Global rural and remote prehospital trauma systems: a scoping review

There are limited data on the global availability of trauma care from a prehospital systems perspective, particularly for rural and remote populations. This scoping review aimed to identify and describe prehospital services for rural and remote areas within defined trauma systems worldwide. We searched MEDLINE, EMBASE, and CINAHL for literature published between 2013 and 2025. Studies were included if they addressed rural or remote populations and provided clear descriptions of prehospital trauma systems. A total of 880 abstracts were screened, and 34 studies were included in the final analysis, representing data from 14 countries. The majority were from the United States ( n = 13; 38%) and Norway ( n = 3; 9%). Four studies (12%) were from low- and middle-income countries (Kenya, Nepal, South Africa). “Classic” prehospital providers included paramedics ( n = 25; 74%), police ( n = 3; 9%), firefighters ( n = 1; 3%), search and rescue ( n = 4; 12%), coast guard ( n = 1; 3%), and border guards ( n = 1; 3%). Fifteen studies (44%) described “contextually specific” models, such as integrated physician-paramedic teams ( n = 11), wilderness EMS providers ( n = 1), and community-based responders ( n = 3). Identified system strengths included improved access to care and better patient outcomes. Key challenges included limited resources and inadequate communication infrastructure. This review highlights the importance of contextually adapted prehospital frameworks as effective models for trauma care in rural and remote settings.