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Regional anaesthesia (RA), particularly peripheral nerve blocks (PNBs), is gaining importance in prehospital trauma care. These techniques offer effective analgesia while reducing opioid use, thus improving patient comfort and limiting side effects. Despite these advantages, only a few emergency medical services (EMS) currently include PNBs in routine prehospital analgesia. With the expected increase in elderly trauma - especially hip fractures - there is rising interest in using blocks such as the fascial iliaca compartment block (FICB) and femoral nerve block (FNB) before hospital arrival. These techniques are generally safe, easy to learn, and effective for lower limb pain. However, implementation in the field remains complex. Key challenges include defining clear indications, developing simple and safe procedures, training EMS personnel (including paramedics and physicians), and managing potential complications such as local anesthetic systemic toxicity (LAST). This session will explore practical approaches to expand the use of RA in prehospital care, address safety aspects, present training strategies, and highlight successful international examples. Indications for Peripheral Nerve Blocks PNBs can significantly improve prehospital pain control while limiting systemic opioid use. Common trauma patterns are amenable to specific blocks: FICB for proximal femoral fractures, interscalene block for shoulder dislocations or proximal humeral fractures, axillary plexus block for injuries to the distal upper limb, and FNB for patellar dislocations or isolated thigh trauma. These examples underline the clinical value of RA, especially in elderly or multimorbid patients. Structural Heterogeneity in European EMS EMS systems in Europe differ substantially in organisation, staffing, and procedural authority. In physician-led models - often staffed by anesthesiologists - RA techniques from hospital settings can be readily applied prehospitally. In contrast, systems relying on advanced paramedics often face legal or operational restrictions, and limited RA training may hinder broader adoption. Thus, system structure strongly influences RA feasibility. Ultrasound Access in the Prehospital Setting Nerve stimulation is often unsuitable in acute trauma due to patient discomfort and anatomical limitations. Ultrasound offers real-time imaging, lowers vascular puncture risk, and reduces the likelihood of LAST, making it the preferred guidance method. While portable ultrasound devices are increasingly available, access across EMS systems remains uneven and is a key factor in ensuring safe and effective RA delivery. Safety Considerations Safety concerns, especially regarding LAST, often limit RA use in EMS. Yet real-world data show that complications are rare and manageable, even in non-physician-led services. Ultrasound use further enhances block precision and safety. Although on-scene time is a valid concern, studies suggest that PNBs, including FICBs, do not significantly delay transport or affect outcomes. When standard hygiene measures are observed, infection risk is minimal. Access to lipid therapy for LAST management remains variable, but network-based solutions may help bridge this gap. Training and Role Distribution Structured training is crucial for safe PNB implementation in prehospital care. Hospital-based concepts can be adapted for emergency physicians. Moreover, growing evidence supports the safe use of PNBs by trained paramedics and nurses under clear protocols and supervision. In the long term, interdisciplinary models and emerging technologies such as AI-assisted ultrasound may support broader, scalable integration - even in physician-limited systems. These key topics will be addressed in the upcoming lecture, which will focus on real-world applications, current evidence, and international experiences. Participants will gain insight into how to translate RA principles into safe, feasible practice for trauma patients in the prehospital setting.