Abstract Objectives: To synthesise and critically examine the most urgent global challenges facing Emergency Medicine (EM), including system pressures, workforce vulnerabilities, climate‑related threats, conflict‑driven emergencies, infectious disease risks, inequities in access, and gaps in digital and research capacity. The review aims to identify cross‑cutting determinants and propose system‑level strategies to strengthen resilience and equity in emergency care worldwide. Design: Narrative review. Methods: A thematic narrative review was conducted using literature from PubMed, WHO and UN agency reports, global emergency medicine organisations, and international policy documents. Sources were selected for relevance to global emergency care, with emphasis on Low and Middle‑Income Countries (LMICs). Themes were identified through iterative synthesis and conceptual mapping. Results:Ten major global issues emerged: Emergency department overcrowding and access block, driven by rising demand, inadequate inpatient capacity, and weak primary care integration. Workforce shortages and burnout, exacerbated by migration, violence against healthcare workers, and gender inequities. Climate change, contributing to heat‑related illness, extreme weather events, and shifting disease patterns. Conflict, displacement, and humanitarian crises, increasing trauma burden and complex emergency needs. Infectious disease threats and antimicrobial resistance, revealing persistent gaps in preparedness and stewardship. Rising non‑communicable disease burden, increasing demand for time‑critical interventions. Digital transformation gaps, including inequitable access to digital tools and concerns around AI ethics and cybersecurity. Prehospital care deficiencies, particularly in LMICs lacking organised EMS systems. Financial and structural inequities, limiting timely access to emergency care. Global research disparities, with LMICs under‑represented in EM research and clinical trials. Conclusions: Emergency medicine is at a pivotal moment, shaped by converging global pressures that threaten system capacity, equity, and resilience. Addressing these challenges requires coordinated investment in infrastructure, workforce protection, climate‑resilient systems, equitable digital innovation, and strengthened global research capacity. Emergency care must evolve from a reactive service to a proactive, system‑shaping discipline central to global health security.
I et al. (Sun,) studied this question.