Table 2.

Challenges affecting the management of preventable deaths due to road traffic injuries in the pre-hospital phase based on the participants’ opinions in Iran

Categories	Subcategories	Code examples
Low quality of victim management	Low quality of clinical care	-Wrong intubation -Insufficient fluid therapy of patients -Not using cervical collar for the victims
	Lack of accurate clinical assessment	-Inadequate report of medical history of patients to the hospital by technicians -Incomplete clinical examination of the patients by technicians -Unsuitable diagnosis of clinical status due to negligence in victim survey
Poor management of the crash scene	Lack of rapid access to patient	-Lack of prompt presence of staff of the Red Crescent at the scene -Lack of sufficient skills in Red Crescent staff for rapid releasing of the victim -Lack of adequate equipment for the Red Crescent staff in releasing the victim
	Lack of scene safety	-Necessity of supervision on ambulance equipment to prevent robbing of equipment by bystanders at the scene -Lack of proper cooperation of the police to prevent quarrels at the crash scene -Physical fight between angry people and EMS technician at the crash scene
Poor communication and coordination	Poor communication of EMS staff	-Deficiency of communication infrastructures -Necessity of teamwork by prehospital rescue team
	Lack of uniform commandership at the crash scene	-Indecisiveness of the rescue team at the crash scene -Irrelevant interference and assertions by different bystanders at the crash scene -Dominance of the police over the crash scene most of the time
Lack of adequate rules and regulations	Lack of protocols and guidelines	-Necessity of reviewing the educational curriculum of Medical Emergencies major -Necessity of assessing educational needs of prehospital rescue team -The need for use of experienced and tactful staff in prehospital emergency care -Necessity of continuous and up-to-date education of the staff providing prehospital emergency care
	Lack of clear checklists for duties	-Necessity of providing public education for dealing with road traffic injuries -Lack of familiarity of the public with first aid principles -Secondary damage to the victims by wrong interference of irrelevant individuals at the crash scene
Poor time management	Elongated response time at the crash scene	-Time-consuming path to the crash scene due to unfamiliarity of the staff with uncrowded routes -Lack of collaboration of people in opening the way for the ambulance -Lack of management of the police to avoid pile-ups at the crash scene
	Elongated time of victim transport	-Wandering of ambulances at the crash scene due to lack of exit path for ambulances -Not opening the road for ambulances by people from the crash scene to the hospital
Low quality of training	Insufficient training of EMS Staff	-Necessity of revising educational curriculum for EMS major -Necessity of assessing needs of prehospital EMS staff -Necessity of using skilled and tactful clinical staff in prehospital emergency care -Necessity of up-to-date training of prehospital rescue team
	Inadequate public training	-Necessity of providing public education on proper approach to road accident victims -Unfamiliarity of the public with first aid principles -Secondary damage to the victims due to the wrong interference of irrelevant individuals

EMS: Emergency medical service.