operational characteristics of an expanded BLS dispatch segment in Berlin EMS. Methods: A retrospective observational study analysed 2,132,246 EMS missions in Berlin, Germany, between 2020 and 2024. Missions were retrospectively classified according to dispatch codes included in the expanded BLS segment, designed to allocate incidents with lower expected requirements for ALS-level interventions to appropriately qualified EMS personnel. Analyses included dispatch characteristics, clinical findings from electronic patient care records, observed safety-related indicators, and ALS response intervals. Results: Overall, 28.7% of EMS missions were classified within the expanded BLS segment. Traumatic and psychiatric presentations represented the most frequent diagnostic groups. Based on predefined clinical indicators, no immediately life-threatening condition was documented in more than 95% of missions. Cardiopulmonary resuscitation occurred in 0.03% of cases, and emergency physician involvement was documented in approximately 3% of cases. Conclusions: A substantial proportion of EMS missions represented a population with predominantly lower expected prehospital treatment complexity within a qualification-based dispatch framework. Structured emergency call interrogation combined with dispatch classification and linked clinical data enabled retrospective evaluation of this approach. Further validation against independent clinical reference standards and linkage with downstream outcomes are required to determine broader applicability. Full article

Background and Objectives: Digital tools are now embedded in anesthesia and intensive care, but access to them, and in particular to digital educational resources, is distributed unevenly across professional groups. This study describes how nurses, residents, and specialist physicians in one department appraise the contribution of digital technologies to continuing education, patient safety, and clinical and managerial decision-making, and how they report using the digital educational resources available to them. The study is descriptive and exploratory. It does not evaluate an educational intervention and does not measure learning. Methods: We conducted an anonymous, paper-based cross-sectional survey of all 198 clinical staff of a tertiary anesthesia and intensive care department between 2 June and 31 July 2025; 161 questionnaires were analyzable (81.3%). The instrument was investigator-developed and has not been validated, and it is therefore treated as a set of individual items rather than as a scale. Four trichotomous items (Yes/No/Cannot appraise) covering continuing education, patient safety, clinical decision-making, and managerial decision-making were designated primary outcomes and are reported as proportions with Wilson 95% confidence intervals, together with between-group differences and their confidence intervals; overall comparisons used the chi-square or Fisher exact test with Cramér’s V as the effect size. Reporting follows STROBE and the CROSS checklist for survey research. Composite indices, regression models, and correlation analyses were devised after data inspection, are labelled exploratory, and are not reported in this manuscript. Results: Daily use of at least one digital tool was reported by 98.1% of respondents. An educational contribution was affirmed by 56.4% of nurses (95% CI 43.3–68.6), 91.9% of residents (82.5–96.5), and 93.2% of specialists (81.8–97.7); the difference was 35.5 percentage points between residents and nurses (95% CI 20.1–49.4) and 36.8 points between specialists and nurses (20.1–50.7). Response distributions differed by professional category on all four items (p < 0.001 for education, patient safety, and clinical decisions; p = 0.005 for managerial decisions; Cramér’s V 0.22–0.31). Explicit disagreement was very rare (1 to 4 respondents per item), so the differences consist almost entirely of the “Cannot appraise” category, which is reported descriptively because the reason for that response was not measured. Reported use of digital educational resources followed the same ordering: e-learning 50.9% of nurses, 98.4% of residents, 93.2% of specialists; simulators 18.2%, 72.6%, 50.0%; webinars 65.5%, 67.7%, 86.4%. These proportions correspond to documented differences in institutional access, since simulation rotations were mandatory for residents only and the e-learning platform was opened to physicians in 2021 but to nursing staff only in October 2023. Conclusions: In this single department, response distributions on all four appraisal items differed by professional category, and reported use of digital educational resources was lowest in the group with the latest and most restricted institutional access. Because the groups used different technologies under different access conditions, these differences cannot be attributed to professional role itself, and because no learning outcome was measured they are not evidence of educational benefit. The findings are exploratory and support the hypothesis that equalizing access to digital educational resources deserves prospective evaluation. Full article

Background: Emergency medical service (EMS) personnel and volunteers are frequently exposed to traumatic events, placing them at elevated risk for psychological distress, including post-traumatic stress symptoms (PTSSs), depression, and dissociation. This study examined the relationships among PTSS, depression, and dissociation in Israeli EMS personnel, with a particular focus on whether dissociation mediates the association between depression and PTSS. Methods: A cross-sectional study was conducted with 60 EMS personnel in Israel, including 7 paid employees, 37 volunteers, and 16 participants who did not report their employment status. PTSSs were assessed using the Impact of Event Scale-Revised (IES-R), depressive symptoms were measured with the Depression, Anxiety, and Stress Scale (DASS-21), and dissociative experiences were evaluated using the Dissociative Experiences Scale-II (DES-II). Correlational analyses and mediation analyses were performed. Results: Significant positive correlations were found among PTSS, depression, and dissociation. However, mediation analysis indicated that dissociation did not significantly mediate the relationship between depression and PTSS. Conclusions: Although depression and dissociation were both strongly associated with PTSS, dissociation did not account for the association between depression and PTSS in this sample of EMS personnel. These findings suggest that other psychological mechanisms may underlie the relationship between depression and trauma-related symptoms in emergency responders. Further research is warranted to identify these mechanisms and to inform targeted interventions aimed at promoting the mental health and resilience of EMS personnel. Full article

