Telemedicine is increasingly recognized as a transformative tool in pre-hospital care, offering the potential to bridge the gap between the field and the hospital by providing remote specialist support to emergency medical services (EMS) personnel. This scoping review synthesizes evidence from 38 studies to map the efficacy, implementation challenges, and future directions of telemedicine in the pre-hospital setting. The findings indicate that telemedicine interventions—including real-time video consultation, vital signs transmission, and image sharing—can significantly improve diagnostic accuracy, optimize pre-hospital treatment decisions, and reduce time to definitive care for time-sensitive conditions such as stroke, trauma, and cardiac events. However, widespread implementation is hampered by significant barriers, including technological issues like connectivity and interoperability, regulatory and legal complexities, workflow integration challenges, and economic considerations. The review concludes that while telemedicine acts as a clinical force multiplier in EMS, its full potential requires addressing these implementation barriers through robust technology, clear policies, user-centered design, and sustainable funding models. Future research should prioritize large-scale trials and the integration of artificial intelligence to further advance the field. Keywords: Telemedicine, Pre-Hospital Care, Emergency Medical Services, Implementation Challenges, Remote Consultation