Abstract
OBJECTIVE: This qualitative study aimed to identify the key issues within Emergency Medical Services (EMS) in large urban regions. METHODS: This study used qualitative content analysis as its research methodology. The study was conducted in 2023 and involved 21 Iranian EMS stakeholders, selected through purposive sampling with maximum diversity to ensure a broad range of expertise. Data were collected through semi-structured, in-depth interviews, which were conducted until data saturation was reached. The analysis followed the method proposed by Landman and Graneheim, which involved systematic coding and categorization to identify key themes and patterns related to EMS challenges. RESULTS: The study included 17 men and 4 women. The data analysis identified eight subcategories, which were then divided into three main categories based on their similarities. These main categories addressed challenges in EMS delivery, emerging issues in EMS demand, and resource constraints. CONCLUSION: This study highlighted the challenges that Iran's EMS encountered in megacities due to rapid urbanization and an elderly population. Key issues included operational inefficiencies, increasing demand, and limited resources. Addressing these challenges is crucial for enhancing the effectiveness and sustainability of EMS. Further research is required to develop strategies for overcoming these obstacles and strengthening EMS in large urban regions.