Introduction The Emergency Medical Services system is the first system that responds to people who need immediate emergency care. In prehospital, EMS workers deal with various cases. This study focuses on the challenges and weaknesses of the EMS system in dealing with life- threatening critical issues to identify and compare the obstacles that affect the outcomes of the EMS system when exposed to critical care cases by measuring these aspects: patient care, workforce, policy, education, and equipment. Methodology In this research, the sampling technique was Random sampling technique. The study area is the Saudi Red Crescent Authority in Saudi Arabia. The inclusion criteria include field paramedics and EMTs in the Saudi Red Crescent Authority. The sample size is 385. The researchers gathered data by using an online questionnaire. The data were analyzed using SPSS Inc. Categorical data were presented as frequencies and percentages. Results In total of 674, the results were that most of the respondents fell within the 31–40 age range (61.4%). The majority of respondents were EMTs (83.7%). The study revealed that 80.0% of respondents responded to over 20 critical cases. The majority of females were in the central area. Paramedic specialists were more likely to work in the western area in critical cases. 69.1% believing four members were satisfactory. The older respondents had the highest proportion (54.5%) of those who believed that two squad members were enough to handle one critical case. Additionally, 80.7% reported shortages of tools or drugs, with drugs being the most commonly missing material (45.7%). 77.5% agree to change the policy to enhance their dealings with critical cases. The study found the participants agreed that they need more practice to deal with critical cases, with a percentage of 62.2%. Also, 74.3% believe the curriculum needs adjustment. Finally, to improve patient outcomes, the Saudi EMS system requires updated protocols, further training sessions, and better workforce distribution. A multifaceted strategy is required to address these issues, including better resource management, gender diversity, and the balance of regional resources.

Keywords: Obstacles, Emergency Medical Service , Critical Care, Paramedics, Emergency Medical Technician, Prehospital.