Background/Objectives: The use of antidepressants and anxiolytics has increased worldwide, raising concerns about treatment patterns, medication safety, and rational use. This study aimed to characterize the frequency, utilization patterns, and safety-related aspects of antidepressant and anxiolytic use among healthcare students and university staff at a Brazilian public university. Methods: A cross-sectional study was conducted between September 2024 and June 2025 using an online questionnaire administered to students and staff at the University of São Paulo, Brazil. Descriptive statistics and multivariable logistic regression were applied to characterize medication utilization patterns and evaluate factors associated with antidepressant and/or anxiolytic use. Results: Among the 300 participants, 167 (55.7%) reported antidepressant and/or anxiolytic use during the previous six months. Most users reported treatment for more than one year (59.9%), anxiety as the primary indication (68.3%), and prescription by a healthcare professional (93.4%). A total of 203 medications were reported, with selective serotonin reuptake inhibitors being the most common pharmacological class (42.4%). Among users, 99 (59.3%) reported at least one self-reported adverse effect, most commonly excessive drowsiness, reduced libido/sexual dysfunction, dry mouth, headache, and nausea. No statistically significant independent associations were identified between antidepressant and/or anxiolytic use and the evaluated sociodemographic characteristics. Conclusions: Antidepressant and anxiolytic use was frequently reported and was characterized by predominantly long-term, professionally prescribed treatment and frequent self-reported adverse effects. These findings may inform institutional strategies to improve access to mental healthcare while promoting the rational and safe use of psychotropic medications within university settings. Full article

Background: Emergency medical services (EMS) personnel experience high rates of psychological distress yet demonstrate low utilization of mental health services. Factors associated with actual service use—rather than intentions or attitudes—are not well understood. Methods: Using secondary data from 36,697 licensed Florida EMTs and paramedics collected during the 2022 licensure renewal process, logistic regression models evaluated the relative contributions of workplace factors, attitudinal variables, trauma exposure, and mental health symptoms in their association with service utilization. Results: Psychological symptoms, particularly anxiety and depression, were the strongest factors associated with help-seeking. Peer support emerged as one of the few system-level factors associated with increased service use, even after accounting for symptom presence. Stigma-related variables showed weaker and, in some cases, counterintuitive associations. Suicidality and substance use were modestly associated with help-seeking beyond core symptom variables. Findings were consistent among trauma-exposed personnel. Discussion: Results are consistent with the potential value of early identification, routine symptom screening, and integrated, system-level supports such as peer support and access to confidential, occupationally competent care. Full article

Non-communicable diseases (NCDs), including cardiovascular disease, cancer, and chronic respiratory disease, are major causes of death worldwide; addressing NCDs is thus essential. NCDs may contribute to health disparities between rural and urban areas. The COVID-19 pandemic has altered medical and social environments, and NCD management approaches may have changed accordingly. This scoping review aimed to examine themes of reported rural healthcare challenges related to NCD management before and after the COVID-19 pandemic. A literature search of original articles was conducted via PubMed. A thematic analysis was applied to compare the content of studies classified as pre-pandemic and post-pandemic. A total of 23 articles were identified, including 12 studies classified as pre-pandemic and 11 studies classified as post-pandemic. Before the pandemic, commonly reported challenges included low management rates of hypertension and diabetes, instability in pharmaceutical supply, and insufficient training of healthcare personnel. We integrated these into a theme related to “healthcare”. After the pandemic, in addition to the low management rates, studies increasingly addressed mental and nutritional health, multimorbidity, and socioeconomic disparities. We integrated there into a theme related to “society”. Namely, studies classified as pre-pandemic primarily reported healthcare-related aspects, whereas studies classified as post-pandemic more frequently reported broader societal aspects in addition to healthcare-related aspects. These findings may reflect changes in how rural healthcare challenges related to NCDs have been recognized and discussed following the COVID-19 pandemic. Further research is needed to clarify the significance and implications of these reported themes. Full article

