In this paper we describe information, communication, and acceptance issues in a telemedical workflow, taking a pre-hospital emergency medical service (EMS) as an example. EMS workflows are extremely time-critical, impose high responsibility on physicians, and crucially depend on close, well-trained cooperation amongst EMS personnel. Although information and communication technologies (ICT) are increasingly used to support this sensitive and life-critical process, shortcomings in the emergency workflow are still observed. This applies especially in countries in which EMS are not fully standardized (as e.g. in Germany). In this research, we empirically examined organization, communication and information gaps within EMS workflows. Together with emergency staff we schematically modeled a standard workflow circuit and visualized information, communication, and organization issues including ICT usage. Second, combining qualitative (interviews) and quantitative procedures (questionnaire), we evaluated the potential benefits and perceived drawbacks of the usage of telemedical technology in the rescue chain from the perspective of emergency physicians. Results revealed a high potential of ICT in emergency situations but its implementation has to be carefully designed. Beyond the obvious advantages, we identified critical communication and information pitfalls within this workflow. Based on these findings we derive recommendations regarding an optimization of the EMS workflow.