Road trauma is a public health issue worldwide. The Emergency Medical Service (EMS) focuses on improving trauma patient outcomes by providing medical care and transporting patients to the appropriate health facility as quickly as possible. The aim of this study is to provide basic knowledge and recommendations for the improvement of current EMS management practice in relation to road trauma, in particular, in Khon Kaen Province, Thailand. An understanding of current EMS operation in response to Road Traffic Injury (RTI) enhances knowledge that informs the management of EM Services and identifies factors that can achieve better patient outcomes. The study consists of two parts: (i) a description of a road traffic injury and EMS response profile based on data available from KKRH Trauma Registry and the KK EMS database for KK EMS health area, and (ii) an exploratory qualitative analysis using in-depth interviews with KK EMS staff to determine how EMS management and patient outcomes could be improved. Many important road traffic injury risks from an eight year period from 1998-2005 were identified such as being a motorcycle rider, a young male, working as a labourer, not wearing a helmet while riding two-wheeled vehicles, festival and weekend periods, and rural location. The available EMS data from 2003-2007 indicates that EMS responses are to some extent adequate for the requirement of emergency calls. However, the dramatic increase in non-urgent cases in the past several years indicates some level of inefficiency. In-depth interviews with 20 EMS staff, who had experience in EMS employment, provided data for the qualitative part of the study. Thematic analysis was used. EMS staff commented on a number of social issues particularly regarding issues associated with alcohol-related injuries of young male motorcyclists, lack of the public awareness of EM Service provision and the professionalism of EMS staff. The study highlights that the KK social context has an influence on the effectiveness of management of both road safety strategies and EMS provided. The recognition of the impact of local worldview of management needs to be considered in the management of EMS of RTI.