Fragile cooperation in high-casualty traffic incidents: a grounded theory study of inter-organizational emergency response in Iran

BACKGROUND: Road traffic injuries remain one of Iran's top four causes of death, posing a continuing public health and governance concern. Inter-organizational cooperation is frequently fragmented, particularly in mass-casualty traffic incidents, despite the existence of numerous emergency response organisations. In addition to developing a grounded conceptual framework that explains patterns of coordination failure, this study aims to theorise and model inter-organizational cooperation in such occurrences in Iran. METHODS: From 2020 to 2024, this qualitative grounded theory study was carried out. Through semi-structured interviews and expert panel discussions, twenty-seven managers, experts, and emergency response professionals from EMS, police, fire departments, the Iranian Red Crescent Society, and academic institutions took part. The Corbin and Strauss constant comparative approach, which uses open, axial, and selective coding, was used to analyse the data. RESULTS: "Fragile Cooperation" emerged as the main category from the investigation. Adaptive and maladaptive tendencies alternated in interorganisational collaboration. Paternalistic leadership in chaotic conditions, advocacy and volunteer participation, personalised crisis encounters, increased interaction after significant incidents, and selfless risk-taking were examples of adaptive tactics. Vague responsibility boundaries, cooperation-averse communication structures, interorganisational bias and competitiveness, conflicts of interest, and disorganised event scene management were examples of maladaptive tactics. The main tactic for enhancing collaboration, according to participants, is the creation of a unified emergency response system with a single national emergency number and integrated dispatch structure. CONCLUSIONS: The interorganisational collaboration of Iranian emergency response systems is highly dependent on relational and contextual factors and is structurally fragile. Sustainable improvement requires institutional reforms, unified emergency dispatch procedures, integrated operating protocols, and interoperable communication technology.