BackgroundTime indices are key elements in prehospital medical emergencies. The amount of calls to EMS and the number of missions they have undertaken have been impacted by the Covid-19 epidemic. ObjectivesThis study's goal was to evaluate pre-hospital EMS time indices at the apex of the Covid-19 outbreak. MethodsData was extracted retrospectively from the Asayar Automation System, which records details on all emergency medical calls resulting in patient transport. The study period was from March 2018 to March 2021, covering the pre-COVID period and the first through sixth peaks of the pandemic in Iran. Standardized data extraction procedures were used to minimize bias in this retrospective review. ResultsIn this study, most transport missions occurred during the fifth peak (n=2811). In addition, the majority of missions were related to the age group above 60 years (31.1%), and the highest rate of patient transport (65.9%) was observed in male patients. Traumatic events, cardiac emergencies, impaired consciousness, and psychiatric disorders were respectively the main causes of patient transport. Moreover, a significant difference was observed between time indices of various Covid-19 peaks (P<0.001). ConclusionsEven though the structure of Iran's emergency system is based on the American-Anglo model, and rapid patient transfers to medical facilities are prioritized, the epidemic of COVID-19 resulted in increased calls and missions and affected time indices. Therefore, it is suggested that the method and type of service provision be modified during similar crises.