Trauma is a leading cause of mortality in low- and middle-income countries (LMICs), where effective prehospital care can significantly improve survival. However, the development of robust prehospital systems is hindered by systemic barriers, including fragmented services, inadequate resources, and undertrained personnel. This study aimed to systematically map the evidence on these challenges and the solutions being implemented to overcome them. We conducted a scoping review following the PRISMA-ScR guidelines. A scoping search was conducted in PubMed, ScienceDirect, and EBSCO databases was performed to identify primary research studies focused on prehospital trauma care in LMICs. After screening, a total of 23 articles met the inclusion criteria. Data related to barriers and facilitators were extracted, charted, and synthesized using a thematic analysis approach. Four key themes of barriers were consistently identified across the 23 studies: deficits in provider training and continuous education; inadequate infrastructure, physical resources, and communication systems; fragmented governance and a lack of standardized clinical protocols; and significant sociocultural obstacles, including a lack of public awareness and fear of legal repercussions for providing aid. Conversely, effective facilitators centered on context-specific training for both lay and professional responders; community-based initiatives that empower local volunteers as first responders; the application of low-cost, appropriate technology for communication and dispatch; and the establishment of supportive policy and legal frameworks. Strengthening prehospital trauma care in LMICs requires a paradigm shift away from simply attempting to replicate resource-intensive models from high-income countries. The evidence synthesized in this review strongly suggests that the most effective and sustainable pathway lies in fostering context-specific, community-driven solutions. Investing in lay responder training and low-cost technological innovations, all supported by clear national governance, represents a powerful strategy to reduce the burden of preventable death and disability in these settings.