AimThis study aimed to conduct a psychometric evaluation of the Persian adaptation of the Emergency Medical Services Safety Attitudes Questionnaire (EMS-SAQ).MethodsIn this cross-sectional study, the validity and reliability of the EMS-SAQ were assessed among 484 Iranian pre-hospital emergency department employees between February and June 2023.ResultsFive factors were extracted namely safety climate, teamwork, job satisfaction, stress management, and working conditions with explained 38.75% of the total variance. The goodness of fit indexes confirmed the model (χ2 = 409.031, DF = 196, χ2 /df = 2.087, CFI = 0.900, IFI = 0.901, PCFI = 0.763 and PNFI = 0.701, and RMSEA = 0.069 [CI90% 0.059–0.078]).ConclusionThe Persian version of the SAQ-EMS, comprising 22 items across five factors, demonstrated good validity and reliability. It is recommended to undertake qualitative studies focusing on the concept of patient safety in pre-hospital settings, considering diverse contexts and cultural nuances to develop more robust assessment tools.