Introduction: About 54% of all injury deaths in developing counties are attributable to lack of prehospital care. The study aims to ascertain the current state, determinants, and opportunities for strengthening prehospital care delivery in Cameroon Methods: From July 2015 to January 2017, Cameroon Trauma Registry was implemented simultaneously at Laquintinie Hospital of Doula, Limbe Regional Hospital, and Catholic Hospital Pouma. Data was subjected to descriptive and inferential analysis. A multiple logistic regression models was built to predict getting prehospital care. Results: The 7879 patients were mostly male (72.6%), urban dwellers (94%), self-employed (39%) averaging 31.4 years (SD = 15.5). The commonest causes of injury were road traffic crashes (53%), blunt force (15%) and falls (15%). About 669 (9%) patients got prehospital care such as hemostasis (55.3%), fracture immobilization (24%), repositioning (10%), and giving fluid infusions (8%). Friends (35.8%), medical personnel (30.4%), or passersby (20.2%) provided prehospital care. Transport was via taxis (56%), motorcycles (18%), and private vehicles (16%). Predictors of getting prehospital care were injuries at school (perfect predictor), home (OR = 3.10, p < 0.0001), public places (OR = 3.79, p < 0.0001), or distance. 5 km from the hospital (OR = 4.06, p < 0.0001), and rural residence (OR = 4.43, p < 0.0001). Discussion: Prehospital care is typically provided by untrained laypersons in rural and distant areas, and schools. Formal lay provider training may improve prehospital care capacity and access and can drive health system growth. Conclusion: Formal prehospital trauma systems are limited in Cameroon. Prehospital care development can drive health system growth. Study findings and literature suggest that prehospital trauma care delivery can be improved by leveraging and training lay first-responders to provide prehospital care.