Background: Pre-hospital emergency medicine also referred to as pre-hospital care, immediate care, or emergency medical services medicine is a medical subspecialty which focuses on caring for seriously ill or injured patients before they reach hospital, and during emergency transfer to hospital or between hospitals to providing timely care to victims of sudden and life-threatening injuries or emergencies in order to prevent needless mortality or long-term morbidity. Therefore, the aim of this paper to review the available pre-hospital emergency system model in relation to the contexts of Ethiopia with implication of selecting the model suits to the country. Methods: Initial search of PubMed, Scopus, and Web of Science were systematically searched for studies of Pre-Hospital Medical Emergency Service Systems Models from 2005 until January 30, 2021. Studies evaluating Pre-Hospital Medical Emergency Service systems with evidence of widespread adoption (Anglo-American, Franco-German, Dutch, Sarajevo and the Japanese models and uniform and tiered response). This approach began from the philosophical perspective that prehospital services should be performed and reported in adherence to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Results: The result of this study showed that resource constraints and cost-efficient emergency medical service affecting the utilization of pre-hospital services. Conclusion: Given resource constraints, considerations and cost-efficient emergency medical service our finding suggest that Anglo- American model and two-tiered pre-hospital ambulance system consisting of semi advanced and basic life support for emergency and nonemergency patient care that support by trained Emergency Medical Technicians were effective for resource less developed country including Ethiopia.