Explaining the challenges of helicopter emergency medical service personnel in transporting life-threatening casualties: a qualitative study

Abstract Background Helicopter Emergency Medical Services (HEMS) provide rapid medical care in geographically challenging and time-critical situations. This study explored the challenges experienced by HEMS personnel in western Iran. Methods A qualitative study using the conventional content analysis approach of Graneheim and Lundman was conducted between April and October 2023. Semi-structured interviews were conducted with 17 HEMS personnel in Hamadan and Kermanshah provinces. Data were analyzed using MAXQDA software. Results Five major themes emerged: operational and environmental challenges (e.g., logistical delays and adverse weather conditions), communication and coordination challenges (e.g., inter-team miscommunication and protocol gaps), clinical and technical demands (e.g., rapid decision-making and equipment limitations), psychological and emotional challenges (e.g., trauma exposure and threats from patients’ relatives), and systemic and contextual obstacles (e.g., inadequate training and outdated helicopters). Participants described substantial challenges related to patient management, interagency communication, flight safety, and psychological well-being, which were further exacerbated by resource limitations and organizational constraints. Conclusion HEMS personnel in western Iran experience complex and interrelated operational, clinical, psychological, and systemic challenges that affect both patient care and workforce well-being. Strengthening specialized HEMS training, integrated communication systems, infrastructure, and psychological support programs may improve the effectiveness and sustainability of HEMS services in resource-limited settings. Clinical trial number Not applicable.