The evolving nature of irregular warfare and the increasingly frequent violations of human rights law and international humanitarian law pose unique challenges for humanitarian actors delivering trauma care in conflict settings. A scoping review was conducted on PubMed, Scopus, and Web of Science and a web search (on Google, Google scholar and Bing) to analyze and review past humanitarian interventions offering trauma care in conflict settings. Relevant records were identified from scientific and grey literature. The thematic areas identified by the framework for a Public Health Emergency Operations Centre were used to facilitate the synthesis and analysis. Eleven records examining all phases of conflict identifying gaps throughout the continuum of care in the trauma systems were included. Challenges, solutions and requirements in transportation capacity, data collection methodologies, field coordination mechanisms, and rehabilitative care services were highlighted. Addressing the shortages in skilled healthcare workers, implementing quality improvement measures, and developing standardized training curricula were some of the requirements reported. Our findings suggest that a multidimensional approach emphasizing strong coordination, with inclusive partnerships, is fundamental for effective trauma care systems in conflict zones. Key recommendations include robust medical transport, comprehensive healthcare training, preemptive mass casualty planning, standardized educational materials, continuous context reassessment, data protection, and improved transparency. These strategies could enhance trauma care interventions, ensuring they are effective, equitable, accountable, and sustainable.

Purpose: The objective of this study was to offer a comprehensive synthesis of the existing Key performance indicators (KPIs) used in the evaluation of the pre-Hospital response to disasters and mass casualty incidents (MCIs). Methods: At the end of December 2022 a scoping review has been performed on PubMed, Scopus, Embase, and Medline to identify articles describing the use of KPIs to assess the performance of first responders during the prehospital phase of an MCI (real or simulated). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, fourteen articles were included in the analysis. Results: Eleven articles applied indicators in exercises and/or simulations. Two articles proposed new KPIs, and one used KPIs for developing a model for benchmarking pre-Hospital response. All articles analyzed quantitative indicators of time, whereas two studied indicators of structure, of process, and of outcome as well. Conclusion: The findings from this review emphasize the need for employing common terminology and using uniformed data collection tools, if obtaining standardized evaluation method is the goal to be achieved.

Heatwaves are periods of unusual heat, whose frequency and intensity is increasing. Heatwaves also translate into emergency healthcare dysfunctions, but evidence on how to mitigate these effects still needs to be provided. This multicentric study aimed to identify the interactions between heatwaves and prehospital emergency medicine (PHEM). After obtaining informed consent, PHEM personnel working full-time in different districts of the Veneto Region, Northern Italy, were recruited. Their perspective was captured through semi-structured interviews and analyzed using content analysis methodology. Thirteen subjects participated in the study. Their insights were categorized into four themes: perception of heatwaves; clinical impact of heatwaves; social factors and heatwaves; heatwaves and emergency medical service (EMS). According to the interviewees, the strain on EMSs during heatwaves may be partially reduced by interventions targeting vulnerable populations, primary care, social networks, and education and information. Specific public health actions could follow the surge science principles of staff, stuff, structure, and system to help policymakers improve EMS surge capacity planning, preparedness, and responses. The present study also identified PHEM vulnerabilities and targets of interventions to implement heat–health action plans, mitigate the risk of prehospital emergency care dysfunction, and improve EMS sustainability and preparedness against heatwaves and the changing climate.

Purpose: The aim of this study is to investigate the opinions and perspectives of The Novel Integrated Toolkit for Enhanced Prehospital Life Support and Triage in Challenging and Large Emergencies (NIGHTINGALE) end-users and tool developers regarding Key Performance Indicators (KPIs) and benchmarks that assess the prehospital response to Mass Casualty Incidents (MCIs) enhanced by the NIT-MR. Methods: A qualitative study employing focus group discussions was conducted to collect opinions and perspectives of end-users and tool developers regarding KPIs and benchmarks in MCI response using the NIT-MR. The criteria considered for the selection and distribution of participants within the groups was the nature of their involvement within the NIGHTINGALE project and their familiarity with the tools to be discussed. Results: Thirty-one participants from different countries were included. Four themes emerged during data analysis which are: definition/explanation is the personal understanding of participants of the term KPI, process of KPI development and relationship with User Requirements is the decision process for assigning KPIs to user requirements, benchmarking is the mental process of associating a benchmark to a KPI or for developing a benchmark, and technical/medical gap is the gap of understanding between each sides’ fields. Conclusion: This study emphasized the need for a structured approach to using KPIs and bridging the gap between technological and medical worlds, taking the NIGHTINGALE project, funded by the European Union, which aims to develop a technological toolkit for first responders in mass casualty incidents as an example. These insights are crucial for enhancing disaster response.

Background: Trauma care is a central component of humanitarian medical response in conflict zones. However, essential operational knowledge—referral pathways, triage practices, logistical coordination, and team leadership—remains largely undocumented and inconsistently applied. The absence of structured learning mechanisms perpetuates fragmentation and impedes quality improvement across missions. Our study aimed to capture and analyze the field‐based experiences of humanitarian health professionals to define practical, system‐oriented requirements for effective trauma care in conflict settings. Methods: We conducted a qualitative, exploratory study grounded in 19 in‐depth, semi‐structured interviews with experienced humanitarian health professionals. Participants were purposively sampled for their experience across prehospital care, hospital‐based trauma response, and humanitarian coordination. Thematic analysis was used to identify structural patterns, operational challenges, and field‐informed strategies that shape trauma care delivery in conflict‐affected contexts. Reporting of this study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results: Participants described trauma care in conflict settings as dependent on interlocking requirements of six interdependent domains. Effective coordination was portrayed not as a technical function but as a relational one, built on trust, preparedness, and shared ownership across agencies and communities. Information exchange needed to be ethically governed, technically reliable, and tailored to fragile environments, relying on simplicity, redundancy, and low‐tech tools co‐developed with local actors. Prehospital care and transport systems were seen as decisive and in need of deliberate design, rooted in safety mapping, role‐adapted responder models, and integration with local infrastructure. Workforce competence extended beyond clinical skills to include cross‐functional agility, cultural literacy, and ethical resilience. Education and training were considered incomplete unless they prepared staff with conflict‐specific competencies, supported by structured, simulation‐based training for both expatriate and local staff. Finally, the absence of embedded operational research was viewed as a critical gap, with respondents calling for real‐time learning systems that inform both frontline response and long‐term planning. Conclusion: Trauma care in modern conflict cannot rely on improvisation or technical skill alone. It must be underpinned by ethical, resilient and locally grounded systems. Our study highlights the operational knowledge of field practitioners, offering a foundation for building trauma care systems that are integrated, resilient, locally anchored, and worthy of the people they aim to serve.

Acute necrotic cholecystitis (ANC), marked by gallbladder wall necrosis, carries high morbidity if diagnosis and treatment are delayed. Ultrasound is the first-line imaging for suspected cholecystitis, but its sensitivity for necrosis is limited. This case underscores the value of surgical ultrasound competency in emergency decision-making. A 57-year-old woman with diabetes, asthma, and hypothyroidism presented with severe epigastric pain and systemic inflammation. Emergency ultrasound showed gallbladder wall thickening, pericholecystic fluid, and gallstones. CT confirmed necrosis with possible microperforation. An informal ultrasound by surgical residents later that day identified microperforations, expediting the decision for subtotal laparoscopic cholecystectomy. Surgery was successful, and recovery was uneventful. Ultrasound, when performed by trained surgical teams, enables rapid diagnosis and management of complex cholecystitis. Structured ultrasound training during residency could enhance diagnostic accuracy, reduce treatment delays, and improve outcomes in acute surgical emergencies.