Emergency Response and Patient Transport in Remote Indigenous Communities: A Scoping Review

Prehospital and inter-facility transport, such as air medical retrieval and pre-birth evacuation, often move Indigenous patients in rural and remote settings out of their communities, where care is already shaped by fragmented funding and structural inequities; no review has mapped these pathways globally. This scoping review mapped evidence on prehospital emergency response and patient transport for this population. A librarian-assisted PubMed, Embase, and Scopus search was conducted for English-language publications on March 9, 2026. Eligible studies included an explicit rural Indigenous population with a defined prehospital pathway. Two reviewers independently screened titles and abstracts and assessed full texts, and a third reviewer resolved disagreements. Data were charted using a standardized form and synthesized descriptively. Across eight countries, 76 studies met the inclusion criteria, primarily from Australia (n = 29) and Canada (n = 23). Air transport and medical evacuation was the most frequently described pathway (71%), followed by ground transport (51%). Explicit description of paramedic or emergency medical services (24%) and dispatch/9-1-1 (12%) were depicted less frequently. Additionally, pathways were commonly described but rarely evaluated: only 12/76 (16%) publications used an evaluative design, and no pathway was evaluated in more than 7 of 76 publications (9%). The most reported barriers were infrastructure and communications (92%), cost and jurisdiction (87%), and distance to definitive care (83%). All percentages describe how often a topic was reported across the 76 included publications, and not its prevalence in practice. An explicit cultural-safety framework was applied in 9% of the publications, and community-led governance of the research in 7%. The published evidence disproportionately described transporting patients out of their communities. Community first response and tele-support were described more often than their standing in the literature suggests; however, they were rarely evaluated, and Indigenous-led governance of the research itself was reported in 7% of publications. Low reporting frequency does not establish that these models are uncommon in application and practice. Future priorities include community-partnered evaluation of community-based capacity and telehealth-supported care, alongside the development of patient and family cultural safety.