In this paper we describe the information, communication, and acceptance issues in a tele-medical workflow, taking a pre-hospital emergency medical service (EMS) as an example. EMS workflows are extremely time-critical, impose a high responsibility, and crucially depend on a close, well-trained cooperation between EMS personnel. Though increasingly information and communication technologies (ICT) are used to support this sensitive and life-critical process, still, shortcomings in the emergency workflow are observed, especially in countries as Germany in which EMS are not fully standardized. We empirically examined organizational, communication and information gaps within EMS workflows. Together with emergency staff we schematically modeled a standard workflow circuit and visualized information, communication, and organizational issues including ICT usage. Second, in semi-standardized interviews with emergency physicians, we identified critical communication and information gaps within this workflow. Based on this we derive first recommendations regarding an optimization of the EMS workflow.