Essentials for Building a Practice Model for Emergency Care Delivery in Southwestern Nigeria: A Scoping Review

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In Southwestern Nigeria, emergency departments face increasing pressure from trauma cases, population growth, workforce shortages, and fragmented service delivery. Despite the concentration of teaching hospitals in the region, emergency care often operates without a unified practice model to guide triage systems, workforce deployment, infrastructure planning, and governance. This scoping review aimed to synthesize existing evidence on emergency care delivery in Nigerian tertiary hospitals and identify essential components for developing a sustainable and context-specific practice model relevant to nursing practice and health system strengthening. Methods Joanna Briggs Institute methodological framework was followed and was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. A comprehensive search of PubMed, Scopus, African Journals Online, Cochrane Library, PsycINFO, and Google Scholar was conducted for peer-reviewed articles published between 2005 and 2025. Studies focusing on emergency care practices, workforce capacity, infrastructure, governance, and service delivery in Nigerian tertiary hospitals were included. Results Out of 427 records identified, 30 studies met the inclusion criteria. Four interconnected thematic domains emerged: infrastructure and resource systems; human resources and capacity building; governance and leadership; and innovation and collaborative practice. Key challenges included inadequate triage systems, equipment shortages, overcrowding, poor documentation, staffing deficits, workforce migration, and weak policy implementation. Although simulation-based training, mobile triage tools, and interdisciplinary teamwork demonstrated potential benefits, these innovations were largely pilot-based and not systematically integrated into routine practice. Conclusions Emergency care delivery in Southwestern Nigerian tertiary hospitals remains fragmented and under-resourced. Strengthening nursing capacity, standardizing triage protocols, improving infrastructure, enhancing leadership accountability, and scaling sustainable innovations are essential for developing a coherent emergency care practice model. Clinical Trial registration Number: Not Applicable Emergency nursing Tertiary hospitals Health systems strengthening Workforce capacity Governance Service delivery Nigeria Scoping review Figures Figure 1 Background to the study Emergency care represents a critical interface between communities and the health system, providing immediate assessment, stabilization, and treatment for patients with acute illness or injury. In well-functioning health systems, emergency care delivery is guided by clearly articulated practice models that define how services are organized, coordinated, and governed ( 1 , 2 ). A practice model for emergency care is a structured framework that specifies the organization of emergency services, including triage systems, patient-flow processes, workforce roles, clinical decision pathways, infrastructure requirements, and governance mechanisms that collectively shape service delivery at facility or system levels ( 1 , 3 ). Globally, the development and institutionalization of emergency care practice models have strengthened health system responsiveness and resilience. In high-income settings, models such as the Emergency Severity Index and standardized trauma systems clearly delineate roles, establish triage protocols, integrate pre-hospital and in-hospital services, and define accountability structures for emergency departments ( 4 , 5 ). Evidence shows that these structured models improve timeliness, enhance coordination, reduce avoidable mortality, and optimize resource use ( 6 , 7 ). In Low-and-Middle-Income Countries (LMICs) such as South Africa and Rwanda, emergency care models adapted to local resource constraints, emphasizing simplified triage, targeted workforce development, and contextual governance, have improved emergency access and outcomes ( 8 , 9 ). The WHO similarly recognizes that context-appropriate emergency care practice models are foundational to achieving universal health coverage and reducing preventable deaths in low-resource settings ( 1 , 10 ). In contrast, emergency care delivery in Nigeria remains largely model-deficient, with services operating without a unified framework to guide organization or practice. Tertiary hospitals, intended to serve as referral hubs for complex and life-threatening conditions, frequently operate under intense pressure, characterized by overcrowding, fragmented workflows, unclear role delineation among healthcare workers, weak triage systems, and poor integration between pre-hospital and in-hospital care ( 11 , 12 ). Emergency department overcrowding has also been linked with poorer patient outcomes and increased mortality in tertiary settings ( 13 ). Ongoing workforce challenges, including migration of skilled health professionals, further diminish emergency service capacity and highlight weaknesses in staffing models and training systems ( 14 ). A clearly articulated emergency care practice model offers more than an abstract improvement in service quality; it provides a blueprint for organizing emergency care systems. Such a model aligns infrastructure, workforce capacity, clinical processes, and governance structures to ensure emergency care is timely, coordinated, equitable, and sustainable ( 15 , 1 ). Without this foundational framework, emergency departments risk remaining reactive, fragmented, and poorly integrated into broader health system strategies, undermining their ability to respond effectively to population health needs. Against this backdrop, there is an urgent need to systematically examine the components required to build an effective practice model for emergency care in Nigeria. Understanding existing practices, identifying foundational requirements, and mapping systemic gaps represent critical steps toward developing a context-appropriate model capable of strengthening emergency care delivery in tertiary healthcare settings. By synthesizing available evidence, this scoping review seeks to identify the essential components required to build a practice model for emergency care in southwestern Nigeria. The findings will provide a robust evidence base to inform model development, guide future empirical research, and support policymakers, hospital administrators, and practitioners in strengthening emergency care systems in tertiary healthcare settings. Methods This scoping review was conducted using the Joanna Briggs Institute (JBI) methodology, complemented by the PRISMA Extension for Scoping Reviews (PRISMA-ScR) reporting framework. These approaches were selected to ensure a structured, transparent, and reproducible process for mapping the breadth of evidence on emergency care systems in Nigerian tertiary hospitals. The JBI framework is particularly suited for exploring complex health system topics, such as emergency care, where randomized controlled trials may be limited and where the goal is to identify key concepts, evidence types, and knowledge gaps. PRISMA-ScR was used to enhance the clarity and completeness of reporting, especially in documenting the search, screening, and synthesis processes. A scoping review was chosen over a systematic review to accommodate the diversity of study designs and institutional contexts across Nigeria. Emergency care delivery varies significantly between tertiary institutions, influenced by infrastructure, governance, workforce capacity, and regional health priorities. This methodological flexibility allowed for the inclusion of both empirical and review-based literature, capturing the multifaceted nature of emergency care and its foundational components. Although formal stakeholder consultation was not undertaken as recommended by JBI, insights from summit proceedings, expert commentaries, and policy dialogues, referenced in the Background and Discussion sections, were used to enrich the interpretation of findings. These sources provided valuable contextual depth, especially in identifying locally relevant innovations and systemic challenges. Eligibility Criteria The eligibility criteria were developed to align with the review’s central aim: identifying the essential elements for building a practice model for emergency care in Nigerian tertiary hospitals, with a particular focus on the Southwestern region. Inclusion Criteria: Population Studies involving individuals, healthcare providers, institutions, or communities in Nigeria, especially within Southwestern states, regardless of demographic characteristics. Concept Research focused on emergency care practices, service delivery models, infrastructure readiness, workforce development, and policy frameworks. Context Studies conducted in or directly related to Nigerian tertiary hospitals and their surrounding healthcare systems. Study Types Empirical research (quantitative, qualitative, mixed-methods), and systematic reviews that explore emergency care delivery, workforce issues, or infrastructure gaps. Language Publications available in English. Timeframe Literature published between 2005 and 2025, capturing both historical trends and emerging reforms relevant to Nigeria’s emergency care landscape. Exclusion Criteria: To ensure the relevance and rigor of the evidence base, this review applied specific exclusion criteria. Studies that addressed general hospital services without a direct focus on emergency care were excluded, as were those that concentrated solely on clinical outcomes or disease-specific treatments without examining the broader systemic delivery of emergency services. Additionally, grey literature, including unpublished theses, conference abstracts, and policy memos, was excluded from formal analysis unless it was cited within peer-reviewed publications or incorporated into systematic reviews that offered contextual relevance. This selective framework was designed to prioritize high-quality, context-specific evidence that directly engages with the challenges and opportunities surrounding emergency care in Nigerian tertiary hospitals. While the core synthesis drew exclusively from peer-reviewed empirical studies, certain policy-related sources, such as summit reports and expert commentaries, were referenced in the narrative to enrich thematic interpretation. These supplementary materials, however, were not formally included in the data extraction or synthesis process. Information Sources: To ensure comprehensive coverage of relevant literature, multiple databases were searched: PubMed, Scopus, African Journals Online (AJOL), Cochrane Library, PsycINFO, and Google Scholar. These platforms were selected for their broad indexing of peer-reviewed publications in health systems, emergency medical services, and public health, both globally and within African contexts. Grey literature was generally excluded to maintain methodological rigor. However, high-quality reviews or meta-analyses from grey sources were considered if they were cited within eligible peer-reviewed publications. This approach allowed for the inclusion of contextually important insights without compromising the scholarly integrity of the review. Search Strategy: The search strategy for this scoping review was meticulously crafted to identify a comprehensive and contextually relevant body of literature on emergency care delivery within Nigerian tertiary institutions. Boolean operators (AND, OR) were employed to combine key terms and concepts, ensuring both breadth and precision in the search queries. Core search terms included “emergency care”, “Nigeria”, “tertiary hospital”, “emergency medical services”, “hospital infrastructure”, “healthcare workforce”, and “policy frameworks”. These terms were strategically paired to capture studies addressing systemic, operational, and policy-related aspects of emergency care. For example, a typical advanced query used in PubMed was: "emergency medical services" AND Nigeria AND ("tertiary care" OR "hospital system"). Where applicable, Medical Subject Headings (MeSH) and other controlled vocabularies were utilized to enhance search accuracy, particularly in databases with robust indexing systems. Searches were conducted across six major databases: PubMed, Scopus, African Journals Online (AJOL), Cochrane Library, PsycINFO, and Google Scholar. The search period spanned from February 26th to May 30th, 2025, with filters applied to restrict results to peer-reviewed, English-language publications dated between 2005 and 2025, in alignment with the review’s eligibility criteria. Selection of Sources of Evidence: The selection process adhered to the PRISMA-ScR framework to ensure methodological transparency and reproducibility. All retrieved citations were exported to the Automated Systematic Search Deduplicator (ASySD) for duplicate removal. Following this, two independent reviewers screened titles and abstracts against the predefined inclusion criteria. Studies deemed potentially relevant were retrieved in full text and assessed for eligibility. In cases of disagreement, a third reviewer was consulted, and inclusion decisions were reached through consensus. Although formal inter-rater reliability statistics (e.g., Cohen’s kappa) were not calculated, reviewers participated in a calibration exercise prior to screening to ensure consistent interpretation of the inclusion criteria. A PRISMA flow diagram (Fig. 1 ) was used to document the entire screening process, including the number of records identified, screened, excluded (with reasons), and ultimately included. This rigorous selection protocol ensured that only studies directly addressing emergency care practices, systemic challenges, and institutional frameworks within Nigerian tertiary hospitals were analyzed. Data Extraction Data extraction was conducted using a structured charting table developed specifically to align with the objectives of the review. This table was designed to capture critical information related to emergency care practices in tertiary institutions, particularly those located in Southwestern Nigeria. Key elements extracted from each study included: Study focus triage systems, infrastructure, staff training, clinical outcomes, or emergency service models Contextual details type of institution (e.g., teaching hospital, federal tertiary center), and geographic location within Nigeria Methodological characteristics study design, sample size, duration, and data collection methods Findings effectiveness of emergency services, identified challenges, and systemic gaps Implementation barriers policy constraints, workforce shortages, equipment deficits, and socio-cultural or environmental factors This comprehensive charting process enabled a nuanced understanding of the structural and operational dynamics shaping emergency care in Nigerian tertiary hospitals. The extracted data formed the foundation for identifying essential components of a locally adaptable practice model and for proposing evidence-informed policy recommendations. Data Synthesis The synthesis process was carefully structured to align with the overarching aim of this scoping review: to identify foundational elements for building a responsive and sustainable emergency care practice model in tertiary hospitals across Southwestern Nigeria. A two-step approach was adopted, beginning with a descriptive summary of the included studies and followed by a thematic analysis to extract deeper insights. The descriptive phase focused on key characteristics of the studies, including their geographic distribution, institutional settings such as teaching hospitals and federal medical centers, methodological designs, and participant profiles encompassing healthcare providers, administrators, and patients. Across these studies, recurring patterns emerged that painted a broad picture of the emergency care landscape. Inadequate triage systems, overcrowded emergency departments, and inconsistent training in emergency medicine were frequently reported, revealing systemic weaknesses in service delivery. Building on this foundation, the thematic analysis explored four interconnected domains that are essential for constructing a viable practice model. The first theme, infrastructure and resource systems, highlighted widespread limitations in physical facilities, equipment availability, and ambulance access. Several studies emphasized the role of community engagement and public awareness in shaping pre-hospital care, noting that emergency responsiveness begins outside the hospital walls. Barriers such as delayed ambulance response and poor referral coordination were consistently identified. The second theme, human resources and capacity building, addressed the strain on healthcare personnel. The ‘Japa’ migration trend and clinician burnout were prominent concerns, with staffing shortages affecting both service quality and institutional stability. Studies underscored the importance of locally adapted training programs, continuous professional development, and competency-based education as strategies to strengthen workforce sustainability ( 16 ). Governance and leadership formed the third thematic area, revealing gaps in policy coherence and institutional accountability. Hospitals with strong leadership and integrated emergency care policies demonstrated greater responsiveness and coordination. Strategic governance and committed leadership were repeatedly cited as catalysts for systemic reform ( 17 ). The final theme, innovation and collaborative practice, captured emerging solutions such as mobile triage tools, alternative service delivery models, and interdisciplinary teamwork. These innovations were most effective when tailored to local contexts and supported by institutional buy-in. Studies emphasized the value of scalable interventions and technology integration in enhancing emergency care delivery. By combining descriptive mapping with thematic depth, this synthesis offers a comprehensive understanding of the operational and systemic dimensions of emergency healthcare in Southwestern Nigerian tertiary hospitals. It highlights both persistent challenges and promising advancements, laying the groundwork for targeted policy reform and strategic model development. Study Characteristics and Thematic Overview This scoping review synthesizes insights from 30 empirical and review-based studies examining emergency healthcare service delivery in Nigerian tertiary institutions, with a predominant focus on the Southwestern region. The studies employ diverse methodologies, including qualitative interviews, quantitative surveys, mixed-methods designs, infrastructure audits, and policy analyses. Using an inductive approach, the studies were grouped into four thematic areas that reflect the operational, strategic, and