<![CDATA[Background: Access to emergency care in rural and remote areas is often constrained by long travel distances, a shortage of specialist personnel, and limited supporting facilities, creating a risk of delayed treatment during the critical golden hour. Telemedicine has been proposed as a strategy to bridge this gap through remote consultation, clinical decision support, and early triage. This narrative systematic review aims to summarize current evidence on the effectiveness of telemedicine in rural emergency care services. A literature search was conducted in PubMed, Scopus, Google Scholar, and Garuda databases using combinations of keywords related to telemedicine, telehealth, emergency care, and rural settings for publications from 2019-2026, supplemented by a review of telemedicine policy in Indonesia. Fourteen primary sources meeting the relevance criteria were thematically synthesized. The review found that telemedicine contributes to improved diagnostic accuracy, faster response times, reduced unnecessary patient referrals or transfers, and higher patient and provider satisfaction, although benefits were more consistent for non-critical cases than for high-acuity cases requiring immediate hands-on intervention. Cost-effectiveness varied depending on the scale of implementation and available infrastructure. In Indonesia, telemedicine implementation in underdeveloped, border, and island regions (DTPK) shows similar potential but continues to face internet connectivity constraints, regulatory readiness gaps, and a shortage of trained human resources. This review concludes that telemedicine is effective as a complement to, not a replacement for, conventional emergency care in rural areas, and its success depends on infrastructure investment, standardized clinical protocols, and strengthened local healthcare workforce capacity. Keywords: Telemedicine; Telehealth; Emergency Care; Rural]]>
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