Background Emergency Medical Services (EMS) have been always considered as a vital service provided by of many Red Cross and Red Crescent (RCRC) national societies worldwide and in Middle East and North Africa (MENA) region in particular during emergency and non-emergency contexts. The role to supporting the national wide health system in prehospital stage has got special attention during COVID 19 due to overwhelming health care facilities. The national societies have played a key role in mitigating the impact of the COVID 19 on the healthcare facilities by activating and growing their EMS capacities and expanding their scope of services in the prehospital stage. To define capacities and areas for improvement in RCRC national societies, we’ve developed a tool to survey different aspects of EMS. Methodology A questionnaire was designed by the IFRC MENA health team based on Prehospital emergency management system PEMS conceptual framework for assessment. 67 questions were grouped into 5 domains: governance and dispatch, Human Resources (H.R.) & Logistics, EMS Education, EMS operation and quality , and EMS disaster preparedness. Two open-ended questions were added to define areas of improvement and what national societies can offer to enhance capacities for other national societies in the region… The questionnaire was piloted with EMS leaders at Lebanese Red Cross. Between the period of April 2022 and August 2022, the online questionnaire was sent to four national society EMS managements, Lebanese Red Cross LRC , Palestine Red Crescent Society PRCS , Saudi Red Crescent Authority SRCA and Syria Arab Red Crescent SARC. The answers were collected using SurveyMonkey platform and validation workshops were held with all four EMS managements. For the qualitative questions of the perceived weaknesses and strengths, interviews with EMS managements were recorded and transcript. Analysis tools of SurveyMonkey was utilized for quantitative data analysis, and qualitative data was explored manually using thematic analysis methodology. Results The input from the four national societies revealed variation in governance, structure, and scope of services of EMS among them. We can highlight the main outcomes under each domain EMS Governance and Dispatch The four NSs are considering scoop and run operational model. The percentage of acute to cold cases in day to day practice is varying with predominance of cold cases among all. SRCA, PRCS in West Bank, and LRCS central dispatch center are using fully automated dispatch system, while LRC is using semi-automated in the regional dispatch centers, and SARC and PRCS branches in Gaza and Jerusalem are using manual (paper based) dispatch system. EMS H.R. & Logistics LRC, PRCS and SARC are mainly relying on volunteers to run EMS daily operations while SRCA depends on 6000 full time employees to operate 24/7 EMS services. SRCA EMS fleet is considered the largest among the four NSs with around 1,400 vehicles, LRC came next with 390 vehicles, then PRCS with 180, and lastly SARC with 112. EMS Education Both LRC and SRCA are running international accredited emergency courses including Basic Life Support (BLS), Advanced Life Support, Prehospital Trauma Life Support (PTLS), Advanced Trauma Life Support, and other relevant courses. On the other hand, PRCS and SARC are considering academic and locally customized training courses to train their EMS staff and volunteers. EMS Operation and Quality The service coverage of the four EMS in urban areas ranges between 80 – 100% while coverage decreases in rural areas to reach under 50% in some regions. Quality assurance and regular monitoring are areas that need to be standardized and systematized in most cases. EMS Disaster Preparedness Specialized training program for Mass Causality Incidences (MCI) is conducted in LRC, PRCS and SRCA. LRC, SARC, and SRCA possess a standardized approach for major incidence management as part of their disaster management

Keywords: EMS, MENA NSs, RED CROSS EMT, RED CRESCENT EMS , Saudi red crescent authority , Lebanese red cross EMS , Syria Arab Red crescent EMS , Palestine red Crescent EMS