Alireza Rahimi,
Volume 24, Issue 2 (9-2025)
Abstract
Background and purpose: Pre-hospital Emergency Medical Services (EMS) play a pivotal role in managing life-threatening conditions. However, evidence suggests that the Iranian EMS system faces multifaceted challenges across human, managerial, and infrastructural dimensions. This study aimed to conduct a comprehensive meta-synthesis to identify and analyze the challenges characterizing pre-hospital EMS in Iran, based on research evidence published between 2014 and 2025.
Methods: This study employed a meta-synthesis approach utilizing the seven-step framework by Sandelowski and Barroso (2006). A systematic search of major domestic and international databases using relevant keywords yielded 414 initial records. Following a rigorous screening process based on inclusion/exclusion criteria and quality appraisal, 25 articles were selected for the final analysis. Data were synthesized and categorized using thematic analysis.
Results: The findings revealed that the challenges facing the Iranian pre-hospital EMS can be categorized into six main themes: human resources, logistics and infrastructure, organizational and managerial barriers, socio-cultural issues, and educational deficits. A deeper analysis highlighted the multifaceted and intertwined nature of these obstacles. The results indicate that these challenges do not exist in isolation but are interconnected within a complex network of cause-and-effect relationships.
Conclusion: The findings confirm that the challenges within Iran's emergency system mirror global trends and overlap significantly with issues reported in other low- and middle-income countries (LMICs). Addressing these problems requires a holistic and systemic approach that simultaneously targets human, logistical, organizational, and socio-cultural dimensions, while ensuring system preparedness for potential accidents and disasters.
