The annual Hajj mass gathering, drawing around three million pilgrims, necessitates intricate coordination among various organizations to provide essential services, including emergency medical services (EMS). This qualitative study investigates the factors that influenced EMS during the 2019 Hajj through the use of 26 semi-structured interviews with EMS responders, followed by seven key informant interviews. Through an open coding process, a total of 49 codes were identified, with the 20 most frequent codes providing valuable insights into the intricacies of EMS operations. Key challenges that have been identified encompass traffic control point management, language barriers, insufficient patient medical history, and a surge in non-emergency cases. The nature of emergency response hinged on these factors influenced by the level of coordination and the meticulousness of the organizing and planning. There is a need for improved coordination among the participating agencies in the Hajj mass gathering. It is imperative for the participating agencies to enhance their intra-agency and inter-agency coordination and engage in pre-planning for conflict resolution in order to optimize the interoperability of security and medical services. This intra-agency and inter-agency effort for effective coordination should be the cornerstone of future improvements in the planning of EMS provision.
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