This is because EMS managers don’t believe that public education is a part of the EMS mission”. (Participant 1) Infrastructure A number of factors were mentioned as potential obstacles to an efficient infrastructure for pre-hospital trauma care such as lack of GPS system, sub-standard road infrastructures (including lack of an

emergency lane in cities and free-ways Inhibitors,research,lifescience,medical outside cities), lack of infrastructures for helicopter ambulances in the big cities, and an inadequate telecommunication system. “On the free-ways outside the cities there is no special lane for emergency services and no time standard for access to an Wortmannin cell line under-pass or slip road [to change direction on the free-way]. On some freeways we have to drive 3 to 4 minutes to reach a slip road and in other places 6 to 7 minutes”. Inhibitors,research,lifescience,medical (Participant 5) “One problem that we have is sub-standard roads. We don’t have special lanes for emergency services in all streets in the city and because of that it very often takes a long time to reach the crash scene due to the traffic”. (Participant 9) Core category: Interaction and common understanding Interaction and common understanding was identified as the core category in this Inhibitors,research,lifescience,medical study. This category was visible among all actors involved inside and outside the EMS system, including

health policy makers, managers and staff within the EMS, laypeople, actors within involved organizations on the crash scene, and actors within other influential sectors outside EMS. The participants indicated that the misconceptions about the role of EMS among health policy makers and EMS managers may result from their inadequate knowledge about EMS principles

and standards. Moreover, they stated that this was aggravated by the Inhibitors,research,lifescience,medical weakness of the current EMS structure which hinders better coordination and interaction between different actors and EMS centers across the country. According to the participants, the development of EMS (including increasing its resources and quality improvement Inhibitors,research,lifescience,medical in EMS) requires that the health policy makers and EMS managers deepen their understanding of the EMS. Participants believed that the conflicts and inadequate interaction between staff in general was PAK6 caused by a poor communication system and their inadequate knowledge and skills. They also argued that lack of documented protocols about individuals responsibilities led to misunderstandings among staff about their respective duties. Furthermore, the participants reported that the role of different organizations involved in the management of a crash is not clear and also that there is inappropriate communication, information and knowledge exchange between these organizations. These facts hinder an effective interaction between them, which makes it difficult to reach a common understanding about their respective roles in the crash scene.