Iran is one of the countries with considerable road traffic injuries.  Pre-hospital interventions have an important role in preventing mortalities and disabilities caused by traffic accidents. The present study aimed to explore the barriers of pre-hospital care in traffic injuries in Tehran, Iran. A qualitative content analysis approach was conducted based on 21 semi-structured interviews with 18 participants.  A purposeful sampling method was applied until reaching data saturation.  Interviews were transcribed verbatim, and then data condensing, labeling, coding and defining categories were performed by qualitative content analysis. Four main barriers including 4 main concepts and 13 subconcepts emerged; they included Barriers related to people, Barriers related to metropolitan infrastructure, Barriers related to the profession and Barriers related to managerial issues. Based on the findings of this study, pre-hospital service barriers in traffic accidents have many dimensions including cultural, structural and managerial domains. Policy makers in health system can use these findings to promote the quality of pre-hospital services, especially in the field of traffic injuries.