Biomedical scientists/researchers are critical to advancing human health, but their experiences of occupational stress, burnout, and subsequent consequences are surmised but understudied. The current narrative review aimed to search and summarize existing literature and scientific discourse specific to biomedical scientist burnout to better understand the prevalence and unique drivers of stress in this population and highlight critical areas that require further research and intervention efforts. The authors searched six primary databases from August 2024 to December 2025 using defined search terms to identify peer-reviewed articles and scientific discourse related to occupational burnout of academic medicine biomedical faculty researchers, postdoctoral researchers, or lab personnel. Prevalence and primary drivers of burnout, stress mediators, and mitigation/intervention recommendations were extracted from the included works. A total of 16 empirical articles and 4 non-empirical works were included. Over 30% of biomedical scientists exhibit high occupational burnout, nearly 45% report high distress, and just over 34% experience high emotional exhaustion. Seven primary drivers of biomedical scientist distress were identified including intense workloads/expectations, funding pressures, and lack of perceived organizational support/recognition. Biomedical scientist burnout prevalence appears comparable to clinical faculty but is driven, in part, by distinct stressors. The attributable organization and societal cost of biomedical scientist burnout remain unquantified. The current review establishes a significant need for further research and tailored efforts to address the distinct needs of biomedical scientists across academic medical centers. Full article

Background and Objectives: Psychological distress is common in acute coronary syndrome (ACS), yet its relationship with objective coronary anatomical complexity is incompletely understood. The Kessler Psychological Distress Scale-10 (K10) is a brief self-report instrument that measures non-specific psychological distress over the preceding four weeks. We investigated whether the K10 score is associated with the anatomical SYNTAX I score and the clinical–anatomical SYNTAX II PCI score in patients hospitalized with ACS. Materials and Methods: This prospective, single tertiary-center observational study assessed 865 adult patients with suspected or confirmed ACS between 6 January 2026 and 5 June 2026. After applying predefined inclusion and exclusion criteria, 750 consecutive eligible patients with complete K10, SYNTAX I, and SYNTAX II PCI data were included in the final analytic cohort. The cohort consisted of STEMI in 337 patients (44.9%), NSTEMI in 310 (41.3%), and unstable angina pectoris in 103 (13.7%). The validated Turkish version of the K10 scale was administered after pain control and hemodynamic stabilization, within 24–48 h of admission, by trained study personnel blinded to the final SYNTAX analysis. SYNTAX I and SYNTAX II PCI scores were calculated by two blinded interventional cardiologists. The primary endpoint was SYNTAX I score ≥ 23; the key secondary endpoint was SYNTAX II PCI score ≥ 36, interpreted as a cohort-based high clinical–anatomical risk threshold. Results: Mean age was 61.3 ± 11.6 years, and 543 patients (72.4%) were men. Mean K10, SYNTAX I, and SYNTAX II PCI scores were 23.7 ± 6.7, 22.4 ± 9.5, and 31.2 ± 9.6, respectively. K10 score correlated with SYNTAX I (Spearman rho = 0.417, p < 0.001) and SYNTAX II PCI (rho = 0.348, p < 0.001). Each 5-point increase in K10 was independently associated with SYNTAX I ≥ 23 (extended model-adjusted odds ratio [OR] 1.84, 95% confidence interval [CI] 1.59–2.12; p < 0.001) and SYNTAX II PCI ≥ 36 (extended model-adjusted OR 2.26, 95% CI 1.85–2.75; p < 0.001). K10 predicted SYNTAX I ≥ 23 with an area under the curve (AUC) of 0.706 (95% CI 0.674–0.744; cutoff ≥ 24) and SYNTAX II PCI ≥ 36 with an AUC of 0.693 (95% CI 0.654–0.736; cutoff ≥ 26). Adding K10 to the extended clinical model improved cross-validated AUC for SYNTAX I ≥ 23 from 0.708 to 0.774 and for SYNTAX II PCI ≥ 36 from 0.871 to 0.905; bootstrap optimism-corrected AUCs were 0.754 and 0.899, respectively. The findings remained consistent in sensitivity analyses excluding prior CABG patients, adjusting for psychiatric history/medication use, and evaluating patients whose K10 was completed before angiography. Conclusions: In this prospective ACS cohort, early in-hospital assessment of K10-defined recent psychological distress was independently associated with both anatomical and clinical–anatomical coronary complexity. K10 should not replace angiographic risk scoring, but it may help identify a psychocardiological phenotype characterized by higher coronary disease burden and greater clinical vulnerability. Full article

