Title: Emergency and Mass Casualty Response in Resource-Limited and Geographically Isolated Environments: Systems, Training, and Technology
Authors: Stephen Vure Gbaraba, Florence Eribenne, Helen Ekwi Osinem, Sylviastella Favour Peteranaba
Volume: 10
Issue: 9
Pages: 1-19
Publication Date: 2026/09/28
Abstract:
Emergency and mass-casualty events place disproportionate pressure on health systems operating under resource scarcity, weak infrastructure, and geographic isolation. This review examined the organizational, clinical, technological, and community-level determinants of effective response in such environments, with emphasis on system coordination, workforce preparedness, logistics, essential services, and emerging digital capabilities. A thematic review approach was used to synthesize evidence across command structures, triage and referral pathways, transport and communication, simulation and competency development, telemedicine, drones, mobile platforms, remote diagnostics, trauma stabilization, infection control, community preparedness, cross-sector partnerships, and implementation priorities. The findings indicate that response effectiveness depends principally on the alignment between casualty demand and locally available surge capacity rather than on casualty numbers alone. Persistent weaknesses include fragmented governance, workforce shortages, limited specialist access, unreliable transport, communication failures, fragile supply chains, and inadequate infrastructure. Recurrent simulation, interprofessional training, community responder development, and decentralized preparedness were identified as critical for strengthening operational readiness. Digital tools can extend specialist reach, improve situational awareness, accelerate logistics, and support decision-making, but their benefits remain conditional on interoperability, cybersecurity, connectivity, workforce readiness, and sustainable financing. The review further demonstrates that resilient emergency systems require coordinated participation from health services, governments, humanitarian actors, military structures, private organizations, and local communities. It concludes that locally adapted, integrated, and scalable response architectures offer the most credible pathway to reducing preventable mortality and service disruption. Policy priorities should include sustained investment in emergency care, resilient communications and energy systems, standardized data platforms, recurrent training, stronger referral networks, and context-specific implementation research across remote, underserved, disaster-vulnerable populations in all regions.