Background <p>High turnover intention among pre-hospital Emergency Medical Services (EMS) professionals threatens the sustainability of these vital health services. This study aimed to determine the global prevalence of turnover intention and identify its predictive factors to inform effective retention strategies.</p> Methods <p>This systematic review and meta-analysis followed the PRISMA 2020 guidelines. The PubMed, Web of Science, and Scopus databases were comprehensively searched up to August 31, 2025. Observational studies reporting on turnover intention and its associated factors were included. The pooled prevalence was calculated using a random-effects model, and influencing factors were analyzed within the expanded Job Demands-Resources (JD-R) framework.</p> Results <p>From 2,077 identified records, 27 studies with an overall sample size of 129,580 participants were eligible for the systematic review. A meta-analysis of 19 studies revealed a global pooled prevalence of turnover intention of 23.5% (95% CI: 16.6%-32.1%). The prevalence was significantly higher in studies with small sample sizes (36.4%) compared to those with large sample sizes (11.7%) (<i>p</i> &lt; 0.001). The pooled prevalence also differed significantly across North America (13.4%), Europe (31.6%), and other regions (45.7%) (<i>p</i> &lt; 0.001). Job dissatisfaction and job stress were the most frequently reported predictors, followed by burnout, high workload, inadequate compensation, and poor physical and mental health.</p> Conclusion <p>Approximately one in four EMS professionals worldwide intend to leave their job. This phenomenon is a response to the imbalance between high job demands and inadequate resources. Retaining this critical workforce requires a dual approach: strengthening resources at the organizational level and implementing structural reforms at the macro-policy level.</p>