Other ; Background: Out of hospital emergency care (OHEC), also known as prehospital care, has been shown to reduce morbidity and mortality from serious illness. We sought to summarize literature for low and low-middle income countries to identify barriers to and key interventions for OHEC delivery. Methods: We performed a systematic review of the peer review literature from January 2005 to March 2015 in PubMed, Embase, Cochrane, and Web of Science. All articles referencing research from low or low-middle income countries addressing OHEC, emergency medical services, or transport/transfer of patients were included. We identified themes in the literature to form six categories of OHEC barriers. Findings: A total 1,927 titles were identified through our search, of these only 31 met criteria for inclusion in the review. Barriers to OHEC were divided into one of six categories that included: culture/community, Infrastructure, communication/coordination, Transport, Equipment and Personnel. Lack of transportation was the most common problem (20/31, 65%) hindering OHEC. Ambulance was the most common mode (22/31, 71%) of transporting patients; however many patients still relied on alternative means of transportation such as hired cars, and animal drawn carts. Fifty-eight percent (18/31) of articles identified a lack of skilled personnel as a key barrier, with 32% (10/31) of OHEC being delivered by laypersons without formal training. Only forty-percent (12/31) of the systems identified in the review described a uniform access phone number for emergency medical service activation. Interpretation: Policy makers and researchers that seeking to improve OHEC in low and low-middle income countries should focus on increasing the availability of transport and trained providers while improving patient access to the OHEC system. The review yielded articles with a primary focus in Africa, highlighting a need for future research in diverse geographic areas.