Health in Emergencies and Disasters Quarterly

fa Living with Embodied Uncertainty: A Phenomenological Study of Risk, Ethics, and Systemic Strain Among Iranian Helicopter Emergency Medical Services Providers اورژانس Emergency پژوهشي Research <div style="text-align: justify;">Background: Helicopter Emergency Medical Services (HEMS) in resource-limited settings represent critical but structurally constrained lifelines. While operational challenges are documented, a profound knowledge gap persists: the lived phenomenological experience of frontline providers navigating the intersection of acute clinical risk, chronic systemic strain, and embodied ethical decision-making remains unexplored. This study addresses this gap by investigating the essence of meaning-making among Iranian HEMS personnel operating under significant duress. Methods: An interpretive phenomenological design was employed. Through purposive maximum-variation sampling, eleven HEMS providers from three Iranian bases participated in in-depth, semi-structured interviews. Data were analyzed using Reflexive Thematic Analysis (RTA) within a phenomenological framework. Rigor was ensured via a structured reflexivity protocol, consensus coding, member checking, and audit trail maintenance. The study received full ethical approval. Results: The analysis crystallized in the core phenomenon of "Embodied Uncertainty" a pervasive state of being wherein professional agency is continuously negotiated within and against systemic constraints through bodily, cognitive, and moral dimensions. This essence is constituted by five interconnected themes: 1) Vocational Calling and Existential Sacrifice, 2) Operational Vigilance as a Habituated State, 3) Ethical Decision-Making Under Constraint as Moral Residue, 4) Training as a Ritual of Anticipatory Control, and 5) Systemic Pessimism as Crystallized Foresight. Crucially, the findings delineate a direct, lived pathway from operational friction and resource scarcity to tangible moral injury, where ethical dilemmas are not just cognitively processed but somatically retained ("engraved in muscle memory"). Conclusion: This study makes a seminal contribution by theorizing "Embodied Uncertainty" as a fundamental framework for understanding prehospital work in constrained systems. It moves beyond cataloging stressors to model the dynamic embodiment of systemic failure. The findings compel a paradigm shift from individual resilience narratives toward structural accountability. We propose three evidence-based, actionable pillars for reform: (1) Mandatory, psychologically-informed post-mission debriefing systems to process moral residue; (2) High-fidelity, interprofessional simulation training co-designed with crews to bridge preparedness gaps; and (3) National ethical guidelines for aeromedical retrieval co-created with frontline providers. Ultimately, this research posits that provider well-being is the foundational determinant of HEMS safety and sustainability a critical imperative for global prehospital systems facing analogous constraints.</div> Emergency Medical Services, Air Ambulances, Clinical Decision-Making, Qualitative Research 0 0 http://hdq.uswr.ac.ir/browse.php?a_code=A-10-397-5&slc_lang=fa&sid=1 Mohammadreza Azadeh azade.emt@gmail.com No Department of nursing, Faculty of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran Mohammadamin HajidehAbadi hajidehabadi79@yahoo.com No Department of nursing, Faculty of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran Mina Gaeni mkaeeni@yahoo.com No Department of nursing, Faculty of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran Mohadeseh Motamed Jahromi mohadesehmotamed@gmail.com No Department of Public Health, Faculty of Health, Fasa University of Medical Sciences, Fasa, Iran Mohammad Parvaresh Masoud mparvaresh@muq.ac.ir Yes Department of Emergency Medical, Faculty of Allied Medical Sciences, Qom University of Medical Sciences, Qom, Iran