Aims To describe the injury patterns and strategies employed by a Specialised Care Team managing direct and indirect injuries during the Gaza war, with particular emphasis on injuries from explosive weaponry.

Methods This descriptive observational study was analysed retrospectively from data by four specialised care teams mobilised into Rafah between February and June 2024. All cases with an orthopaedic component were included. Injuries were categorised according to region and acuity. Procedures were classified using standard orthopaedic terminology. Data were analysed descriptively. Any possible associations were assessed using appropriate statistical analysis.

Results 2340 patients were managed, of which 55.73% had acute injuries and 26.32% were of the high-velocity type. Children constituted 32.71% of cases seen. Lower limb injuries predominated and were significantly more likely to require surgical intervention (p<0.001). Among the procedures performed, wound debridement, change of dressings, and toilette and suturing accounted for over 80% of the operative workload, reflecting a damage-control approach. More than 65% of the workload related to managing musculoskeletal infection.

Conclusions Blast injuries from explosive weaponry generate a high burden of limb trauma necessitating a damage-limiting approach in a resource limited environment. Our findings highlight the essential role non-governmental organisations play in delivering life and limb saving assistance in Gaza.

Background Emergency response care providers including military medics, firefighters, paramedics and law enforcement officers deliver time-critical care in complex operational environments. Despite their frontline role, these professionals remain underrepresented in research activity and no validated instrument exists to assess research engagement barriers and enablers in this workforce.

Methods A cross-sectional survey instrument was developed using Cooke’s Research Capacity Development Framework, capturing individual, organisational and cultural influences on research engagement. Items were generated through literature synthesis and expert consultation and deployed via Qualtrics. Content validity was assessed using a structured Content Validity Index (CVI) process in which an expert panel rated item relevance on a four-point scale. Item-level CVI (I-CVI) was calculated as the proportion of experts rating items 3 or 4. Items with I-CVI below 0.80 were removed or revised.

Results Eighteen experts assessed 32 items. Thirty items (93.8%) met the retention criterion (I-CVI≥0.80) and were retained with minor refinements; two items (I-CVI=0.78) were removed. Retained item I-CVI values ranged from 0.83 to 1.00, with excellent scale-level content validity (S-CVI/Ave=0.93). Qualitative feedback informed improvements to clarity and cross-context applicability, with common themes around organisational culture, leadership endorsement, mentoring access and recognition.

Conclusion This study reports the systematic development and content validation of a novel instrument to assess research engagement barriers and enablers across emergency responder disciplines, providing a foundation for pilot testing and psychometric validation.

Aim This paper aimed to conceptualise command competence in paramedicine as a distinct professional capability required for major incident management.

Methods An interpretive conceptual synthesis was undertaken across literature addressing command, leadership and decision-making in complex, time-critical and high-consequence environments. Concepts were examined for their explanatory relevance to the systems-level judgement required to direct paramedic major incident responses.

Results The synthesis identified clinical expertise and operational experience as necessary, but insufficient, foundations for command. Command competence was conceptualised as an adaptive systems-level capability arising through the interaction of systems orientation, situational awareness, adaptive decision-making, prioritisation and coordination.

Conclusion Command competence should be distinguished from clinical expertise, seniority and generic leadership capability. The proposed framework provides a provisional account of the capabilities that may underpin paramedic operational command and a basis for future empirical examination, education and workforce development.

Introduction The effective management of pain in the prehospital setting remains a significant challenge, especially in regions with prolonged transport times to medical facilities, such as the Scottish Highlands. The Highland Prehospital Immediate Care and Trauma (PICT) Team is a land-based trauma team operating out of Inverness and covering a large part of the Scottish Highlands.

Methods This retrospective case series evaluates the safety and efficacy of prehospital nerve blocks performed by the Highland PICT Team between April 2019 and August 2023. The study includes 96 cases where nerve blocks, primarily fascia iliaca compartment blocks and femoral nerve blocks, were administered to patients with traumatic injuries, notably femoral fractures.

Results The findings of this case review indicate that nerve blocks are a viable option for prehospital pain management, with no reported adverse events directly attributable to the blocks. The use of nerve blocks by the Highland PICT Team was associated with significant reductions in pain, although documentation of pain scores and vital signs was inconsistent.

Conclusion Standardisation of documentation practices related to prehospital nerve block provision and the development of a specific NB data collection tool may enhance future data capture and audit processes. Prehospital nerve blocks appear to be effective in providing analgesia for patients with femoral fractures and potentially other traumatic injuries. There is the need for further prospective research to expand the evidence base for the use of nerve blocks in the prehospital environment, particularly in remote and rural settings.