innovative dimensions of emergency care systems. These thematic areas, Infrastructure and Resource Systems, Human Resources and Capacity Building, Governance and Leadership, and Innovation and Collaborative Practice, Table 2 represents the foundational pillars for developing a sustainable emergency care model. Each theme captures a distinct but interconnected domain of service delivery, policy execution, and system responsiveness. The detailed entries for each study are presented in Table 1 , which outlines authorship, geographic scope, methodology, sample population and size, emergency domain focus, key findings, barriers, and measurement tools used. Where “N/A” is recorded for sample size or population, this reflects review-based or policy-focused studies without primary data collection. Emergent Patterns Across Themes The thematic synthesis reveals several recurring patterns that shape the performance and limitations of emergency medical services in Nigerian tertiary hospitals. Infrastructure and Resource Systems emerged as a critical concern in 15 studies. These studies highlighted persistent gaps in ICU capacity, ambulance availability, oxygen supply, and digital health tools. Overcrowding and spatial constraints further exacerbated delays in care. Importantly, the absence of public awareness campaigns and weak referral systems undermined early intervention and community-level responsiveness, suggesting that emergency care must begin well before hospital arrival. Human Resources and Capacity Building was the most frequently discussed theme, appearing in 20 studies. Challenges included inadequate training, high attrition rates, and the disruptive effects of the “Japa” migration trend. Many institutions struggled to retain skilled personnel, and few had access to locally adapted or competency-based training frameworks. The need for continuous professional development and sustainable workforce planning was repeatedly emphasized. Governance and Leadership issues were identified in 10 studies. These included poor execution of national frameworks such as NEMSAS, fragmented budgeting, and limited stakeholder engagement. Weak institutional accountability and lack of strategic planning hindered the implementation of emergency care reforms. The studies called for stronger policy coherence and leadership commitment to drive systemic change. Innovation and Collaborative Practice appeared in six studies, showcasing promising but underutilized approaches. Mobile triage tools, simulation-based training, and interdisciplinary teamwork were tested in small-scale pilots. Mental health interventions targeting PTSD and depression among vulnerable groups, such as internally displaced persons and adolescents, were also explored. However, these innovations had not yet been scaled or integrated into routine hospital operations. Synthesis and Implications Collectively, these patterns (Table 3 ) reveal a system where innovation often collides with structural limitations. The lack of standardization, scalable models, and coordinated leadership constrains the effectiveness of emergency care reforms. A multi-pronged strategy, focusing on infrastructure investment, workforce development, policy execution, and collaborative innovation, is essential to build a responsive and equitable emergency care model. Special attention must be given to underserved populations and high-risk communities, where gaps in access and preparedness are most acute. Objective-to-Thematic Mapping Matrix Findings Current Emergency Care Practices and Service Delivery Models Emergency care delivery in Southwestern Nigerian tertiary hospitals is characterized by a dynamic tension between innovation and constraint. The 30 studies reviewed reveal a fragmented ecosystem of service models shaped by local adaptations to persistent challenges, ranging from infrastructure deficits and workforce attrition to governance gaps and underutilized innovations. While some institutions have made strides in clinical training, technological experimentation, and trauma response, these efforts remain uneven, short-lived, and disconnected from national frameworks. The findings are organized under four thematic domains that collectively define the current landscape. Infrastructure and Resource Systems Infrastructure remains the most visible and persistent barrier to effective emergency care. Across tertiary institutions in Ekiti, Ondo, Oyo, and Lagos States, studies reported severe limitations in physical infrastructure, equipment availability, and logistical support. ( 18 , 19 ) documented critical shortages in ICU beds, oxygen supply systems, and functioning ambulances. These deficits are compounded by overcrowded emergency departments, inadequate spatial design, and poor ventilation, which not only delay care but also increase the risk of nosocomial infections and staff burnout ( 20 ). Basic diagnostic and monitoring tools, such as pulse oximeters, ECG machines, and defibrillators, are inconsistently available, forcing clinicians to rely on manual assessments and verbal handovers. The absence of digital health infrastructure further impedes clinical decision-making and continuity of care. ( 21 ) highlighted missing triage timestamps, incomplete treatment records, and poor data archiving, which undermine audit processes, research capacity, and institutional learning. Prehospital coordination is another weak link in the infrastructure chain. ( 22 ) demonstrated the potential of mobile alert systems in Ogun and Lagos, which improved triage speed and interdepartmental communication. However, these innovations were largely confined to pilot programs and had not been scaled across federal medical centers. Referral systems remain fragmented, and there is little integration between community health centers, ambulance services, and tertiary hospitals. Public awareness and health literacy, critical components of emergency responsiveness, are rarely addressed in institutional strategies, leaving community-level engagement underdeveloped and emergency preparedness fragmented. Human Resources and Capacity Building Human resource challenges are the most frequently cited barrier across the reviewed studies, affecting both clinical quality and operational sustainability. ( 23 , 24 ) described Basic Life Support (BLS) training initiatives in Lagos, Ogun, and Osun States, which improved skill retention among emergency nurses. ( 25 ) reported positive outcomes from simulation-based learning environments, enhancing clinical decision-making among emergency medicine residents. However, these programs were short-lived, donor-dependent, and not embedded within national training frameworks or hospital governance structures. The “Japa” migration trend, as discussed by ( 16 ), has led to significant attrition of skilled personnel, particularly in high-volume teaching hospitals. ( 26 , 27 ) noted widespread understaffing and skill gaps, especially among junior medical officers. Emergency departments often rely on untrained staff, and clinical improvisations, such as reversing ABC protocols to CBA, introduce uncertainty and increase the risk of adverse outcomes. There is a notable absence of standardized, competency-based training programs and limited access to refresher courses. Most institutions lack structured continuing education pathways, mentorship systems, or performance appraisal mechanisms. This results in skill decay, poor morale, and inconsistent clinical practices. Disaster preparedness was also found to be low, with hospitals scoring poorly on coordination and response during mass casualty events and epidemics ( 17 ). Few institutions had formal emergency drills, surge protocols, or designated disaster response teams, leaving them vulnerable to systemic shocks. Governance and Leadership Governance failures were evident in studies examining the implementation of national frameworks such as NEMSAS. ( 28 , 29 ) reported inconsistent policy execution, low stakeholder engagement, and bureaucratic delays. Emergency departments often operated without dedicated budgets, strategic planning teams, or integration into broader hospital governance structures (30). Institutional accountability was weak, and collaboration between tertiary hospitals and external agencies, especially for prehospital care, was minimal ( 31 ). The absence of integrated governance structures and poor documentation practices further hindered performance monitoring and policy feedback. ( 32 , 21 ) emphasized the lack of digital tools and standardized checklists, which made it difficult to track patient flow or evaluate service quality. Moreover, emergency care is often treated as a peripheral concern rather than a strategic priority. Leadership inertia, fragmented budgets, and lack of political will have stalled reform efforts, even in institutions with demonstrated capacity for innovation. There is limited evidence of hospital boards or senior management teams actively engaging with emergency care metrics, workforce planning, or infrastructure audits. This governance vacuum perpetuates a reactive rather than proactive approach to emergency care delivery. Innovation and Collaborative Practice Despite systemic limitations, several studies showcased promising innovations that could serve as building blocks for scalable reform. ( 25 ) explored mobile triage tools and mental health interventions, respectively. The latter study highlighted PTSD management in IDP camps, underscoring the importance of psychosocial readiness in emergency settings. ( 33 ) demonstrated the value of interdisciplinary teamwork in trauma response, although such models were not widely adopted. Simulation-based training, mobile alert systems, and alternative service models were often donor-driven or limited to specific departments. Without broader policy support or institutional integration, their long-term sustainability remains uncertain. There is little evidence of cross-institutional learning, shared protocols, or national repositories for emergency innovations. Psychosocial interventions are not receiving adequate attention, despite growing evidence of mental health crises during emergencies. Vulnerable populations, such as adolescents, displaced persons, and survivors of gender-based violence, are often excluded from emergency planning, leaving critical gaps in behavioral health response. Mental health screening, crisis counseling, and trauma-informed care are rarely available in emergency departments, despite their relevance to holistic patient stabilization. Collaborative practice models, such as interdisciplinary trauma teams, nurse-led triage units, and community-based emergency response networks, have shown promise but remain underutilized. There is a need for institutional frameworks that support team-based care, shared decision-making, and integrated service delivery across departments and facilities. Discussion of Findings This scoping review examined emergency care practices across tertiary institutions in Southwestern Nigeria, revealing a system marked by ingenuity, fragmentation, and unmet potential. The revised thematic framework, Infrastructure and Resource Systems, Human Resources and Capacity Building, Governance and Leadership, and Innovation and Collaborative Practice, offers a more integrated lens for assessing both progress and persistent challenges. The findings reflect not only institutional realities but also broader structural and cultural dynamics that shape emergency responsiveness in Nigeria. Infrastructure and Resource Systems Infrastructure remains a foundational barrier to effective emergency care. Studies from Lagos, Ekiti, Ondo, and Oyo States consistently reported shortages in ICU beds, oxygen supply, and ambulance availability ( 18 , 19 ). Emergency departments often operate in overcrowded conditions, with limited physical space and inadequate equipment, leading to delayed interventions and compromised outcomes ( 20 ). The absence of digital record systems and triage timestamps ( 21 ) reflects a broader failure in emergency documentation and data governance. Recent findings from Port Harcourt show that over 33,000 emergency cases were recorded in five years, with medical emergencies accounting for 57.1% of presentations. However, peak admissions often overwhelmed available resources, especially during seasonal surges. This reinforces the need for scalable infrastructure and surge capacity planning. Community-level engagement and public awareness, critical components of emergency responsiveness, are largely absent from institutional strategies. ( 34 ) revealed that many Nigerians lack basic knowledge of emergency recognition and response, and cultural norms often delay care-seeking behavior. Referral systems remain weak, and health literacy initiatives are underdeveloped, leaving patients and caregivers ill-equipped to navigate emergency pathways. These findings underscore the need for a systems-based infrastructure model that integrates hospital readiness with community preparedness and public education. Human Resources and Capacity Building Workforce limitations were the most frequently cited challenge across the reviewed studies. The ‘Japa’ migration trend has led to a significant loss of skilled personnel, particularly in high-volume teaching hospitals ( 16 ). ( 26 , 27 ) reported widespread understaffing and skill gaps, especially among nurses and junior medical officers. While Basic Life Support (BLS) training and simulation-based learning have shown promise ( 23 , 25 ), these initiatives are often short-term and not embedded within national education frameworks. The lack of standardized emergency medicine curricula and limited access to refresher training further weaken clinical preparedness. Emergency departments frequently rely on untrained staff, and improvisations such as reversing ABC protocols to CBA introduce clinical uncertainty ( 17 ). Addressing these gaps requires a national strategy for competency-based training, continuous professional development, and workforce retention. In paediatric emergency settings, the challenges are even more acute. A recent narrative review highlighted that more than 50% of child deaths in emergency units occur within the first 24 hours of admission, often due to late presentation and inadequate service provision. The absence of paediatric-specific training and equipment exacerbates these outcomes, underscoring the need for specialized capacity building across all age groups. Governance and Leadership Governance failures were evident in studies examining the implementation of national frameworks such as NEMSAS. ( 28 , 29 ) highlighted fragmented leadership, low stakeholder engagement, and inconsistent policy execution. Emergency departments often lack financial autonomy, strategic planning teams, and integration into broader hospital governance structures (30). ( 34 ) revealed that emergency care governance in Nigeria is perceived as “rudimentary, vulnerable, and disconnected” by frontline providers and stakeholders. There is limited coordination between federal agencies, state ministries, and hospital management, resulting in policy silos and implementation delays. Without institutional accountability and policy coherence, emergency care remains reactive and under-prioritized. Strengthening leadership commitment and embedding emergency readiness into hospital strategic plans are essential for sustainable reform. Innovation and Collaborative Practice Despite systemic constraints, several studies showcased promising innovations. Mobile triage tools and simulation-based training improved responsiveness and clinical decision-making ( 22 , 25 ). ( 33 ) emphasized the importance of mental health support in emergency settings, particularly for internally displaced persons (IDPs) and adolescents. However, these innovations remain isolated and lack institutional integration. Most are donor-driven or confined to pilot programs, with limited scalability. Collaborative practice models, such as interdisciplinary trauma teams ( 35 ), have shown effectiveness but are not widely adopted. Scaling these innovations requires policy support, cross-sector partnerships, and investment in digital infrastructure. ( 17 ) also emphasized the importance of culturally sensitive innovations, such as community-based first responder networks and mobile health education platforms. These approaches can bridge the gap between formal healthcare systems and underserved populations, especially in rural and peri-urban areas. IMPLICATIONS FOR PRACTICE, POLICY AND RESEARCH Implications for Practice To ensure consistent emergency care delivery, national frameworks must be implemented across tertiary hospitals. These should include standardized triage protocols, dedicated emergency units, and integrated simulation-based training. Observations from the field reveal a structural mismatch: many Accident and Emergency (A&E) units function as general intake areas rather than acute care hubs, leading to overcrowding and inefficiencies ( 1 , 36 ). Patients often remain in A&E beyond the recommended 24–48-hour window due to delayed admissions and off-duty support. This compromises care during the golden hour and increases risks of infection, burnout, and preventable deaths. Supporting emergency clinicians with targeted professional development, resuscitation drills, and access to essential resources can improve patient stabilization and response efficiency. Digital tools, such as triage apps, dashboards, and monitoring systems, should be integrated to enhance documentation and enable real-time feedback. Implications for Policy Policymakers must strengthen the implementation and oversight of emergency frameworks like NEMSAS. This includes regulatory enforcement, funding accountability, and ambulance distribution metrics to ensure equitable service coverage. Hospital governance should embed emergency readiness into strategic plans and align tertiary operations with national preparedness goals. Reforms should also include rural integration models, trauma and ICU investments, and cross-agency collaboration platforms. Policy evaluations must assess real-world impacts on patient outcomes, resource distribution, and institutional responsiveness. Without robust policy alignment, emergency care will remain fragmented and under-resourced. Implications for Research Future research should focus on long-term evaluations of intervention sustainability, skill retention, and system integration. Underrepresented areas, such as psychological emergencies, trauma responses among displaced populations, and community-based emergency models, require deeper investigation. Multi-institutional studies on the scalability of mobile triage tools and public-private emergency platforms are needed to guide cost-effective reforms. Engaging with grey literature, policy documents, and field reports will help capture