Background Injuries in desert recreational sports often result in significant delays in reaching healthcare providers, especially when the injury site is distant from built roads and human habitation. Therefore, reducing pre-hospital delay is crucial for minimizing injury-related mortality and morbidity.

Aim We aimed to identify actors and resources in pre-hospital emergency care in desert recreational injuries in the United Arab Emirates (UAE). In addition, we sought to understand the stages of pre-hospital delays and their contributing factors in the region.

Methods Our qualitative study had 53 in-depth interviews and snowballing technique to identify participants. Actors were identified through participant responses and further interviewed to identify pre-hospital delays. Audio-recorded interviews were transcribed, translated, and analyzed in NVivo. Framework analysis and reflexivity exercises were conducted. Themes included actors, resources, systems, and delay.

Findings Influential actors in post-injury system are riders, rider club, family, tour operators, and emergency care workers. Resources and infrastructure that supported emergency care access include tour companies, public trauma care ambulance despatch system, and universal health insurance support.

Pre-hospital delay occurred in four stages: (i) Delayed decision to avail emergency care due to incompetence in assessing injury severity. (ii) Delay in seeking emergency care- due to communication barriers, trust issues, previous experience and lack of insurance coverage. (iii) Rescue delay due to terrain, weather, network coverage, and rider awareness. (iv) Delay in locating trauma facility due to insurance coverage, facility preference, or information system disconnect. Lack of insurance coverage causes delay in availing medical help, completing treatment, and rehabilitation for injured riders.

Conclusion To reduce pre-hospital delays in desert recreational injuries, it is vital to identify the public agency and social support network around injured riders, enhancing their competencies in injury assessment and emergency care protocol. Additionally, addressing financing gaps with universal insurance and implementing an integrated information system linked to trauma care can facilitate a continuum of care, reducing delays. This study highlights the influential actors in the post-injury system, the resources and infrastructure supporting emergency care access, the four major stages of pre-hospital delay, and the significant role of insurance in availing medical help and completing treatment.