Background <p>Effective Emergency Medical Services are crucial for enhancing public health outcomes, particularly in regions prone to emergencies. This study assesses the current state of public Emergency Medical Services in Nakuru County, Kenya, identifying gaps in service delivery and contextualizing findings within the broader health infrastructure.</p> Methods <p>An exploratory sequential mixed-methods cross-sectional study was conducted in Nakuru County. The qualitative phase comprised three focus group discussions with twenty Emergency Medical Services personnel and five key informant interviews with health managers. Findings informed the development of a questionnaire survey administered across all nineteen ambulance stations to assess infrastructure and resources systematically.</p> Results <p>Qualitative analysis revealed six major themes: infrastructure and resource deficiencies, human resource challenges, training needs, psychological and physical health risks, systemic barriers, and community engagement gaps. Quantitative findings demonstrated that all twenty ambulances were classified as Basic Life Support, with significant equipment deficiencies including absent automated external defibrillators (100%), oximeters (95%), and blood glucose monitoring devices (100%). No dedicated Emergency Medical Services personnel were assigned to ambulances beyond drivers. Only fifteen per cent of facilities had specialized Accident and Emergency Departments.</p> Conclusion <p>Critical gaps in infrastructure, equipment, human resources, and training compromise Emergency Medical Services delivery in Nakuru County. Addressing these deficiencies through enhanced training, equipment upgrading, and community engagement can strengthen the Emergency Medical Services framework and improve health outcomes.</p>