Barriers and facilitators to provide effective pre-hospital trauma care for road traffic injury victims in Iran: a grounded theory approach

A qualitative study design using a grounded theory approach was selected. The data, collected via in-depth interviews with 15 pre-hospital trauma care professionals, were analyzed using the constant comparative method.Seven categories emerged to describe the factors that hinder or facilitate an effective pre-hospital trauma care process: (1) administration and organization, (2) staff qualifications and competences, (3) availability and distribution of resources, (4) communication and transportation, (5) involved organizations, (6) laypeople and (7) infrastructure. The core category that emerged from the other categories was defined as "interaction and common understanding". Moreover, a conceptual model was developed based on the categories.Improving the interaction within the current pre-hospital trauma care system and building a common understanding of the role of the Emergency Medical Services (EMS) emerged as key issues in the development of an effective pre-hospital trauma care process.Road traffic injuries (RTIs) are a major public health problem globally causing more than a million deaths and almost 50 million injuries every year [1]. Low and middle income countries (LMICs) account for 90% of Disability Adjusted Life Years (DALYs) lost and for 90% of the deaths from road traffic crashes [1-3]. As the majority of trauma deaths in LMICs occur in the pre-hospital setting [4-6], it is suggested that improvements in pre-hospital trauma care can contribute to a decrease in crash-related mortality and morbidity [4,7-11].The pre-hospital trauma care process consists of six key steps: detection, reporting, response, on-scene care, care in transit and transfer to definitive care [12] (The six steps inspired from the Emergency Medical Services-EMS-symbol or so-called 'Star of Life' symbol created by the US National Highway Traffic Safety Administration which presents six EMS functions[13]). The essential elements of a pre-hospital trauma care system include prompt commun