Romanian county Public Health Directorates (PHDs) were central to local COVID-19 crisis management, yet subnational differences in institutional response capacity remain insufficiently quantified. This study aimed to examine institutional characteristics associated with COVID-19 response capacity among Romanian PHDs. An observational comparative design included 20 PHDs—10 from counties with university medical centers (UC) and 10 from non-university counties (NUC)—using 2020–2022 averages derived from public activity reports and official statistical databases. Seven indicators were analyzed: county population, area, number of employees, institutional budget, personnel density, prior health crisis experience, and diversity of COVID-19 response measures. Group differences were assessed using the Mann–Whitney U test, and associations using Spearman’s rank correlation. UC PHDs had larger workforces (133 vs. 67 employees, p = 0.001), higher budgets (24.3 vs. 7.6 million RON, p = 0.001), greater prior crisis experience (2.4 vs. 0.8 crises, p = 0.001), and broader response portfolios (5.6 vs. 3.0 measure categories, p < 0.001). Personnel density did not differ significantly (17.80 vs. 18.59 employees/100,000 inhabitants, p = 0.614). Response diversity correlated strongly with workforce size (ρ = 0.87), budget (ρ = 0.88), and prior crisis experience (ρ = 0.81; all p < 0.001). These findings suggest that absolute institutional resources and accumulated experience may be more relevant to crisis response capacity than population-adjusted staffing alone. Full article

This study primarily aimed to evaluate how the chemical form and carrier medium of radionuclide contamination influence the effectiveness of skin decontamination procedures. In addition, the study sought to identify decontamination strategies that align with recommended practices while reducing reliance on intensive mechanical cleaning methods. Although skin damage was not directly evaluated, the findings provide valuable information for improving the safety of decontamination procedures used by personnel handling radioactive materials and by emergency responders involved in radiological and CBRN (Chemical, Biological, Radiological, and Nuclear) incidents. Accidental spills of radiopharmaceuticals in laboratories and medical facilities, as well as contamination associated with uranium mining, fuel-cycle operations, spent fuel management, and the decommissioning of nuclear facilities, may involve radioactive isotopes present in a variety of chemical forms and solutions. Fresh porcine skin was used as an experimental model, and skin temperature was maintained at 37 °C to simulate physiological conditions. Europium-152 (¹⁵²Eu) was selected as the model radionuclide. Deionized water, concentrated nitric acid (HNO₃), saturated sodium hydroxide (NaOH) solution, and ethanol were used as carrier media representing different chemical environments of ¹⁵²Eu contamination. To simulate realistic contamination scenarios, contaminating solutions were allowed to dry on the skin surface before decontamination. The influence of contaminant chemistry, carrier medium, and drying conditions on radionuclide penetration and subsequent decontamination effectiveness was investigated. Particular attention was given to the extent to which different physicochemical forms of contamination affected radionuclide removal from the skin. The results demonstrated that the chemical form of the contaminant and the drying conditions were key factors determining decontamination efficiency. Among the tested methods, a decontamination kit consisting of a soap-based solution, the complexing agent DTPA, and an absorbent non-woven swab achieved the highest radionuclide removal efficiency. These findings indicate that successful radionuclide decontamination depends strongly on the physicochemical properties of the contaminant. The combined use of a complexing agent, detergent-based formulation, and absorbent material can significantly enhance radionuclide removal from contaminated skin surfaces. Furthermore, the study highlights the importance of considering contaminant chemistry when developing effective and safe decontamination protocols for radiological and CBRN incidents. Full article

(1) Background: Prehospital emergency workers frequently experience workplace violence and trauma, raising their risk of post-traumatic stress disorder (PTSD) symptoms and burnout, yet their link to quiet quitting remains poorly understood. We tested whether the PTSD–quiet quitting association is statistically patterned through perceived occupational stress and emotional exhaustion. (2) Methods: In a cross-sectional online survey, prehospital emergency professionals in Türkiye who reported workplace violence within the previous six months completed the PTSD-Short Scale, Perceived Occupational Stress Scale, Job-Related Emotional Exhaustion Scale, and Quiet Quitting Scale. Serial mediation was tested with PROCESS Model 6 (5000 bootstrap resamples), with an age- and gender-adjusted sensitivity analysis, and reporting followed the STROBE checklist. (3) Results: Of 327 respondents, 305 were analysed. PTSD symptoms were associated with quiet quitting (β = 0.460, p < 0.001). With both mediators entered, the direct path was non-significant (β = 0.105, p = 0.071), indicating full statistical mediation. The serial route through stress and exhaustion was the largest indirect pathway (B = 0.155, 95% CI [0.091, 0.217]), and the model explained 42.1% of the variance. Self-reported, single-session data mean the indirect effects are best treated as upper-bound estimates. (4) Conclusions: PTSD symptoms were indirectly related to quiet quitting through occupational stress and emotional exhaustion. The high correlation between the two mediators suggests one broad strain process rather than two distinct stages. Because the design is cross-sectional, it precludes causal ordering; longitudinal studies are needed. Clinically, the findings highlight reducing workplace violence and monitoring stress and exhaustion to limit disengagement among prehospital staff. Full article