OBJECTIVE Making an accurate clinical diagnosis in the field of prehospital is of great challenge in medical services. This study aimed to determine agreement between prehospital and in-hospital diagnoses. METHODS The diagnostic agreement was determined by a comparison of the discharge diagnosis with the prehospital emergency technicians in a period of 6 months at the emergency medical services in northwest Azerbaijan. The diagnostic agreement of discharge diagnoses was compared with the fist diagnosis by the paramedics. The results were analyzed using the kappa agreement coefficient and the chi-square test. RESULTS The overall agreement between the diagnosis made by the emergency medical technicians and the hospital's first diagnosis was 67% (95% confidence interval [CI], 61%-77%; k = 0.61; 95% CI, 0.56-0.67), whereas the agreement between the first diagnosis made by the emergency medical technicians and the hospital discharge diagnosis was 58% (95% CI, 49%-65%; k = 0.42; 95% CI, 0.37-0.48).There was a high proportion of diagnostic agreement for pregnancy (100%), poisoning by drugs (88%), essential (primary) hypertension (86%), and ischemic heart diseases (72%). There was a low proportion of diagnostic agreement for weakness (39%), mixed anxiety and depressive disorder (43%), and cerebellar stroke syndrome (59%). CONCLUSIONS Our attention in practice and emergency medical courses should be directed to diseases that have a subjective history, such as weakness and anxiety, due to the high proportion of incorrect diagnoses by the prehospital emergency technician. It should be noted that most of the incorrectly diagnosed cases were overestimated with another coronary syndrome.