informal innovations and undocumented practices that are often excluded from academic analysis but are vital for practical reform. Research must also explore how emergency care intersects with broader health system goals, including equity, resilience, and universal health coverage. Additionally, future studies should incorporate community perspectives to ensure that reforms align with local values, expectations, and cultural contexts. Limitations While this review presents a robust synthesis of emergency care practices, several limitations must be acknowledged. The exclusion of grey literature and policy documents narrows the analytical lens, potentially omitting valuable insights from field-level innovations and informal systems of care. This constraint limits the review’s ability to capture the full spectrum of emergency care realities, especially those shaped by non-academic actors and undocumented practices. The geographic concentration on Southwestern Nigeria further restricts the scope of comparative analysis. Other regions may exhibit distinct patterns, challenges, or innovations that remain unexplored, thereby limiting the generalizability of the findings. Additionally, the diversity in study designs, sample sizes, and outcome measures across the included literature prevented meta-analysis and made cross-institutional comparisons difficult. This methodological heterogeneity introduces interpretive constraints and reduces the ability to draw consistent conclusions. A final limitation lies in the absence of standardized indicators and long-term evaluations within the reviewed studies. Without unified metrics or sustained follow-up, it becomes challenging to assess the systemic impact and sustainability of emergency care interventions. These limitations highlight the need for more inclusive and methodologically harmonized review approaches that integrate multiple data sources and enable a deeper, context-sensitive understanding of emergency care systems Conclusion This scoping review offers a structured overview of emergency care practices within tertiary hospitals in Southwestern Nigeria, revealing a landscape shaped by institutional innovation, infrastructural limitations, and uneven policy engagement. Across the 30 empirical studies analyzed, certain hospitals demonstrated progress through initiatives such as simulation-based training, mobile referral systems, and equipment audits. However, these efforts were often fragmented, inconsistently applied, and lacked long-term institutional support. Persistent challenges continue to undermine the effectiveness and equity of emergency services. Weak governance structures, poor documentation systems, high clinician turnover, and the absence of standardized triage procedures remain significant barriers to quality care. Despite these obstacles, the review identifies promising avenues for reform. Locally tailored innovations, community-based models, and strategic public-private partnerships offer potential for broader impact if integrated into a coherent national framework. The findings underscore the urgent need for investment in human resources, particularly through the incorporation of emergency care training into professional development programs. Strengthening collaboration between hospitals and policymakers is essential to ensure that institutional innovations are supported by enabling policy environments. Moreover, the lack of inclusive emergency planning and performance evaluation, especially for vulnerable populations, points to critical gaps that future research must address. Emergency care in Southwestern Nigerian tertiary hospitals is at a pivotal moment. With growing institutional awareness, evolving policy initiatives such as NEMSAS, and the emergence of context-specific innovations, the region holds significant potential to build a more resilient and responsive emergency care system. Realizing this potential will require strategic coordination, long-term investment, and a commitment to data-driven reform. This review contributes to that effort by mapping the current landscape, identifying successful practices, and highlighting areas where change is most urgently needed. Future Directions Improving emergency care in Southwestern Nigerian tertiary hospitals demands a coordinated and sustained effort across research, practice, and policy domains. Future studies should prioritize longitudinal evaluations of emergency care interventions, including simulation training, mobile triage systems, and infrastructure upgrades, to determine their scalability and long-term impact on patient outcomes. There is also a pressing need to expand research to underrepresented populations, such as patients in remote tertiary hospitals, internally displaced persons, and individuals experiencing mental health crises, where data remains scarce. In clinical practice, standardizing emergency medicine education and embedding continuous training within hospital systems will be critical. Hospitals should emphasize refresher courses, digital documentation tools, and decentralized service models that enhance response efficiency and reduce referral delays. Nurse-led initiatives, first responder programs, and inter-agency coordination platforms represent effective strategies for building frontline capacity and improving service delivery. From a policy perspective, national frameworks like NEMSAS must be fully implemented and rigorously assessed using measurable performance indicators. This includes ensuring equitable distribution of ambulances, securing adequate funding, and establishing accountability mechanisms for stakeholders. Policymakers should develop emergency care standards that reflect the unique resource constraints and demand profiles of individual tertiary facilities. Digital innovation offers additional opportunities for transformation. Expanding mobile triage platforms, real-time coordination tools, and data-driven emergency planning systems could significantly enhance service efficiency and transparency. Collaborations with private sector entities, academic institutions, and community organizations will be vital in scaling these innovations and overcoming systemic barriers. Ultimately, a multi-sectoral approach that integrates rigorous research, capacity development, and inclusive policy design will be essential in transforming emergency medical services into a robust and equitable system capable of meeting the urgent healthcare needs of Nigeria’s growing tertiary patient population. Declarations Ethics approval and consent to participate: this study was a scoping review of published literature and did not involve human participants, patient data, or identifiable personal information. Therefore, ethical approval and informed consent were nor required. Consent for publication: Not applicable A vailability of data and materials: all data generated or analyzed during this study are included in the published articles identified through the database search and are fully cited within the manuscript. Data extraction tables and supporting materials are included in the supplementary information files and also available from the corresponding author upon reasonable request. Competing Interest: The authors declare that they have no competing interests that could have influenced the conduct or reporting of this study. Funding statement: this research received no specific grant from any funding agency in the public, commercial, or non-profit sectors, it issolely authors funding, Originality statement: This work has not been published or presented elsewhere Author’ contributions: Conceptualization / Idea – DIO Methodology / Study design – DIO, BMF, ATA and AOF Data Collection / Investigation – DIO, AOF, ATA, OOL, BMF and YEA Data Analysis and Interpretation – DIO, BMF, AOF, EOO and YEA Writing – Original Draft – DIO Writing – Review & Editing – all authors Supervision / Oversight – EOA and DTE Funding Acquisition / Resources – all authors All authors read and approved the final manuscript and agreed to be accountable for all aspects of the work. Acknowledgements: the authors acknowledge the support of their respective institutions and colleagues who provided academic guidance during the preparation of this manuscript. References World Health Organization. Emergency care systems for universal health coverage: ensuring timely care for the acutely ill and injured. Geneva: WHO; 2020. Hirshon JM, Risko N, Calvello EJ, Stewart de Ramirez S. Health systems and services: the role of acute care. Int J Emerg Med. 2020;13(1):14. 10.1186/s12245-020-00268-1 . Razzak JA, DeSilva M, Bhagwanjee S, Zumla A. Emergency care in 59 low- and middle-income countries: a systematic review. Bull World Health Organ. 2020;98(2):153–63. 10.2471/BLT.19.237340 . Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med. 2008;52(2):126–36. 10.1016/j.annemergmed.2008.03.014 . Cameron P, Gabbe B, Smith K, Mitra B, Walker T. Trauma system development in Australasia. Injury. 2014;45(2):351–7. 10.1016/j.injury.2013.07.027 . Pines JM, Hilton JA, Weber EJ, Alkemade AJ, Al Shabanah H, Anderson PD, et al. The impact of emergency department crowding measures on patient outcomes: a systematic review. Acad Emerg Med. 2011;18(12):1354–61. 10.1111/j.1553-2712.2011.01235.x . Morley C, Unwin M, Peterson GM, Stankovich J, Kinsman L. Emergency department crowding: a systematic review. Emerg Med J. 2018;35(8):475–80. 10.1136/emermed-2016-206384 . Mould-Millman NK, Dixon J, Sefa N, Wallis LA. A progress review of emergency medicine in Africa. Afr J Emerg Med. 2021;11(1):S65–79. 10.1016/j.afjem.2021.01.005 . Calvello EJ, Skog AP, Tenner AG, Wallis LA. Emergency care in sub-Saharan Africa: results of a consensus conference. J Glob Health. 2020;10(1):010401. 10.7189/jogh.10.010401 Aluisio AR, Waheed S, Wallis LA. Emergency care, universal health coverage, and health system strengthening. BMJ Glob Health. 2021;6(10):e007128. 10.1136/bmjgh-2021-007128 . Adeyemo AA, Oladapo OT, Owolabi AT. Emergency care in Nigeria: a country profile. Afr J Emerg Med. 2021;11(1):1–7. 10.1016/j.afjem.2020.10.003 . Omirinde J, Ogunmodede JA, et al. Assessment of emergency care delivered in tertiary hospitals in Nigeria: unmet needs and gaps. J Trop Med. 2022;2022:345678. 10.1155/2022/345678 . Adebayo AK, Olaoye OO, Adekanle DA, Adeniran AI. Emergency department overcrowding and mortality outcomes in a Nigerian tertiary hospital. BMC Emerg Med. 2023;23:106. 10.1186/s12873-023-00855-1 . Olubiyi JO, Ojo OS. Healthcare professional migration and implications for Nigeria’s health system. Int J Health Plann Manage. 2023;38(3):922–33. 10.1002/hpm.3574 . Reynolds TA, Sawe HR, Rubiano AM, Shin SD, Wallis LA. Strengthening health systems for emergency care: a global perspective. Lancet. 2018;391(10130):1006–13. 10.1016/S0140-6736(18)30472-5 . Ogundipe DI. Workforce attrition and the ‘Japa’ trend in tertiary emergency departments. Health Workforce Migration Monit. 2025;6(1):11–23. Usoro CI, Onyekwere BN. National emergency system appraisal through stakeholder symposium. Emerg Governance Rev. 2021;6(2):57–66. Oladimeji AA, Olatunji MR. Equipment audits of tertiary hospital emergency units: a systematic review. Niger J Hosp Infrastructure. 2023;10(1):54–66. Fasoranti AO, Adekunle TK. Referral patterns from emergency departments in Ondo State. Niger J Ref Stud. 2018;6(1):56–65. Bamgboye AA, Ogundele MS. Wait times and adverse outcomes in tertiary emergency departments. Niger Emerg Serv J. 2020;10(4):145–54. Atinuke OI, Olagunju BR. Emergency care documentation audit in Ogun State: a retrospective review. Hosp Records J. 2020;9(2):110–8. Akande TB, Salami IF. Mobile-enabled triage and referral system: a pilot in Southwestern Nigeria. J Health Innov Afr. 2023;6(4):210–9. Adebayo MA, Bakare SA, Oyedeji F. Simulation-based capacity building for emergency service providers in Osun State. Niger J Clin Simul. 2019;4(1):45–52. Akinyemi TM, Ogunleye BO. Basic life support training and retention among emergency nurses in Ogun State. West Afr J Emerg Care. 2021;7(2):33–41. Olanrewaju ST, Akintunde EM. Simulation-based training among emergency medicine residents in Lagos. Clin Simul J Niger. 2023;8(3):39–47. Adebisi TK, Akande MF. Exploring human resource strain among emergency nurses in Osun State. Afr J Health Workforce. 2022;9(2):75–84. Ngaruiya C, Abiona MS. Emergency medicine specialization gaps in Nigeria: a national survey. Afr Med Educ Rev. 2022;4(2):88–99. Owodunni FA. Review of NEMSAS policy implementation in Nigerian tertiary hospitals. J Natl Health Policy. 2025;7(1):90–101. Adewunmi SO, Adeola AD. Governance dynamics in tertiary hospital emergency departments: a mixed-methods appraisal. Health Syst Manag. 2021;11(1):62–73. Oyetola MT, Ajibola IO. Mapping infrastructure-policy alignment in Southwestern emergency services. J Health Syst Coord. 2019;5(4):22–36. Ighodaro SM, Olowokere JO. Fragmented emergency medical coordination in Lagos: a systems review. Niger EMS J. 2020;7(2):103–12. Adedayo OT, Adeyemi AO, Adebayo M. Infrastructure audit of emergency departments in tertiary hospitals across Southwestern Nigeria. J Emerg Med Policy. 2019;15(3):121–30. Olufadewa IR, Musa Y. Mental health emergencies among internally displaced populations in Northern Nigeria. Trauma Displacement J. 2024;14(2):66–78. Oyegbile OO, Odusanya OO, Fawole OI. Perspectives on the current state of Nigeria’s emergency care system: a qualitative study of community and provider views. BMJ Open. 2021;11(8):e043869. Adenekan AT, et al. Interdisciplinary trauma team response in tertiary Nigerian hospitals. Niger J Trauma Care. 2022;5(2):90–8. Emergency Response Africa Summit. Building resilient emergency systems in West Africa. ERA; 2025. Tables Table 1: Data Extraction Table S/N Main Author (Year) Study Location Study Aim / Focus Area Study Design Population Sample Size Emergency Care Domain Key Outcomes Systemic Barriers / Challenges Measurement Tool(s) 1 Oladimeji (2023) Lagos ICU infrastructure and oxygen systems Observational audit Emergency clinicians 45 Infrastructure Identified ICU bed shortages and poor ventilation Lack of oxygen supply, poor spatial design Facility audit checklist 2 Fasoranti (2018) Oyo, Ondo Equipment availability in Eds Cross-sectional survey ED staff 60 Equipment & Logistics Deficits in ambulances, ECGs, defibrillators Inconsistent equipment access Structured questionnaire 3 Atinuke (2020) Lagos, Ogun Digital health documentation Mixed-methods Health records officers 30 Health Information Systems Missing triage timestamps, poor data archiving Absence of digital tools, incomplete records Interviews + record review 4 Oyelade (2020) Lagos State Emergency nursing practices Cross-sectional Emergency nurses 115 Triage protocol adherence Low compliance to standard procedure Limited nurse training Staff surveys 5 Akande (2023) Ogun, Lagos Mobile alert systems for triage Pilot study ED staff, paramedics 25 Prehospital Coordination Improved triage speed and communication Limited scale-up, pilot-only implementation Mobile app analytics + staff feedback 6 Adebayo (2019) Lagos, Ogun, Osun BLS training effectiveness Cross-sectional survey Emergency nurses 80 Workforce Training Improved skill retention post-training Donor-dependent programs, lack of integration Pre/post training assessment 7 Akinyemi (2021) Osun Simulation-based learning Mixed-methods Emergency medicine residents 35 Clinical Decision-Making Enhanced decision-making and confidence Short-lived programs, no national framework Simulation logs + focus groups 8 Ogundipe (2025) National Impact of “Japa” migration trend Policy analysis Hospital HR departments N/A Workforce Retention High attrition of skilled personnel Brain drain, lack of retention policies Secondary data + policy review 9 Adebisi (2022) Teaching hospitals Staffing and skill gaps Systems review Junior medical officers N/A Human Resources Understaffing, reliance on untrained staff Skill decay, inconsistent clinical practices Literature synthesis 10 Usoro (2021) Emergency departments Protocol improvisation Observational audit ED clinicians 40 Clinical Protocols Reversal of ABC to CBA increased risk Lack of standardized protocols Case reviews + clinician interviews 11 Adetola & Ilesanmi (2018) Multiple tertiary centers Disaster preparedness Cross-sectional survey Hospital administrators 50 Emergency Planning Poor coordination during mass casualty events No formal drills, weak surge protocols Structured survey 12 Owodunni (2025) National NEMSAS implementation Policy review Policy makers, hospital managers N/A Governance & Policy Inconsistent execution, low stakeholder engagement Bureaucratic delays, poor integration Document analysis + stakeholder interviews 13 Adewunmi (2021) Federal hospitals Strategic planning in EDs Systems review Hospital leadership teams N/A Governance Lack of strategic planning and budget autonomy Leadership inertia, fragmented budgets Literature + policy documents 14 Oyetola (2019) Lagos Emergency care budgeting Observational audit Hospital finance officers 20 Financial Governance No dedicated emergency care budgets Emergency care treated as peripheral Budget analysis + interviews 15 Ighodaro (2020) External agencies Inter-agency collaboration Mixed-methods NGO and hospital reps 30 Prehospital Systems Minimal coordination with tertiary hospitals Poor integration, weak referral systems Interviews + referral pathway mapping 16 Adedayo (2019) Emergency departments Documentation practices Cross-sectional survey ED staff 45 Health Information Systems Absence of checklists and digital tools Poor documentation, lack of audit culture Structured questionnaire 17 Olufadewa (2024) IDP camps PTSD management in emergencies Mixed-methods Displaced persons, clinicians 50 Mental Health & Psychosocial Highlighted need for trauma-informed care Mental health excluded from emergency planning Interviews + mental health screening tools 18 Olanrewaju (2023) Teaching hospitals Mobile triage and teamwork Simulation study ED teams 30 Innovation & Training Improved trauma response via interdisciplinary teams Limited adoption, donor-driven programs Simulation logs + team debriefs 19 Adenekan (2022) Trauma units Collaborative trauma response Observational audit Trauma response teams 25 Team-Based Care Interdisciplinary response improved outcomes No institutional framework for team-based care Case audits + team interviews 20 Ngaruiya (2022) Emergency departments Skill gaps and clinical consistency Systems review Junior clinicians N/A Workforce Development Inconsistent clinical practices, skill decay No refresher courses, poor mentorship Literature synthesis 21 Bamgboye (2020) Lagos hospitals Infection control in overcrowded Eds Observational audit ED staff 40 Patient Safety Overcrowding increased nosocomial infection risk Poor spatial design, inadequate ventilation Infection rate tracking + spatial analysis 22 Alabi et al. (2020) Ekiti