Introduction Primary healthcare (PHC) emergency services are critical as the first line of defence against life-threatening conditions, significantly reducing mortality and morbidity. Globally, life-threatening emergencies (LTEs) such as acute myocardial infarction, stroke, severe trauma and respiratory failure frequently present first at PHC centres, particularly in low- and middle-income countries. However, inadequate emergency preparedness at the primary care level contributes to substantial avoidable mortality and long-term disability. Many PHC centres, especially in underserved and rural areas, face substantial challenges including inadequate equipment, insufficient training and poor referral systems which compromise emergency care quality and outcomes. Despite the recognised importance of PHC in emergency care, there is currently no synthesised evidence comprehensively mapping the barriers and facilitators that influence LTE management at this level. This systematic review aims to synthesise evidence on barriers and facilitators in managing LTEs at PHC centres to inform effective interventions and policy development. Methods and analysis This systematic review will comprehensively search PubMed/MEDLINE, Scopus and Web of Science for relevant literature published up to 31 May 2026. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two independent researchers will conduct a three-stage screening process: initial title/abstract evaluation, full-text assessment and manual review of reference lists. Any disagreements between reviewers will be adjudicated by the lead investigator. The eligibility criteria and research question will be established using the SPIDER framework, which examines Sample, Phenomenon of Interest, Design, Evaluation and Research Type components. Methodological quality will be appraised using the Mixed Methods Appraisal Tool (2018). Extracted data will be systematically collected using a standardised form. A ‘best fit’ framework synthesis approach, complemented by thematic analysis, will be employed to integrate qualitative evidence. Ethics and dissemination The protocol for this systematic review has received ethical approval from the Research Ethics Committee of Tabriz University of Medical Sciences (approval number: IR.TBZMED.VCR.REC.1404.061). The committee confirmed that the study objectives do not involve direct patient contact or clinical interventions, and therefore, the review meets ethical standards for research based exclusively on published literature. Findings will be disseminated through peer-reviewed publication, conference presentations and policy briefs. Systematic review registration Registration number PROSPERO CRD420251071584.
Amir‐Behghadami et al. (2026) studied this question.