Background: Deaths and disabilities due to the lack of proper Emergency Medical Rescue Services (EMRS) is a global public health concern, also in Dhaka city, Bangladesh.The study aimed at contributing to improve the EMRS in Dhaka city by assessing and identifying major shortcomings with possible solutions. Methods:The study was conducted in July/August 2017, after analyzing medical and relevant records, a one week observational study was conducted in 4 purposively selected hospitals in Dhaka city. The Mode of transport to the emergency centre and delay times were determined by observing and assessing medical records of the incoming patients. Information on the management of incoming emergency calls and trips of the ambulances were also documented. Satisfaction and perceived experience with the services was investigated by in-depth interviews of 56 patients relatives. 23 EMRS providers and managers were interviewed for their perceptions and recommendations.Results: Our document analysis of 2 study hospitals in Dhaka showed that 45.9% of total deaths (N = 13707) in 2014 were due to cardiovascular diseases, road traffic incidents, other accidents, and suicides. During the observation in 4 study hospitals, only 11.3% of the 734 emergency patients used ambulances to get to hospital, while 63% used rickshaws/motor-rickshaws and 25.8% bus/ car. 55.6% of emergency patients got to hospital after 60 minutes/later after start of symptoms (median delay 120 minutes; range: 40-2880 minutes). The median delay of ambulances (call to hospitalization) was 85 minutes (day-time 102 minutes; night 45 minutes). On emergency request only 23.6% of the 127 callers, a hospital ambulance was sent to the patient, while the other cases were not supported due to unavailability, long distance, and high fare issues of ambulance. Ambulances were used in only 10.7% of their available time for transporting patients. Ambulances were poorly equipped (unskilled driver, oxygen and rarely with first aid box). Satisfaction level about current services among patients relatives was low (only 1.8 on a scale of 4; N = 56). Major reasons of their not calling for an ambulance at emergencies were unavailability (67.3%) and unknowing phone number (51.9%). EMRS providers and managers complained about the poor structure of EMRS. Major concerns were: Policy deficit, corruption, no coordination centre with unique phone number, poor ambulance services, and traffic-jams. Conclusion:To reduce the number of deaths and disabilities, Dhaka needs to upgrade and improve its EMRS through a step-by-step process of telephone assisted emergency first responders led pre-clinical care.