Background: With the outbreak of Coronavirus Disease 2019 (COVID-19), the workload of the Iran’s health care system along with Pre-hospital Emergency Service (PHES) increased significantly so that Iranian fledgling emergency system had never experienced such a crisis. With regard to the importance of the function of PHES as the front line staff of Iran’s health system and its role in controlling the recent epidemic crisis, this study was conducted to identify the challenges of PHES function in the face of COVID-19 pandemic. Methods: The study was conducted with qualitative approach through content analysis in 2021. Semi-structured interviews were used to collect data. Sampling was purposive and continued until data saturation. After 24 interviews, the data were saturated. The extracted codes were thoroughly prepared as a data pool. After encoding all available data, the related codes were categorized into a single theme. After extracting the themes, a network of themes, related to the research topic, was drawn, and then, the relationship between the themes was analyzed. Results: Data analysis undertaken for the qualitative study resulted in the identification of four main themes included: challenges related to facilities and equipment, living with uncertainty, professional and organizational capabilities, and burnout. Conclusion: PHES personnel have an important and key role in providing care to patients during COVID-19 epidemic period. Individual and systemic challenges were among the most important issues in the experiences of these personnel. These challenges require organizational planning and special attention of health policy makers to maintain the staff’s physical and mental health during the pandemic and the possible crises ahead.

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Background. emergency medical Services (emS) are an important part of the healthcare system. decision making is the most important part of their profession, as they often have to make a quick decision and act upon it, despite the critical conditions of the patient. They are often the first to deal with COVID-19, and they experience severe physical, mental or moral stress. Objectives. The aim of this study was to determine the level of Professional Moral Courage (PMC) of Pre-Hospital Emergency (PHE) staff in the management of patients with COVID-19. Material and methods. This descriptive, analytical study was conducted in 2020. A total of 200 PHE staff entered the study, recruited by the census sampling method. Data collection was undertaken using a validated moral courage questionnaire. The data was analyzed using SPSS version/21 with descriptive and analytic tests. Results. The mean age of the participants was 34.42 ± 7.14, and mean of their work experience was 10.29 ± 6.59 years, of the mean moral courage score was 90.77 ± 2.97. There was a significant relationship between the mean score of moral courage and age, type of employment and participation in disaster exercises and training courses (p < 0.001). Conclusions. The findings of the study showed a significant relationship between various variables and level of moral courage in PHE staff. Awareness of the moral courage of PHE staff is the first step to improve their preparedness. This study provides evidence of the need and potential positive impact of moral education opportunities for healthcare team.