A qualitative needs assessment of Lima's prehospital emergency trauma system: Identifying challenges and opportunities for improvement

Background: In Peru, a middle-income country experiencing rapid urbanization, the prehospital system faces numerous challenges, particularly in the efficient and effective care of patients with trauma. This study aimed to examine stakeholder perspectives to identify system challenges and opportunities for improvement in Lima's prehospital emergency care system. Methods: Semistructured qualitative interviews were conducted with 49 providers from 4 urban hospitals and multiple prehospital agencies in Lima. Participants included physicians, trainees, volunteer firefighters, and emergency service personnel. Interviews were conducted in Spanish, audio-recorded, transcribed, translated to English, and analyzed using thematic analysis. Results: Four major themes emerged: System Structure and Organization, Communication and Coordination, Sociocultural Context, and System Improvement Needs. Key challenges included fragmented emergency response services, limited hospital and prehospital capacity, poor communication between agencies, frequent mis-triage, and lack of standardized prehospital training. Prehospital-specific challenges included absence of formal paramedic recognition, procedural limitations for volunteer providers, and inadequate oversight. Participants identified priority interventions including strategic resource allocation, unified emergency communications, standardized hospital notification protocols, formal provider training frameworks, and public education campaigns. Conclusion: Lima's prehospital system faces interconnected challenges requiring a phased approach to improvement. Short-term interventions should focus on prehospital trauma training implementation, whereas long-term efforts may address structural issues of dispatch and system unification. These findings provide a foundation for designing and implementing targeted interventions within Lima's rapidly urbanizing setting and also may be applicable in other similar middle-income settings.