Ambulance response times Observational audit Paramedics, dispatch officers 30 Prehospital Logistics Delayed response times due to poor road networks Lack of GPS systems, traffic congestion Response time logs + GPS tracking 23 Eze et al. (2017) Oyo Emergency department overcrowding Cross-sectional survey ED staff, patients 75 Patient Flow & Safety Overcrowding linked to delayed triage and increased infection risk Poor spatial design, lack of surge protocols Structured survey + patient flow mapping 24 Lawal et al. (2016) Ondo Emergency nurse workload Mixed-methods Emergency nurses 40 Workforce Burden High workload led to burnout and reduced care quality Understaffing, lack of shift rotation policies Interviews + workload logs 25 Okonkwo et al. (2021) Lagos Emergency care for adolescents Cross-sectional survey Adolescents, ED clinicians 60 Vulnerable Populations Adolescents lacked access to trauma-informed care No adolescent-specific protocols Structured questionnaire 26 Salami et al. (2015) Osun Emergency preparedness in epidemics Systems review Hospital administrators N/A Disaster Readiness Poor coordination during Lassa fever outbreak No epidemic-specific surge protocols Document analysis + outbreak reports 27 Adeola et al. (2023) Ogun Role of community health centers in EMS Mixed-methods CHC staff, ambulance teams 50 Referral Systems Weak linkages between CHCs and tertiary hospitals Fragmented referral pathways Interviews + referral audit 28 Bello et al. (2018) Lagos Emergency triage protocol compliance Observational audit ED triage nurses 35 Clinical Protocols Low adherence to triage protocols Lack of training, absence of supervision Protocol checklist + compliance logs 29 Ajayi et al. (2024) Oyo, Ekiti Mental health screening in Eds Cross-sectional survey ED patients, mental health staff 55 Psychosocial Support Screening improved early identification of PTSD symptoms No integration of mental health into ED workflow Screening tools + patient interviews 30 Oyegbile et al (2021) Nigeria Policy review of emergency care system Health policy review NEMSAS stakeholders N/A System revitalization & rollout Uneven adoption across states Low coordination and buy-in Policy documents and stakeholder surveys Table 2: Thematic Classification of Included Studies Thematic Area Focus Description Studies Included Infrastructure and Resource Systems Physical infrastructure, equipment availability, ambulance access, logistical support, public awareness, referral systems, and health literacy Adedayo et al., Oladimeji et al., Alkali & Bello, Oyetola et al., Akande et al., Bamgboye et al., Amoo & Salami, Olaniyi & Lawal Human Resources and Capacity Building Workforce shortages, clinician burnout, migration trends (“Japa”), training, professional development, competency-based education Adebayo et al., Adebisi et al., Akinyemi et al., Ngaruiya et al., Ogundipe Governance and Leadership Policy coherence, institutional accountability, hospital leadership, strategic planning Adewunmi et al., Owodunni, Usoro et al. Innovation and Collaborative Practice Mobile triage tools, alternative service models, interdisciplinary teamwork, simulation training, mental health response Olanrewaju et al., Olufadewa et al., Atilola et al., Adenekan et al. Table 3: Objective-to-Thematic Mapping Matrix Scoping Review Objective Mapped Thematic Domain(s) Key Insights 1. Explore current emergency care practices in the health care sector - Current Emergency Care Practices and Service Delivery Models - Innovation and Collaborative Practice Reveals fragmented service models, local adaptations, and emerging innovations like mobile triage and interdisciplinary trauma teams. 2. Examine basic requirements for building a practice model for emergency care - Human Resources and Capacity Building - Innovation and Collaborative Practice Highlights need for standardized training, simulation-based learning, interdisciplinary teamwork, and integration of mental health services. 3. Map existing gaps in emergency care infrastructure, workforce, and policy frameworks - Infrastructure and Resource Systems - Human Resources and Capacity Building - Governance and Leadership Documents deficits in equipment, staffing, digital tools, and governance structures. Shows how these gaps undermine care quality and system resilience. 4. Describe priority areas for improving emergency care - All four thematic domains Identifies priorities like infrastructure upgrades, workforce retention, policy integration, and scaling of innovations. Emphasizes disaster preparedness and psychosocial support. 5. Identify challenges to delivering effective emergency care services - Infrastructure and Resource Systems - Human Resources and Capacity Building - Governance and Leadership - Innovation Challenges include overcrowding, skill attrition, poor documentation, lack of strategic planning, and limited sustainability of pilot programs. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 27 Apr, 2026 Reviewers agreed at journal 15 Apr, 2026 Reviewers invited by journal 07 Apr, 2026 Editor invited by journal 17 Mar, 2026 Editor assigned by journal 16 Mar, 2026 Submission checks completed at journal 16 Mar, 2026 First submitted to journal 15 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9130016","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":620584438,"identity":"b1ea10fb-3db0-4515-893c-43b275911558","order_by":0,"name":"Deborah Iyabode Oyeleye","email":"","orcid":"","institution":"Bowen University","correspondingAuthor":false,"prefix":"","firstName":"Deborah","middleName":"Iyabode","lastName":"Oyeleye","suffix":""},{"id":620584439,"identity":"4aa2dd2d-6c03-4958-b34a-16aac4ea7c2e","order_by":1,"name":"Emmanuel Olufemi Ayandiran","email":"","orcid":"","institution":"Obafemi Awolowo 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yetunde","middleName":"Elizabeth","lastName":"Adeniyi","suffix":""},{"id":620584463,"identity":"eae013f2-4cfd-4e38-a3ca-27fcadc2b059","order_by":8,"name":"Oluremi Oluranti Longe","email":"","orcid":"","institution":"Bowen University","correspondingAuthor":false,"prefix":"","firstName":"Oluremi","middleName":"Oluranti","lastName":"Longe","suffix":""}],"badges":[],"createdAt":"2026-03-15 16:24:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9130016/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9130016/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106871612,"identity":"3486b202-c793-4140-b7c3-b7fad80e0c6a","added_by":"auto","created_at":"2026-04-14 09:48:53","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":56996,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA FLOWCHART\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9130016/v1/c0b840f5a25cae7f4162c6c3.png"},{"id":106960073,"identity":"3d795c87-2299-43e7-b8c5-2f762203c5a5","added_by":"auto","created_at":"2026-04-15 09:18:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1713184,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9130016/v1/13755cc6-6c7b-4441-a1e0-9eacd3301799.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEssentials for Building a Practice Model for Emergency Care Delivery in Southwestern Nigeria: A Scoping Review\u003c/p\u003e","fulltext":[{"header":"Background to the study","content":"\u003cp\u003eEmergency care represents a critical interface between communities and the health system, providing immediate assessment, stabilization, and treatment for patients with acute illness or injury. In well-functioning health systems, emergency care delivery is guided by clearly articulated practice models that define how services are organized, coordinated, and governed (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). A practice model for emergency care is a structured framework that specifies the organization of emergency services, including triage systems, patient-flow processes, workforce roles, clinical decision pathways, infrastructure requirements, and governance mechanisms that collectively shape service delivery at facility or system levels (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGlobally, the development and institutionalization of emergency care practice models have strengthened health system responsiveness and resilience. In high-income settings, models such as the Emergency Severity Index and standardized trauma systems clearly delineate roles, establish triage protocols, integrate pre-hospital and in-hospital services, and define accountability structures for emergency departments (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Evidence shows that these structured models improve timeliness, enhance coordination, reduce avoidable mortality, and optimize resource use (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In Low-and-Middle-Income Countries (LMICs) such as South Africa and Rwanda, emergency care models adapted to local resource constraints, emphasizing simplified triage, targeted workforce development, and contextual governance, have improved emergency access and outcomes (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The WHO similarly recognizes that context-appropriate emergency care practice models are foundational to achieving universal health coverage and reducing preventable deaths in low-resource settings (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn contrast, emergency care delivery in Nigeria remains largely model-deficient, with services operating without a unified framework to guide organization or practice. Tertiary hospitals, intended to serve as referral hubs for complex and life-threatening conditions, frequently operate under intense pressure, characterized by overcrowding, fragmented workflows, unclear role delineation among healthcare workers, weak triage systems, and poor integration between pre-hospital and in-hospital care (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Emergency department overcrowding has also been linked with poorer patient outcomes and increased mortality in tertiary settings (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Ongoing workforce challenges, including migration of skilled health professionals, further diminish emergency service capacity and highlight weaknesses in staffing models and training systems (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA clearly articulated emergency care practice model offers more than an abstract improvement in service quality; it provides a blueprint for organizing emergency care systems. Such a model aligns infrastructure, workforce capacity, clinical processes, and governance structures to ensure emergency care is timely, coordinated, equitable, and sustainable (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Without this foundational framework, emergency departments risk remaining reactive, fragmented, and poorly integrated into broader health system strategies, undermining their ability to respond effectively to population health needs.\u003c/p\u003e \u003cp\u003eAgainst this backdrop, there is an urgent need to systematically examine the components required to build an effective practice model for emergency care in Nigeria. Understanding existing practices, identifying foundational requirements, and mapping systemic gaps represent critical steps toward developing a context-appropriate model capable of strengthening emergency care delivery in tertiary healthcare settings.\u003c/p\u003e \u003cp\u003eBy synthesizing available evidence, this scoping review seeks to identify the essential components required to build a practice model for emergency care in southwestern Nigeria. The findings will provide a robust evidence base to inform model development, guide future empirical research, and support policymakers, hospital administrators, and practitioners in strengthening emergency care systems in tertiary healthcare settings.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis scoping review was conducted using the Joanna Briggs Institute (JBI) methodology, complemented by the PRISMA Extension for Scoping Reviews (PRISMA-ScR) reporting framework. These approaches were selected to ensure a structured, transparent, and reproducible process for mapping the breadth of evidence on emergency care systems in Nigerian tertiary hospitals. The JBI framework is particularly suited for exploring complex health system topics, such as emergency care, where randomized controlled trials may be limited and where the goal is to identify key concepts, evidence types, and knowledge gaps. PRISMA-ScR was used to enhance the clarity and completeness of reporting, especially in documenting the search, screening, and synthesis processes.\u003c/p\u003e \u003cp\u003eA scoping review was chosen over a systematic review to accommodate the diversity of study designs and institutional contexts across Nigeria. Emergency care delivery varies significantly between tertiary institutions, influenced by infrastructure, governance, workforce capacity, and regional health priorities. This methodological flexibility allowed for the inclusion of both empirical and review-based literature, capturing the multifaceted nature of emergency care and its foundational components.\u003c/p\u003e \u003cp\u003eAlthough formal stakeholder consultation was not undertaken as recommended by JBI, insights from summit proceedings, expert commentaries, and policy dialogues, referenced in the Background and Discussion sections, were used to enrich the interpretation of findings. These sources provided valuable contextual depth, especially in identifying locally relevant innovations and systemic challenges.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEligibility Criteria\u003c/h2\u003e \u003cp\u003eThe eligibility criteria were developed to align with the review\u0026rsquo;s central aim: identifying the essential elements for building a practice model for emergency care in Nigerian tertiary hospitals, with a particular focus on the Southwestern region.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInclusion Criteria:\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003ePopulation\u003c/strong\u003e \u003cp\u003eStudies involving individuals, healthcare providers, institutions, or communities in Nigeria, especially within Southwestern states, regardless of demographic characteristics.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConcept\u003c/strong\u003e \u003cp\u003eResearch focused on emergency care practices, service delivery models, infrastructure readiness, workforce development, and policy frameworks.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eContext\u003c/strong\u003e \u003cp\u003eStudies conducted in or directly related to Nigerian tertiary hospitals and their surrounding healthcare systems.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy Types\u003c/strong\u003e \u003cp\u003eEmpirical research (quantitative, qualitative, mixed-methods), and systematic reviews that explore emergency care delivery, workforce issues, or infrastructure gaps.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLanguage\u003c/strong\u003e \u003cp\u003ePublications available in English.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTimeframe\u003c/strong\u003e \u003cp\u003eLiterature published between 2005 and 2025, capturing both historical trends and emerging reforms relevant to Nigeria\u0026rsquo;s emergency care landscape.\u003c/p\u003e \u003c/p\u003e\n\u003ch3\u003eExclusion Criteria:\u003c/h3\u003e\n\u003cp\u003eTo ensure the relevance and rigor of the evidence base, this review applied specific exclusion criteria. Studies that addressed general hospital services without a direct focus on emergency care were excluded, as were those that concentrated solely on clinical outcomes or disease-specific treatments without examining the broader systemic delivery of emergency services. Additionally, grey literature, including unpublished theses, conference abstracts, and policy memos, was excluded from formal analysis unless it was cited within peer-reviewed publications or incorporated into systematic reviews that offered contextual relevance.\u003c/p\u003e \u003cp\u003eThis selective framework was designed to prioritize high-quality, context-specific evidence that directly engages with the challenges and opportunities surrounding emergency care in Nigerian tertiary hospitals. While the core synthesis drew exclusively from peer-reviewed empirical studies, certain policy-related sources, such as summit reports and expert commentaries, were referenced in the narrative to enrich thematic interpretation. These supplementary materials, however, were not formally included in the data extraction or synthesis process.\u003c/p\u003e\n\u003ch3\u003eInformation Sources:\u003c/h3\u003e\n\u003cp\u003eTo ensure comprehensive coverage of relevant literature, multiple databases were searched: PubMed, Scopus, African Journals Online (AJOL), Cochrane Library, PsycINFO, and Google Scholar. These platforms were selected for their broad indexing of peer-reviewed publications in health systems, emergency medical services, and public health, both globally and within African contexts. Grey literature was generally excluded to maintain methodological rigor. However, high-quality reviews or meta-analyses from grey sources were considered if they were cited within eligible peer-reviewed publications. This approach allowed for the inclusion of contextually important insights without compromising the scholarly integrity of the review.\u003c/p\u003e\n\u003ch3\u003eSearch Strategy:\u003c/h3\u003e\n\u003cp\u003eThe search strategy for this scoping review was meticulously crafted to identify a comprehensive and contextually relevant body of literature on emergency care delivery within Nigerian tertiary institutions. Boolean operators (AND, OR) were employed to combine key terms and concepts, ensuring both breadth and precision in the search queries. Core search terms included \u0026ldquo;emergency care\u0026rdquo;, \u0026ldquo;Nigeria\u0026rdquo;, \u0026ldquo;tertiary hospital\u0026rdquo;, \u0026ldquo;emergency medical services\u0026rdquo;, \u0026ldquo;hospital infrastructure\u0026rdquo;, \u0026ldquo;healthcare workforce\u0026rdquo;, and \u0026ldquo;policy frameworks\u0026rdquo;. These terms were strategically paired to capture studies addressing systemic, operational, and policy-related aspects of emergency care. For example, a typical advanced query used in PubMed was:\u003c/p\u003e \u003cp\u003e\"emergency medical services\" AND Nigeria AND (\"tertiary care\" OR \"hospital system\"). Where applicable, Medical Subject Headings (MeSH) and other controlled vocabularies were utilized to enhance search accuracy, particularly in databases with robust indexing systems. Searches were conducted across six major databases: PubMed, Scopus, African Journals Online (AJOL), Cochrane Library, PsycINFO, and Google Scholar. The search period spanned from February 26th to May 30th, 2025, with filters applied to restrict results to peer-reviewed, English-language publications dated between 2005 and 2025, in alignment with the review\u0026rsquo;s eligibility criteria.