Introduction: Alcohol contributes to at least 16% of ambulance call-outs in Scotland, placing a significant burden on emergency services. This study aimed to explore the circumstances behind these incidents from the perspective of practicing Scottish Ambulance Service (SAS) clinicians.

Methods: We conducted in-depth qualitative interviews (median duration: 81 minutes) with 31 SAS staff, purposively sampled for diversity in gender (10 women, 21 men), region, and length of service (1–50 years; median 10). Interviews were transcribed and thematically analyzed using both deductive and inductive approaches.

Results: Alcohol-related call-outs typically involved either chronic heavy drinking patterns mainly at home with co-existing mental, social, or emotional issues or acute intoxication in social settings. Clinicians reported a large volume of incidents and felt the public underestimated the proportion caused by chronic problems.

Conclusion: Strategies, policies, and interventions aiming to reduce pressure on emergency services must consider how to provide or improve accessible care for people with chronic alcohol problems, as well as how to reduce acute intoxication to help reduce the amount alcohol related calls SAS staff attend.