Prehospital emergency medical services in Nepal: current status, challenges, and future directions

Nepal, a landlocked country in South Asia, is topographically diverse, consisting of mountains, hills, and plains (Terai). Geographic challenges impede EMS access, especially in remote, mountainous areas with substandard and deteriorated road infrastructure and Fragmented populations. While the nation's healthcare system is gradually advancing, it remains largely centralized and underdeveloped. Prehospital medical care is still in its infancy and is virtually inaccessible to much of the population, especially in remote areas. Although various government policies have been introduced to address this issue, implementation has been inconsistent. This paper aims to provide an overview of the current state of prehospital medical care in Nepal, conduct an analysis of existing policy frameworks to identify key challenges and opportunities, thereby offering insights to guide the development and implementation of future policy initiatives and make recommendations for its future.

This study is a narrative review and policy analysis which examines evidence by systematically searching PubMed, Scopus, Google Scholar, and national databases for literature published between 2000 and 2025, supplemented by primary data and expert insights, and findings are thematically synthesized to assess the current status and challenges of prehospital emergency medical services in Nepal.

Pre-hospital emergency care in Nepal is still in a rudimentary phase. Analysis of the current system underscores that Inconsistent policy implementation, limited infrastructure, and a lack of standardized training are the key barriers to its development. Comparative cross- regional analysis shows that urban areas have relatively better access compared to rural regions, highlighting significant disparities.

Although progress has been made in pre hospital emergency care in recent decades, significant development is required to ensure timely access to emergency medical services. Notable obstacles to the development of pre-hospital care include insufficient infrastructure, scarce resources, and the lack of standardized formal training. Further research is essential to identify the most appropriate prehospital care model for Nepal's distinct geographical and socioeconomic conditions. Ultimately, coordinated efforts among government agencies, non-profit organizations, and international partners are essential to ensure timely and equitable emergency medical services across the country.