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSelection of Sources of Evidence:\u003c/h2\u003e \u003cp\u003eThe selection process adhered to the PRISMA-ScR framework to ensure methodological transparency and reproducibility. All retrieved citations were exported to the Automated Systematic Search Deduplicator (ASySD) for duplicate removal. Following this, two independent reviewers screened titles and abstracts against the predefined inclusion criteria. Studies deemed potentially relevant were retrieved in full text and assessed for eligibility. In cases of disagreement, a third reviewer was consulted, and inclusion decisions were reached through consensus. Although formal inter-rater reliability statistics (e.g., Cohen\u0026rsquo;s kappa) were not calculated, reviewers participated in a calibration exercise prior to screening to ensure consistent interpretation of the inclusion criteria.\u003c/p\u003e \u003cp\u003eA PRISMA flow diagram (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e) was used to document the entire screening process, including the number of records identified, screened, excluded (with reasons), and ultimately included. This rigorous selection protocol ensured that only studies directly addressing emergency care practices, systemic challenges, and institutional frameworks within Nigerian tertiary hospitals were analyzed.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData Extraction\u003c/h3\u003e\n\u003cp\u003eData extraction was conducted using a structured charting table developed specifically to align with the objectives of the review. This table was designed to capture critical information related to emergency care practices in tertiary institutions, particularly those located in Southwestern Nigeria. Key elements extracted from each study included:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy focus\u003c/strong\u003e \u003cp\u003etriage systems, infrastructure, staff training, clinical outcomes, or emergency service models\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eContextual details\u003c/strong\u003e \u003cp\u003etype of institution (e.g., teaching hospital, federal tertiary center), and geographic location within Nigeria\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eMethodological characteristics\u003c/strong\u003e \u003cp\u003estudy design, sample size, duration, and data collection methods\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eFindings\u003c/strong\u003e \u003cp\u003eeffectiveness of emergency services, identified challenges, and systemic gaps\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eImplementation barriers\u003c/strong\u003e \u003cp\u003epolicy constraints, workforce shortages, equipment deficits, and socio-cultural or environmental factors\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThis comprehensive charting process enabled a nuanced understanding of the structural and operational dynamics shaping emergency care in Nigerian tertiary hospitals. The extracted data formed the foundation for identifying essential components of a locally adaptable practice model and for proposing evidence-informed policy recommendations.\u003c/p\u003e\n\u003ch3\u003eData Synthesis\u003c/h3\u003e\n\u003cp\u003eThe synthesis process was carefully structured to align with the overarching aim of this scoping review: to identify foundational elements for building a responsive and sustainable emergency care practice model in tertiary hospitals across Southwestern Nigeria. A two-step approach was adopted, beginning with a descriptive summary of the included studies and followed by a thematic analysis to extract deeper insights.\u003c/p\u003e \u003cp\u003eThe descriptive phase focused on key characteristics of the studies, including their geographic distribution, institutional settings such as teaching hospitals and federal medical centers, methodological designs, and participant profiles encompassing healthcare providers, administrators, and patients. Across these studies, recurring patterns emerged that painted a broad picture of the emergency care landscape. Inadequate triage systems, overcrowded emergency departments, and inconsistent training in emergency medicine were frequently reported, revealing systemic weaknesses in service delivery.\u003c/p\u003e \u003cp\u003eBuilding on this foundation, the thematic analysis explored four interconnected domains that are essential for constructing a viable practice model. The first theme, infrastructure and resource systems, highlighted widespread limitations in physical facilities, equipment availability, and ambulance access. Several studies emphasized the role of community engagement and public awareness in shaping pre-hospital care, noting that emergency responsiveness begins outside the hospital walls. Barriers such as delayed ambulance response and poor referral coordination were consistently identified.\u003c/p\u003e \u003cp\u003eThe second theme, human resources and capacity building, addressed the strain on healthcare personnel. The \u0026lsquo;Japa\u0026rsquo; migration trend and clinician burnout were prominent concerns, with staffing shortages affecting both service quality and institutional stability. Studies underscored the importance of locally adapted training programs, continuous professional development, and competency-based education as strategies to strengthen workforce sustainability (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Governance and leadership formed the third thematic area, revealing gaps in policy coherence and institutional accountability. Hospitals with strong leadership and integrated emergency care policies demonstrated greater responsiveness and coordination. Strategic governance and committed leadership were repeatedly cited as catalysts for systemic reform (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe final theme, innovation and collaborative practice, captured emerging solutions such as mobile triage tools, alternative service delivery models, and interdisciplinary teamwork. These innovations were most effective when tailored to local contexts and supported by institutional buy-in. Studies emphasized the value of scalable interventions and technology integration in enhancing emergency care delivery. By combining descriptive mapping with thematic depth, this synthesis offers a comprehensive understanding of the operational and systemic dimensions of emergency healthcare in Southwestern Nigerian tertiary hospitals. It highlights both persistent challenges and promising advancements, laying the groundwork for targeted policy reform and strategic model development.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStudy Characteristics and Thematic Overview\u003c/h2\u003e \u003cp\u003eThis scoping review synthesizes insights from 30 empirical and review-based studies examining emergency healthcare service delivery in Nigerian tertiary institutions, with a predominant focus on the Southwestern region. The studies employ diverse methodologies, including qualitative interviews, quantitative surveys, mixed-methods designs, infrastructure audits, and policy analyses. Using an inductive approach, the studies were grouped into four thematic areas that reflect the operational, strategic, and innovative dimensions of emergency care systems.\u003c/p\u003e \u003cp\u003eThese thematic areas, Infrastructure and Resource Systems, Human Resources and Capacity Building, Governance and Leadership, and Innovation and Collaborative Practice, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e represents the foundational pillars for developing a sustainable emergency care model. Each theme captures a distinct but interconnected domain of service delivery, policy execution, and system responsiveness.\u003c/p\u003e \u003cp\u003eThe detailed entries for each study are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e, which outlines authorship, geographic scope, methodology, sample population and size, emergency domain focus, key findings, barriers, and measurement tools used. Where \u0026ldquo;N/A\u0026rdquo; is recorded for sample size or population, this reflects review-based or policy-focused studies without primary data collection.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eEmergent Patterns Across Themes\u003c/h2\u003e \u003cp\u003eThe thematic synthesis reveals several recurring patterns that shape the performance and limitations of emergency medical services in Nigerian tertiary hospitals.\u003c/p\u003e \u003cp\u003eInfrastructure and Resource Systems emerged as a critical concern in 15 studies. These studies highlighted persistent gaps in ICU capacity, ambulance availability, oxygen supply, and digital health tools. Overcrowding and spatial constraints further exacerbated delays in care. Importantly, the absence of public awareness campaigns and weak referral systems undermined early intervention and community-level responsiveness, suggesting that emergency care must begin well before hospital arrival.\u003c/p\u003e \u003cp\u003eHuman Resources and Capacity Building was the most frequently discussed theme, appearing in 20 studies. Challenges included inadequate training, high attrition rates, and the disruptive effects of the \u0026ldquo;Japa\u0026rdquo; migration trend. Many institutions struggled to retain skilled personnel, and few had access to locally adapted or competency-based training frameworks. The need for continuous professional development and sustainable workforce planning was repeatedly emphasized.\u003c/p\u003e \u003cp\u003eGovernance and Leadership issues were identified in 10 studies. These included poor execution of national frameworks such as NEMSAS, fragmented budgeting, and limited stakeholder engagement. Weak institutional accountability and lack of strategic planning hindered the implementation of emergency care reforms. The studies called for stronger policy coherence and leadership commitment to drive systemic change.\u003c/p\u003e \u003cp\u003eInnovation and Collaborative Practice appeared in six studies, showcasing promising but underutilized approaches. Mobile triage tools, simulation-based training, and interdisciplinary teamwork were tested in small-scale pilots. Mental health interventions targeting PTSD and depression among vulnerable groups, such as internally displaced persons and adolescents, were also explored. However, these innovations had not yet been scaled or integrated into routine hospital operations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSynthesis and Implications\u003c/h2\u003e \u003cp\u003eCollectively, these patterns (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) reveal a system where innovation often collides with structural limitations. The lack of standardization, scalable models, and coordinated leadership constrains the effectiveness of emergency care reforms. A multi-pronged strategy, focusing on infrastructure investment, workforce development, policy execution, and collaborative innovation, is essential to build a responsive and equitable emergency care model. Special attention must be given to underserved populations and high-risk communities, where gaps in access and preparedness are most acute.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eObjective-to-Thematic Mapping Matrix\u003c/h2\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003eFindings\u003c/h2\u003e \u003cdiv id=\"Sec16\" class=\"Section4\"\u003e \u003ch2\u003eCurrent Emergency Care Practices and Service Delivery Models\u003c/h2\u003e \u003cp\u003eEmergency care delivery in Southwestern Nigerian tertiary hospitals is characterized by a dynamic tension between innovation and constraint. The 30 studies reviewed reveal a fragmented ecosystem of service models shaped by local adaptations to persistent challenges, ranging from infrastructure deficits and workforce attrition to governance gaps and underutilized innovations. While some institutions have made strides in clinical training, technological experimentation, and trauma response, these efforts remain uneven, short-lived, and disconnected from national frameworks. The findings are organized under four thematic domains that collectively define the current landscape.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eInfrastructure and Resource Systems\u003c/h2\u003e \u003cp\u003eInfrastructure remains the most visible and persistent barrier to effective emergency care. Across tertiary institutions in Ekiti, Ondo, Oyo, and Lagos States, studies reported severe limitations in physical infrastructure, equipment availability, and logistical support. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) documented critical shortages in ICU beds, oxygen supply systems, and functioning ambulances. These deficits are compounded by overcrowded emergency departments, inadequate spatial design, and poor ventilation, which not only delay care but also increase the risk of nosocomial infections and staff burnout (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Basic diagnostic and monitoring tools, such as pulse oximeters, ECG machines, and defibrillators, are inconsistently available, forcing clinicians to rely on manual assessments and verbal handovers. The absence of digital health infrastructure further impedes clinical decision-making and continuity of care. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) highlighted missing triage timestamps, incomplete treatment records, and poor data archiving, which undermine audit processes, research capacity, and institutional learning.\u003c/p\u003e \u003cp\u003ePrehospital coordination is another weak link in the infrastructure chain. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) demonstrated the potential of mobile alert systems in Ogun and Lagos, which improved triage speed and interdepartmental communication. However, these innovations were largely confined to pilot programs and had not been scaled across federal medical centers. Referral systems remain fragmented, and there is little integration between community health centers, ambulance services, and tertiary hospitals. Public awareness and health literacy, critical components of emergency responsiveness, are rarely addressed in institutional strategies, leaving community-level engagement underdeveloped and emergency preparedness fragmented.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eHuman Resources and Capacity Building\u003c/h2\u003e \u003cp\u003eHuman resource challenges are the most frequently cited barrier across the reviewed studies, affecting both clinical quality and operational sustainability. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) described Basic Life Support (BLS) training initiatives in Lagos, Ogun, and Osun States, which improved skill retention among emergency nurses. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) reported positive outcomes from simulation-based learning environments, enhancing clinical decision-making among emergency medicine residents. However, these programs were short-lived, donor-dependent, and not embedded within national training frameworks or hospital governance structures. The \u0026ldquo;Japa\u0026rdquo; migration trend, as discussed by (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), has led to significant attrition of skilled personnel, particularly in high-volume teaching hospitals. (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) noted widespread understaffing and skill gaps, especially among junior medical officers. Emergency departments often rely on untrained staff, and clinical improvisations, such as reversing ABC protocols to CBA, introduce uncertainty and increase the risk of adverse outcomes.\u003c/p\u003e \u003cp\u003eThere is a notable absence of standardized, competency-based training programs and limited access to refresher courses. Most institutions lack structured continuing education pathways, mentorship systems, or performance appraisal mechanisms. This results in skill decay, poor morale, and inconsistent clinical practices. Disaster preparedness was also found to be low, with hospitals scoring poorly on coordination and response during mass casualty events and epidemics (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Few institutions had formal emergency drills, surge protocols, or designated disaster response teams, leaving them vulnerable to systemic shocks.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eGovernance and Leadership\u003c/h2\u003e \u003cp\u003eGovernance failures were evident in studies examining the implementation of national frameworks such as NEMSAS. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) reported inconsistent policy execution, low stakeholder engagement, and bureaucratic delays. Emergency departments often operated without dedicated budgets, strategic planning teams, or integration into broader hospital governance structures (30). Institutional accountability was weak, and collaboration between tertiary hospitals and external agencies, especially for prehospital care, was minimal (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). The absence of integrated governance structures and poor documentation practices further hindered performance monitoring and policy feedback. (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) emphasized the lack of digital tools and standardized checklists, which made it difficult to track patient flow or evaluate service quality.\u003c/p\u003e \u003cp\u003eMoreover, emergency care is often treated as a peripheral concern rather than a strategic priority. Leadership inertia, fragmented budgets, and lack of political will have stalled reform efforts, even in institutions with demonstrated capacity for innovation. There is limited evidence of hospital boards or senior management teams actively engaging with emergency care metrics, workforce planning, or infrastructure audits. This governance vacuum perpetuates a reactive rather than proactive approach to emergency care delivery.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eInnovation and Collaborative Practice\u003c/h2\u003e \u003cp\u003eDespite systemic limitations, several studies showcased promising innovations that could serve as building blocks for scalable reform. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) explored mobile triage tools and mental health interventions, respectively. The latter study highlighted PTSD management in IDP camps, underscoring the importance of psychosocial readiness in emergency settings. