In order to reduce crash consequences, EMS capabilities in terms of human and physical resources have improved substantially during

recent years [23,24], but the statistics for crash-related mortality and morbidity do not show a noticeable decrease [24]. Few studies have been done on trauma care for injured people in Iran and those that have been conducted have mainly Inhibitors,research,lifescience,medical focused on evaluating pre-hospital time intervals and quality of trauma care provided in the hospitals [22,25-27]. One exception is a recently published study about the barriers to post-crash management in Iran [24], where the authors mainly discussed the role of laypeople and the involvement of other organizations at the crash scene. Studies conducted on trauma Inhibitors,research,lifescience,medical care in other LMICs have mainly concentrated on availability of resources and effective interventions done in pre-hospital settings, especially training of laypeople and EMS personnel [4,8,18,28-32]. With the aim of exploring the process of pre-hospital trauma care for RTI victims in Iran and identifying potential areas for improvements, the current study explores different aspects of providing pre-hospital trauma care based on Inhibitors,research,lifescience,medical the experience and perceptions of pre-hospital trauma care professionals. Methods A grounded theory approach

was used for the collection and analyses of data. According to Strauss and Corbin [33], findings grounded in data are likely to offer insight, enhance understanding, and provide Inhibitors,research,lifescience,medical a meaningful guide to action. This method is suitable when relatively new areas are to be discovered or if one desires to explore a known area from a fresh perspective [33,34]. Study setting This study was conducted among pre-hospital trauma care professionals, mainly from Tehran, the capital city and the largest city in Iran

with a population of around 13 million [35]. The total number of RTI deaths in Tehran in 2006 was 2645 (20 per 100,000) [36]. The EMS in Iran, which is mainly based on a Basic Life Support (BLS) system [9], is centralized Inhibitors,research,lifescience,medical under the Ministry of Health. Provincial centres are affiliated to the Medical Sciences and Health Services University in each province (Figure ​(Figure1).1). In Tehran city, pre-hospital trauma care is provided by the local EMS center that is directly governed Megestrol Acetate by the national EMS center in Ministry of Health. In 2006 the Tehran EMS centre had 138 ambulance dispatch sites (urban and road-side), 275 ambulances (which were mainly equipped with BLS instruments) and 1614 staff (including physicians, nurses, emergency medical check details technicians and other staff) [36]. Figure 1 Position of the EMS in the Iranian Health care system structure. The EMS center in Tehran receives more than 1000 calls each day [25]. The operators, who answer the calls in the EMS central dispatch, are usually trained nurses.