Open Access Research article

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

Hassan Haghparast-Bidgoli123*, Marie Hasselberg1, Hamidreza Khankeh4, Davoud Khorasani-Zavareh5 and Eva Johansson6

Author Affiliations

1 Division of Global Health, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden

2 The Swedish Research School for Global Health, Partnership between Umeå University and Karolinska Institute, Sweden

3 Health Management and Economics Research Centre, Faculty of Management and Informatics, Isfahan University of Medical Sciences, Isfahan, Iran

4 Department of Nursing, University of Social Welfare and Rehabilitation, Tehran, Iran

5 Department of Public Health, Urmia University of Medical Sciences, Urmia, Iran

6 Nordic School of Public Health, Gothenburg, Sweden

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BMC Emergency Medicine 2010, 10:20  doi:10.1186/1471-227X-10-20

Published: 8 November 2010



Road traffic injuries are a major global public health problem. Improvements in pre-hospital trauma care can help minimize mortality and morbidity from road traffic injuries (RTIs) worldwide, particularly in low- and middle-income countries (LMICs) with a high rate of RTIs such as Iran. The current study aimed to explore pre-hospital trauma care process for RTI victims in Iran and to identify potential areas for improvements based on the experience and perception of pre-hospital trauma care professionals.


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.