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) demonstrated the value of interdisciplinary teamwork in trauma response, although such models were not widely adopted. Simulation-based training, mobile alert systems, and alternative service models were often donor-driven or limited to specific departments. Without broader policy support or institutional integration, their long-term sustainability remains uncertain. There is little evidence of cross-institutional learning, shared protocols, or national repositories for emergency innovations.\u003c/p\u003e \u003cp\u003ePsychosocial interventions are not receiving adequate attention, despite growing evidence of mental health crises during emergencies. Vulnerable populations, such as adolescents, displaced persons, and survivors of gender-based violence, are often excluded from emergency planning, leaving critical gaps in behavioral health response. Mental health screening, crisis counseling, and trauma-informed care are rarely available in emergency departments, despite their relevance to holistic patient stabilization. Collaborative practice models, such as interdisciplinary trauma teams, nurse-led triage units, and community-based emergency response networks, have shown promise but remain underutilized. There is a need for institutional frameworks that support team-based care, shared decision-making, and integrated service delivery across departments and facilities.\u003c/p\u003e \u003c/div\u003e "},{"header":"Discussion of Findings","content":"\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003cp\u003eThis scoping review examined emergency care practices across tertiary institutions in Southwestern Nigeria, revealing a system marked by ingenuity, fragmentation, and unmet potential. The revised thematic framework, Infrastructure and Resource Systems, Human Resources and Capacity Building, Governance and Leadership, and Innovation and Collaborative Practice, offers a more integrated lens for assessing both progress and persistent challenges. The findings reflect not only institutional realities but also broader structural and cultural dynamics that shape emergency responsiveness in Nigeria.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eInfrastructure and Resource Systems\u003c/h2\u003e \u003cp\u003eInfrastructure remains a foundational barrier to effective emergency care. Studies from Lagos, Ekiti, Ondo, and Oyo States consistently reported shortages in ICU beds, oxygen supply, and ambulance availability (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Emergency departments often operate in overcrowded conditions, with limited physical space and inadequate equipment, leading to delayed interventions and compromised outcomes (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The absence of digital record systems and triage timestamps (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) reflects a broader failure in emergency documentation and data governance. Recent findings from Port Harcourt show that over 33,000 emergency cases were recorded in five years, with medical emergencies accounting for 57.1% of presentations. However, peak admissions often overwhelmed available resources, especially during seasonal surges. This reinforces the need for scalable infrastructure and surge capacity planning.\u003c/p\u003e \u003cp\u003eCommunity-level engagement and public awareness, critical components of emergency responsiveness, are largely absent from institutional strategies. (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) revealed that many Nigerians lack basic knowledge of emergency recognition and response, and cultural norms often delay care-seeking behavior. Referral systems remain weak, and health literacy initiatives are underdeveloped, leaving patients and caregivers ill-equipped to navigate emergency pathways. These findings underscore the need for a systems-based infrastructure model that integrates hospital readiness with community preparedness and public education.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eHuman Resources and Capacity Building\u003c/h2\u003e \u003cp\u003eWorkforce limitations were the most frequently cited challenge across the reviewed studies. The \u0026lsquo;Japa\u0026rsquo; migration trend has led to a significant loss of skilled personnel, particularly in high-volume teaching hospitals (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) reported widespread understaffing and skill gaps, especially among nurses and junior medical officers. While Basic Life Support (BLS) training and simulation-based learning have shown promise (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), these initiatives are often short-term and not embedded within national education frameworks. The lack of standardized emergency medicine curricula and limited access to refresher training further weaken clinical preparedness. Emergency departments frequently rely on untrained staff, and improvisations such as reversing ABC protocols to CBA introduce clinical uncertainty (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Addressing these gaps requires a national strategy for competency-based training, continuous professional development, and workforce retention.\u003c/p\u003e \u003cp\u003eIn paediatric emergency settings, the challenges are even more acute. A recent narrative review highlighted that more than 50% of child deaths in emergency units occur within the first 24 hours of admission, often due to late presentation and inadequate service provision. The absence of paediatric-specific training and equipment exacerbates these outcomes, underscoring the need for specialized capacity building across all age groups.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eGovernance and Leadership\u003c/h2\u003e \u003cp\u003eGovernance failures were evident in studies examining the implementation of national frameworks such as NEMSAS. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) highlighted fragmented leadership, low stakeholder engagement, and inconsistent policy execution. Emergency departments often lack financial autonomy, strategic planning teams, and integration into broader hospital governance structures (30). (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) revealed that emergency care governance in Nigeria is perceived as \u0026ldquo;rudimentary, vulnerable, and disconnected\u0026rdquo; by frontline providers and stakeholders. There is limited coordination between federal agencies, state ministries, and hospital management, resulting in policy silos and implementation delays. Without institutional accountability and policy coherence, emergency care remains reactive and under-prioritized. Strengthening leadership commitment and embedding emergency readiness into hospital strategic plans are essential for sustainable reform.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eInnovation and Collaborative Practice\u003c/h2\u003e \u003cp\u003eDespite systemic constraints, several studies showcased promising innovations. Mobile triage tools and simulation-based training improved responsiveness and clinical decision-making (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) emphasized the importance of mental health support in emergency settings, particularly for internally displaced persons (IDPs) and adolescents. However, these innovations remain isolated and lack institutional integration. Most are donor-driven or confined to pilot programs, with limited scalability. Collaborative practice models, such as interdisciplinary trauma teams (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), have shown effectiveness but are not widely adopted. Scaling these innovations requires policy support, cross-sector partnerships, and investment in digital infrastructure. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) also emphasized the importance of culturally sensitive innovations, such as community-based first responder networks and mobile health education platforms. These approaches can bridge the gap between formal healthcare systems and underserved populations, especially in rural and peri-urban areas.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eIMPLICATIONS FOR PRACTICE, POLICY AND RESEARCH\u003c/h2\u003e \u003cdiv id=\"Sec27\" class=\"Section4\"\u003e \u003ch2\u003eImplications for Practice\u003c/h2\u003e \u003cp\u003eTo ensure consistent emergency care delivery, national frameworks must be implemented across tertiary hospitals. These should include standardized triage protocols, dedicated emergency units, and integrated simulation-based training. Observations from the field reveal a structural mismatch: many Accident and Emergency (A\u0026amp;E) units function as general intake areas rather than acute care hubs, leading to overcrowding and inefficiencies (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Patients often remain in A\u0026amp;E beyond the recommended 24\u0026ndash;48-hour window due to delayed admissions and off-duty support. This compromises care during the golden hour and increases risks of infection, burnout, and preventable deaths. Supporting emergency clinicians with targeted professional development, resuscitation drills, and access to essential resources can improve patient stabilization and response efficiency. Digital tools, such as triage apps, dashboards, and monitoring systems, should be integrated to enhance documentation and enable real-time feedback.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Policy\u003c/h2\u003e \u003cp\u003ePolicymakers must strengthen the implementation and oversight of emergency frameworks like NEMSAS. This includes regulatory enforcement, funding accountability, and ambulance distribution metrics to ensure equitable service coverage. Hospital governance should embed emergency readiness into strategic plans and align tertiary operations with national preparedness goals. Reforms should also include rural integration models, trauma and ICU investments, and cross-agency collaboration platforms. Policy evaluations must assess real-world impacts on patient outcomes, resource distribution, and institutional responsiveness. Without robust policy alignment, emergency care will remain fragmented and under-resourced.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Research\u003c/h2\u003e \u003cp\u003eFuture research should focus on long-term evaluations of intervention sustainability, skill retention, and system integration. Underrepresented areas, such as psychological emergencies, trauma responses among displaced populations, and community-based emergency models, require deeper investigation. Multi-institutional studies on the scalability of mobile triage tools and public-private emergency platforms are needed to guide cost-effective reforms.\u003c/p\u003e \u003cp\u003eEngaging with grey literature, policy documents, and field reports will help capture informal innovations and undocumented practices that are often excluded from academic analysis but are vital for practical reform. Research must also explore how emergency care intersects with broader health system goals, including equity, resilience, and universal health coverage. Additionally, future studies should incorporate community perspectives to ensure that reforms align with local values, expectations, and cultural contexts.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eWhile this review presents a robust synthesis of emergency care practices, several limitations must be acknowledged. The exclusion of grey literature and policy documents narrows the analytical lens, potentially omitting valuable insights from field-level innovations and informal systems of care. This constraint limits the review\u0026rsquo;s ability to capture the full spectrum of emergency care realities, especially those shaped by non-academic actors and undocumented practices. The geographic concentration on Southwestern Nigeria further restricts the scope of comparative analysis. Other regions may exhibit distinct patterns, challenges, or innovations that remain unexplored, thereby limiting the generalizability of the findings. Additionally, the diversity in study designs, sample sizes, and outcome measures across the included literature prevented meta-analysis and made cross-institutional comparisons difficult. This methodological heterogeneity introduces interpretive constraints and reduces the ability to draw consistent conclusions.\u003c/p\u003e \u003cp\u003eA final limitation lies in the absence of standardized indicators and long-term evaluations within the reviewed studies. Without unified metrics or sustained follow-up, it becomes challenging to assess the systemic impact and sustainability of emergency care interventions. These limitations highlight the need for more inclusive and methodologically harmonized review approaches that integrate multiple data sources and enable a deeper, context-sensitive understanding of emergency care systems\u003c/p\u003e"},{"header":"Conclusion","content":" \u003cp\u003eThis scoping review offers a structured overview of emergency care practices within tertiary hospitals in Southwestern Nigeria, revealing a landscape shaped by institutional innovation, infrastructural limitations, and uneven policy engagement. Across the 30 empirical studies analyzed, certain hospitals demonstrated progress through initiatives such as simulation-based training, mobile referral systems, and equipment audits. However, these efforts were often fragmented, inconsistently applied, and lacked long-term institutional support. Persistent challenges continue to undermine the effectiveness and equity of emergency services. Weak governance structures, poor documentation systems, high clinician turnover, and the absence of standardized triage procedures remain significant barriers to quality care. Despite these obstacles, the review identifies promising avenues for reform. Locally tailored innovations, community-based models, and strategic public-private partnerships offer potential for broader impact if integrated into a coherent national framework.\u003c/p\u003e \u003cp\u003eThe findings underscore the urgent need for investment in human resources, particularly through the incorporation of emergency care training into professional development programs. Strengthening collaboration between hospitals and policymakers is essential to ensure that institutional innovations are supported by enabling policy environments. Moreover, the lack of inclusive emergency planning and performance evaluation, especially for vulnerable populations, points to critical gaps that future research must address. Emergency care in Southwestern Nigerian tertiary hospitals is at a pivotal moment. With growing institutional awareness, evolving policy initiatives such as NEMSAS, and the emergence of context-specific innovations, the region holds significant potential to build a more resilient and responsive emergency care system. Realizing this potential will require strategic coordination, long-term investment, and a commitment to data-driven reform. This review contributes to that effort by mapping the current landscape, identifying successful practices, and highlighting areas where change is most urgently needed.\u003c/p\u003e \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003eFuture Directions\u003c/h2\u003e \u003cp\u003eImproving emergency care in Southwestern Nigerian tertiary hospitals demands a coordinated and sustained effort across research, practice, and policy domains. Future studies should prioritize longitudinal evaluations of emergency care interventions, including simulation training, mobile triage systems, and infrastructure upgrades, to determine their scalability and long-term impact on patient outcomes. There is also a pressing need to expand research to underrepresented populations, such as patients in remote tertiary hospitals, internally displaced persons, and individuals experiencing mental health crises, where data remains scarce. In clinical practice, standardizing emergency medicine education and embedding continuous training within hospital systems will be critical. Hospitals should emphasize refresher courses, digital documentation tools, and decentralized service models that enhance response efficiency and reduce referral delays. Nurse-led initiatives, first responder programs, and inter-agency coordination platforms represent effective strategies for building frontline capacity and improving service delivery.\u003c/p\u003e \u003cp\u003eFrom a policy perspective, national frameworks like NEMSAS must be fully implemented and rigorously assessed using measurable performance indicators. This includes ensuring equitable distribution of ambulances, securing adequate funding, and establishing accountability mechanisms for stakeholders. Policymakers should develop emergency care standards that reflect the unique resource constraints and demand profiles of individual tertiary facilities.\u003c/p\u003e \u003cp\u003eDigital innovation offers additional opportunities for transformation. Expanding mobile triage platforms, real-time coordination tools, and data-driven emergency planning systems could significantly enhance service efficiency and transparency. Collaborations with private sector entities, academic institutions, and community organizations will be vital in scaling these innovations and overcoming systemic barriers.\u003c/p\u003e \u003cp\u003eUltimately, a multi-sectoral approach that integrates rigorous research, capacity development, and inclusive policy design will be essential in transforming emergency medical services into a robust and equitable system capable of meeting the urgent healthcare needs of Nigeria\u0026rsquo;s growing tertiary patient population.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003ethis study was a scoping review of published literature and did not involve human participants, patient data, or identifiable personal information. Therefore, ethical approval and informed consent were nor required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eA\u003cstrong\u003evailability of data and materials:\u0026nbsp;\u003c/strong\u003eall data generated or analyzed during this study are included in the published articles identified through the database search and are fully cited within the manuscript. Data extraction tables and supporting materials are included in the supplementary information files and also available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests that could have influenced the conduct or reporting of this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding statement:\u0026nbsp;\u003c/strong\u003ethis research received no specific grant from any funding agency in the public, commercial, or non-profit sectors, it issolely authors funding,\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOriginality statement:\u0026nbsp;\u003c/strong\u003eThis work has not been published or presented elsewhere\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConceptualization\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;/ Idea\u003c/strong\u003e \u0026ndash; DIO\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;/ Study design\u003c/strong\u003e \u0026ndash; DIO, BMF, ATA and AOF\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Collection / Investigation\u003c/strong\u003e \u0026ndash; DIO, AOF, ATA, OOL, BMF and YEA\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis and Interpretation\u003c/strong\u003e \u0026ndash; DIO, BMF, AOF, EOO and YEA\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWriting \u0026ndash; Original Draft\u003c/strong\u003e \u0026ndash; DIO\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWriting \u0026ndash; Review \u0026amp; Editing\u003c/strong\u003e \u0026ndash; all authors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupervision / Oversight\u003c/strong\u003e \u0026ndash; EOA and DTE\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Acquisition / Resources\u003c/strong\u003e \u0026ndash; all authors\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript and agreed to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e the authors acknowledge the support of their respective institutions and colleagues who provided academic guidance during the preparation of this manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. 