Objective: To systematically evaluate the clinical effectiveness, operational performance, and feasibility of smart first-aid technologies used in prehospital or simulated emergency settings, with emphasis on time-to-treatment, safety, and outcome improvement.

Methods: We conducted a PRISMA-compliant systematic review of peer-reviewed studies indexed in MEDLINE, Embase, Cochrane CENTRAL, Web of Science, and IEEE Xplore. Eligible studies evaluated smart first-aid devices in prehospital or high-fidelity simulated contexts, reporting clinical, performance, time, feasibility, or safety outcomes. Selection and data extraction were performed in duplicate.

Results: Twenty-two studies met inclusion criteria across six device categories. Bystander AED use was associated with higher survival to discharge (OR ≈ 1.73) and improved neurological outcomes (OR ≈ 2.12). Drone-AED programs arrived before EMS in ~64–67% of cases, gaining 180–200 seconds. CPR feedback tools improved compression quality by ~15–20 percentage points; survival impact was mixed. Mechanical CPR showed no consistent survival benefit. Civilian tourniquet and hemostatic dressing use improved hemorrhage control and reduced transfusion needs. For opioid overdose, 4 mg intranasal naloxone was as effective as 8 mg, with fewer adverse effects.

Conclusions: Smart first-aid devices can reduce treatment delays and enhance process metrics. Early defibrillation showed the strongest clinical benefit, while drone delivery demonstrated promising system-level advantages. Future research should emphasize standardized outcomes, pragmatic trials, and equitable implementation. Study heterogeneity and limited randomized evidence remain key limitations.