Emergency healthcare access for transient populations in mountainous environments: a scoping review

Abstract Background Mountain environments present substantial barriers to emergency healthcare delivery because of difficult terrain, variable weather, limited infrastructure, and prolonged transport times. These challenges are amplified when transient and mobile populations enter geographically constrained settings with limited emergency medical resources. This review mapped the barriers, facilitators, and stages of the emergency care pathway influencing emergency healthcare access for these populations. Methods A scoping review was conducted and reported in accordance with PRISMA-ScR. Scopus, Web of Science, Embase, MEDLINE, CINAHL, and Google Scholar were searched for sources examining emergency healthcare access or delivery for transient or mobile populations in mountain, high-altitude, or rugged-terrain settings. Quantitative, qualitative, mixed-methods, geospatial, operational, and systems-level evidence was eligible. Two reviewers independently screened titles, abstracts, and full texts. Data were charted using a standardized extraction framework and synthesized descriptively. Results Of 737 identified records, 23 sources met the inclusion criteria. Included sources examined tourists, climbers, pilgrims, migrants, disaster-affected populations, and mass-gathering participants across diverse mountain regions. Common barriers included difficult terrain, limited roads, weather variability, altitude-related operational constraints, communication limitations, and insufficient emergency medical system capacity. Predictable surges associated with tourism, pilgrimage, and sporting events frequently strained local resources. Reported facilitators included helicopter emergency medical services, on-site medical clinics, specialized mountain search and rescue systems, telemedicine, drones, and geospatial planning tools. Delays occurred across multiple stages of care, including incident recognition, system activation, responder access, field care, evacuation, interfacility transfer, and definitive care. Conclusions Emergency healthcare access for transient and mobile populations in mountain environments is shaped by the interaction between geography, environmental exposure, system capacity, and population movement. Findings support a chain-of-care planning approach that addresses cumulative delays while accounting for terrain, weather, altitude, and predictable surge demand. Future research should prioritize standardized access measures, geospatial modeling, and evaluation of intervention effectiveness.