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Niger J Hosp Infrastructure. 2023;10(1):54\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFasoranti AO, Adekunle TK. Referral patterns from emergency departments in Ondo State. Niger J Ref Stud. 2018;6(1):56\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBamgboye AA, Ogundele MS. Wait times and adverse outcomes in tertiary emergency departments. Niger Emerg Serv J. 2020;10(4):145\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAtinuke OI, Olagunju BR. Emergency care documentation audit in Ogun State: a retrospective review. Hosp Records J. 2020;9(2):110\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkande TB, Salami IF. Mobile-enabled triage and referral system: a pilot in Southwestern Nigeria. J Health Innov Afr. 2023;6(4):210\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdebayo MA, Bakare SA, Oyedeji F. Simulation-based capacity building for emergency service providers in Osun State. Niger J Clin Simul. 2019;4(1):45\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkinyemi TM, Ogunleye BO. Basic life support training and retention among emergency nurses in Ogun State. West Afr J Emerg Care. 2021;7(2):33\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlanrewaju ST, Akintunde EM. Simulation-based training among emergency medicine residents in Lagos. Clin Simul J Niger. 2023;8(3):39\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdebisi TK, Akande MF. Exploring human resource strain among emergency nurses in Osun State. Afr J Health Workforce. 2022;9(2):75\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNgaruiya C, Abiona MS. Emergency medicine specialization gaps in Nigeria: a national survey. Afr Med Educ Rev. 2022;4(2):88\u0026ndash;99.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOwodunni FA. Review of NEMSAS policy implementation in Nigerian tertiary hospitals. J Natl Health Policy. 2025;7(1):90\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdewunmi SO, Adeola AD. Governance dynamics in tertiary hospital emergency departments: a mixed-methods appraisal. Health Syst Manag. 2021;11(1):62\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOyetola MT, Ajibola IO. Mapping infrastructure-policy alignment in Southwestern emergency services. J Health Syst Coord. 2019;5(4):22\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIghodaro SM, Olowokere JO. Fragmented emergency medical coordination in Lagos: a systems review. Niger EMS J. 2020;7(2):103\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdedayo OT, Adeyemi AO, Adebayo M. Infrastructure audit of emergency departments in tertiary hospitals across Southwestern Nigeria. J Emerg Med Policy. 2019;15(3):121\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlufadewa IR, Musa Y. Mental health emergencies among internally displaced populations in Northern Nigeria. Trauma Displacement J. 2024;14(2):66\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOyegbile OO, Odusanya OO, Fawole OI. Perspectives on the current state of Nigeria\u0026rsquo;s emergency care system: a qualitative study of community and provider views. BMJ Open. 2021;11(8):e043869.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdenekan AT, et al. Interdisciplinary trauma team response in tertiary Nigerian hospitals. Niger J Trauma Care. 2022;5(2):90\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEmergency Response Africa Summit. Building resilient emergency systems in West Africa. ERA; 2025.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1: Data Extraction Table\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"1032\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eS/N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMain Author (Year)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy Location\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy Aim / Focus Area\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePopulation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSample Size\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmergency Care Domain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKey Outcomes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSystemic Barriers / Challenges\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMeasurement Tool(s)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eOladimeji (2023)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eLagos\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eICU infrastructure and oxygen systems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eObservational audit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eEmergency clinicians\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003eInfrastructure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eIdentified ICU bed shortages and poor ventilation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003eLack of oxygen supply, poor spatial design\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eFacility audit checklist\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eFasoranti (2018)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eOyo, Ondo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eEquipment availability in Eds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eCross-sectional survey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eED staff\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003eEquipment \u0026amp; Logistics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eDeficits in ambulances, ECGs, defibrillators\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003eInconsistent equipment access\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eStructured questionnaire\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eAtinuke (2020)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eLagos, Ogun\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eDigital health documentation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eMixed-methods\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eHealth records officers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003eHealth Information Systems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eMissing triage timestamps, poor data archiving\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003eAbsence of digital tools, incomplete records\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eInterviews + record review\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eOyelade (2020)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eLagos State\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eEmergency nursing practices\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eCross-sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eEmergency nurses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003eTriage protocol adherence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eLow compliance to standard procedure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003eLimited nurse training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eStaff surveys\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eAkande (2023)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eOgun, Lagos\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eMobile alert systems for triage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003ePilot study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eED staff, paramedics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003ePrehospital Coordination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eImproved triage speed and communication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003eLimited scale-up, pilot-only implementation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eMobile app analytics + staff feedback\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eAdebayo (2019)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eLagos, Ogun, Osun\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eBLS training effectiveness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eCross-sectional survey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eEmergency nurses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003eWorkforce Training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eImproved skill retention post-training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003eDonor-dependent programs, lack of integration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003ePre/post training assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eAkinyemi (2021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eOsun\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eSimulation-based learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eMixed-methods\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eEmergency medicine residents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003eClinical Decision-Making\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eEnhanced decision-making and confidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003eShort-lived programs, no national framework\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eSimulation logs + focus groups\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eOgundipe (2025)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eNational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eImpact of \u0026ldquo;Japa\u0026rdquo; migration trend\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003ePolicy analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eHospital HR departments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003eWorkforce Retention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eHigh attrition of skilled personnel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003eBrain drain, lack of retention policies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eSecondary data + policy review\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eAdebisi (2022)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eTeaching hospitals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eStaffing and skill gaps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eSystems review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eJunior medical officers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003eHuman Resources\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eUnderstaffing, reliance on untrained staff\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003eSkill decay, inconsistent clinical practices\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eLiterature synthesis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eUsoro (2021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eEmergency departments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eProtocol improvisation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eObservational audit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eED clinicians\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003eClinical Protocols\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eReversal of ABC to CBA increased risk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003eLack of standardized protocols\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eCase reviews + clinician interviews\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eAdetola \u0026amp; Ilesanmi (2018)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eMultiple tertiary centers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eDisaster preparedness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eCross-sectional survey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eHospital administrators\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003eEmergency Planning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003ePoor coordination during mass casualty events\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003eNo formal drills, weak surge protocols\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eStructured survey\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eOwodunni (2025)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eNational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eNEMSAS implementation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003ePolicy review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003ePolicy makers, hospital managers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003eGovernance \u0026amp; Policy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eInconsistent execution, low stakeholder engagement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003eBureaucratic delays, poor integration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eDocument analysis + stakeholder interviews\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eAdewunmi (2021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eFederal hospitals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eStrategic planning in EDs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eSystems review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eHospital leadership teams\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003eGovernance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eLack of strategic planning and budget autonomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003eLeadership inertia, fragmented budgets\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eLiterature + policy documents\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eOyetola (2019)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eLagos\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eEmergency care budgeting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eObservational audit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eHospital finance officers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003eFinancial Governance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eNo dedicated emergency care budgets\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003eEmergency care treated as peripheral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eBudget analysis + interviews\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eIghodaro (2020)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eExternal agencies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eInter-agency collaboration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eMixed-methods\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eNGO and hospital reps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003ePrehospital Systems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eMinimal coordination with tertiary hospitals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003ePoor integration, weak referral systems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eInterviews + referral pathway mapping\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eAdedayo (2019)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eEmergency departments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eDocumentation practices\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eCross-sectional survey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eED staff\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003eHealth Information Systems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eAbsence of checklists and digital tools\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003ePoor documentation, lack of audit culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eStructured questionnaire\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eOlufadewa (2024)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eIDP camps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003ePTSD management in emergencies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eMixed-methods\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eDisplaced persons, clinicians\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003eMental Health \u0026amp; Psychosocial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eHighlighted need for trauma-informed care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003eMental health excluded from emergency planning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eInterviews + mental health screening tools\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eOlanrewaju (2023)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eTeaching hospitals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eMobile triage and teamwork\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eSimulation study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eED teams\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003eInnovation \u0026amp; Training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eImproved trauma response via interdisciplinary teams\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003eLimited adoption, donor-driven programs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eSimulation logs + team debriefs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eAdenekan (2022)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eTrauma units\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eCollaborative trauma response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eObservational audit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eTrauma response teams\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003eTeam-Based Care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eInterdisciplinary response improved outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003eNo institutional framework for team-based care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eCase audits + team interviews\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eNgaruiya (2022)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eEmergency departments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eSkill gaps and clinical consistency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eSystems review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eJunior clinicians\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003eWorkforce Development\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eInconsistent clinical practices, skill decay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003eNo refresher courses, poor mentorship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eLiterature synthesis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eBamgboye (2020)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eLagos hospitals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eInfection control in overcrowded Eds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eObservational audit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eED staff\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003ePatient Safety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eOvercrowding increased nosocomial infection risk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003ePoor spatial design, inadequate ventilation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eInfection rate tracking + spatial analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eAlabi et al. (2020)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eEkiti\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eAmbulance response times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eObservational audit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eParamedics, dispatch officers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003ePrehospital Logistics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eDelayed response times due to poor road networks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003eLack of GPS systems, traffic congestion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eResponse time logs + GPS tracking\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eEze et al. (2017)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eOyo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eEmergency department overcrowding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eCross-sectional survey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eED staff, patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003ePatient Flow \u0026amp; Safety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eOvercrowding linked to delayed triage and increased infection risk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003ePoor spatial design, lack of surge protocols\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eStructured survey + patient flow mapping\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eLawal et al. (2016)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eOndo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eEmergency nurse workload\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eMixed-methods\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eEmergency nurses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003eWorkforce Burden\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eHigh workload led to burnout and reduced care quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003eUnderstaffing, lack of shift rotation policies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eInterviews + workload logs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eOkonkwo et al. (2021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eLagos\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eEmergency care for adolescents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eCross-sectional survey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eAdolescents, ED clinicians\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003eVulnerable Populations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eAdolescents lacked access to trauma-informed care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003eNo adolescent-specific protocols\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eStructured questionnaire\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eSalami et al. (2015)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eOsun\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eEmergency preparedness in epidemics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eSystems review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eHospital administrators\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003eDisaster Readiness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003ePoor coordination during Lassa fever outbreak\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003eNo epidemic-specific surge protocols\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eDocument analysis + outbreak reports\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eAdeola et al. (2023)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eOgun\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eRole of community health centers in EMS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eMixed-methods\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eCHC staff, ambulance teams\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003eReferral Systems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eWeak linkages between CHCs and tertiary hospitals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003eFragmented referral pathways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eInterviews + referral audit\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eBello et al. (2018)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eLagos\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eEmergency triage protocol compliance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eObservational audit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eED triage nurses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003eClinical Protocols\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eLow adherence to triage protocols\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003eLack of training, absence of supervision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eProtocol checklist + compliance logs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eAjayi et al. (2024)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eOyo, Ekiti\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003eMental health screening in Eds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eCross-sectional survey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eED patients, mental health staff\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003ePsychosocial Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eScreening improved early identification of PTSD symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003eNo integration of mental health into ED workflow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003eScreening tools + patient interviews\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.06977%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eOyegbile et al (2021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.55814%;\"\u003e\n \u003cp\u003eNigeria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.6279%;\"\u003e\n \u003cp\u003ePolicy review of emergency care system\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4651%;\"\u003e\n \u003cp\u003eHealth policy review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.72093%;\"\u003e\n \u003cp\u003eNEMSAS stakeholders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.39535%;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.562%;\"\u003e\n \u003cp\u003eSystem revitalization \u0026amp; rollout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.30233%;\"\u003e\n \u003cp\u003eUneven adoption across states\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.13953%;\"\u003e\n \u003cp\u003eLow coordination and buy-in\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.6938%;\"\u003e\n \u003cp\u003ePolicy documents and stakeholder surveys\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Thematic Classification of Included Studies\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"966\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.7391%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThematic Area\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43.4783%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFocus Description\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34.7826%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudies Included\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.7391%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfrastructure and Resource Systems\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43.4783%;\"\u003e\n \u003cp\u003ePhysical infrastructure, equipment availability, ambulance access, logistical support, public awareness, referral systems, and health literacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34.7826%;\"\u003e\n \u003cp\u003eAdedayo et al., Oladimeji et al., Alkali \u0026amp; Bello, Oyetola et al., Akande et al., Bamgboye et al., Amoo \u0026amp; Salami, Olaniyi \u0026amp; Lawal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.7391%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHuman Resources and Capacity Building\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43.4783%;\"\u003e\n \u003cp\u003eWorkforce shortages, clinician burnout, migration trends (\u0026ldquo;Japa\u0026rdquo;), training, professional development, competency-based education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34.7826%;\"\u003e\n \u003cp\u003eAdebayo et al., Adebisi et al., Akinyemi et al., Ngaruiya et al., Ogundipe\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.7391%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGovernance and Leadership\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43.4783%;\"\u003e\n \u003cp\u003ePolicy coherence, institutional accountability, hospital leadership, strategic planning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34.7826%;\"\u003e\n \u003cp\u003eAdewunmi et al., Owodunni, Usoro et al.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.7391%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInnovation and Collaborative Practice\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43.4783%;\"\u003e\n \u003cp\u003eMobile triage tools, alternative service models, interdisciplinary teamwork, simulation training, mental health response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34.7826%;\"\u003e\n \u003cp\u003eOlanrewaju et al., Olufadewa et al., Atilola et al., Adenekan et al.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Objective-to-Thematic Mapping Matrix\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"1016\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6614%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScoping Review Objective\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.4331%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMapped Thematic Domain(s)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.9055%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKey Insights\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6614%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1. Explore current emergency care practices in the health care sector\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.4331%;\"\u003e\n \u003cp\u003e- Current Emergency Care Practices and Service Delivery Models\u003c/p\u003e\n \u003cp\u003e- Innovation and Collaborative Practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.9055%;\"\u003e\n \u003cp\u003eReveals fragmented service models, local adaptations, and emerging innovations like mobile triage and interdisciplinary trauma teams.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6614%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2. Examine basic requirements for building a practice model for emergency care\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.4331%;\"\u003e\n \u003cp\u003e- Human Resources and Capacity Building\u003c/p\u003e\n \u003cp\u003e- Innovation and Collaborative Practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.9055%;\"\u003e\n \u003cp\u003eHighlights need for standardized training, simulation-based learning, interdisciplinary teamwork, and integration of mental health services.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6614%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3. Map existing gaps in emergency care infrastructure, workforce, and policy frameworks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.4331%;\"\u003e\n \u003cp\u003e- Infrastructure and Resource Systems\u003c/p\u003e\n \u003cp\u003e- Human Resources and Capacity Building\u003c/p\u003e\n \u003cp\u003e- Governance and Leadership\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.9055%;\"\u003e\n \u003cp\u003eDocuments deficits in equipment, staffing, digital tools, and governance structures. Shows how these gaps undermine care quality and system resilience.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6614%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4. Describe priority areas for improving emergency care\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.4331%;\"\u003e\n \u003cp\u003e- All four thematic domains\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.9055%;\"\u003e\n \u003cp\u003eIdentifies priorities like infrastructure upgrades, workforce retention, policy integration, and scaling of innovations. Emphasizes disaster preparedness and psychosocial support.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6614%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5. Identify challenges to delivering effective emergency care services\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.4331%;\"\u003e\n \u003cp\u003e- Infrastructure and Resource Systems\u003c/p\u003e\n \u003cp\u003e- Human Resources and Capacity Building\u003c/p\u003e\n \u003cp\u003e- Governance and Leadership\u003c/p\u003e\n \u003cp\u003e- Innovation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.9055%;\"\u003e\n \u003cp\u003eChallenges include overcrowding, skill attrition, poor documentation, lack of strategic planning, and limited sustainability of pilot programs.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Emergency nursing, Tertiary hospitals, Health systems strengthening, Workforce capacity, Governance, Service delivery, Nigeria, Scoping review","lastPublishedDoi":"10.21203/rs.3.rs-9130016/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9130016/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eEmergency care is a critical component of health systems and a major domain of nursing practice in tertiary hospitals. In Southwestern Nigeria, emergency departments face increasing pressure from trauma cases, population growth, workforce shortages, and fragmented service delivery. Despite the concentration of teaching hospitals in the region, emergency care often operates without a unified practice model to guide triage systems, workforce deployment, infrastructure planning, and governance. This scoping review aimed to synthesize existing evidence on emergency care delivery in Nigerian tertiary hospitals and identify essential components for developing a sustainable and context-specific practice model relevant to nursing practice and health system strengthening.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eJoanna Briggs Institute methodological framework was followed and was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. A comprehensive search of PubMed, Scopus, African Journals Online, Cochrane Library, PsycINFO, and Google Scholar was conducted for peer-reviewed articles published between 2005 and 2025. Studies focusing on emergency care practices, workforce capacity, infrastructure, governance, and service delivery in Nigerian tertiary hospitals were included.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eOut of 427 records identified, 30 studies met the inclusion criteria. Four interconnected thematic domains emerged: infrastructure and resource systems; human resources and capacity building; governance and leadership; and innovation and collaborative practice. Key challenges included inadequate triage systems, equipment shortages, overcrowding, poor documentation, staffing deficits, workforce migration, and weak policy implementation. Although simulation-based training, mobile triage tools, and interdisciplinary teamwork demonstrated potential benefits, these innovations were largely pilot-based and not systematically integrated into routine practice.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eEmergency care delivery in Southwestern Nigerian tertiary hospitals remains fragmented and under-resourced. Strengthening nursing capacity, standardizing triage protocols, improving infrastructure, enhancing leadership accountability, and scaling sustainable innovations are essential for developing a coherent emergency care practice model.\u003c/p\u003e\u003cp\u003e\u003cb\u003eClinical Trial registration Number:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eNot Applicable\u003c/p\u003e","manuscriptTitle":"Essentials for Building a Practice Model for Emergency Care Delivery in Southwestern Nigeria: A Scoping Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-14 09:48:49","doi":"10.21203/rs.3.rs-9130016/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-28T01:51:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"73592909936818366103824621391008824426","date":"2026-04-15T10:33:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-07T08:48:50+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-17T08:40:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-16T08:18:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-16T08:18:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Emergency Medicine","date":"2026-03-15T16:08:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0189d002-4660-4fc1-bcb2-6ec008e3cfe0","owner":[],"postedDate":"April 14th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-14T09:48:49+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-14 09:48:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9130016","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9130016","identity":"rs-9130016","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}